Abstract
Schistosomiasis is one of the major Neglected Tropical Diseases (NTDs) in sub-Saharan Africa. In sub-Saharan Africa, two major human schistosome species namely Schistosoma mansoni and S. haematobium often occur sympatrically largely affecting children. Recognizing the public health impact of Schistosomiasis, the World Health Organization (WHO) is urging member states to regularly treat at least 75% and up to 100%, of all school-aged children at risk of morbidity. For control strategies based on targeted mass drug administration (MDA) to succeed it is essential to have a simple and sensitive test for monitoring the success of these interventions. Current available diagnostic tests, such as egg detection in stool by Kato-Katz (KK) for S. mansoni and detection of eggs or blood (hematuria) in urine for S. haematobium have reduced sensitivity in low intensity settings. The objective of the study was to evaluate active single or duo schistosome infections in school children following MDA using molecular diagnostics (PCR) on filtered urine samples and comparing that against traditional diagnostic tests. This cross-sectional study was conducted among 111 school children aged 7–15 years in Chongwe and Siavonga Districts in Zambia. Species-specific cell-free repeat DNA fragment were amplified from 111 filtered urine samples. Our approach detected eight times more positive cases (total 77) than by KK (9) for S. mansoni and six times more (total 72) than by hematuria (11) for S. haematobium and even more against urine filtration (77 compared to only 6). The same pattern was observed when stratified for age group and sex specific analysis with 100% sensitivity and specificity devoid of any cross amplification. In addition, 69 individuals (62%) were co-infected by both parasites. We have demonstrated a significantly higher prevalence of both species than indicated by the traditional tests and the persistent maintenance of reservoir of infection after MDA. Our approach is an effective means of detecting low intensity infection, which will enhance the effectiveness of surveillance and assess the impact of MDA control programs against schistosomiasis.
Highlights
Schistosomiasis in Africa is an ongoing public health problem, which in recent times has attracted a major campaign to control the disease
The purpose of this research was to determine the effectiveness of detecting small amount of parasite repeat DNA fragments in urine samples from school children infected with S. mansoni or S. haematobium, or both after mass drug administration (MDA) (Fig 1)
We have demonstrated a significantly higher prevalence of S. mansoni or S. haematobium and/ or both in school children than indicated by the classical examination of urine or stool after MDA
Summary
Schistosomiasis in Africa is an ongoing public health problem, which in recent times has attracted a major campaign to control the disease. Recognizing the public health impact of schistosomiasis on school-age children, the World Health Organization (WHO) is urging member states to regularly treat at least 75% and up to 100%, of all schoolaged children at risk of morbidity [3]. Forty three million school-age children received treatment in 2014 comprising >83% of the total number of people treated [1]. As the control programs become more and more effective in reducing the parasite burden in children, the issue of diagnostic sensitivity will become more critical in the assessment of program effectiveness. For mass drug administration (MDA) to succeed, these reservoirs of infection must be diagnosed and the diagnostic method to do so should be one that is easy to operate, sensitive and accurate
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