Abstract

BackgroundWorld Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis. The primary aim of this cross-sectional study was to determine if 4 years of annual mass drug administration (MDA) in primary and secondary schools lowered potential markers of morbidity in infected children 1 year after the final MDA compared to infected children prior to initial MDA intervention.MethodsBetween 2012 and 2016 all students in two primary and three secondary schools within three kilometers of Lake Victoria in western Kenya received annual mass praziquantel administration. To evaluate potential changes in morbidity we measured height, weight, mid-upper arm circumference, hemoglobin levels, abdominal ultrasound, and quality of life in children in these schools. This study compared two cross-sectional samples of Schistosoma mansoni egg-positive children: one at baseline and one at year five, 1 year after the fourth annual MDA. Data were analyzed for all ages (6–18 years old) and stratified by primary (6–12 years old) and secondary (12–18 years old) school groups.ResultsThe prevalence of multiple potential morbidity markers did not differ significantly between the egg-positive participants at baseline and those at 5 years by Mann Whitney nonparametric analysis and Fisher’s exact test for continuous and categorical data, respectively. There was a small but significantly higher score in school-related quality of life assessment by year five compared to baseline by Mann Whitney analysis (P = 0.048) in 13–18 year olds where malaria-negative. However, anemia was not positively impacted by four annual rounds of MDA, but registered a significant negative outcome.ConclusionsWe did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple MDA. This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected. High malaria transmission in this area and/or a lack of suitable methods to measure the more subtle functional morbidities caused by schistosomiasis could be a factor. Further research is needed to identify and develop well-defined, easily quantifiable S. mansoni morbidity markers for this age group.

Highlights

  • World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis

  • We did not detect differences in morbidity markers measured in a population of those infected or re-infected after multiple mass drug administration (MDA)

  • This could have been due to their relative insensitivity or a failure of MDA to prevent morbidity among those who remain infected

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Summary

Introduction

World Health Organization guidelines recommend preventive chemotherapy with praziquantel to control morbidity due to schistosomiasis. The current World Health Organization (WHO) strategy to reduce schistosomiasisassociated morbidity is mass drug administration (MDA) with praziquantel (PZQ) based on the prevalence and intensity of infection in an area [3] Most commonly this translates to yearly or biennial MDA with PZQ in primary schools to treat schistosomiasis in addition to administration of albendazole (ALB) for soil-transmitted helminths (STHs) [4]. While severe disease likely develops in only 5 to 10% of those with substantial, untreated chronic infections [14, 15], the subtle morbidities are thought to have a broader public health impact on most of the over 240 million people with schistosomiasis [12, 16, 17] They are more difficult to assess for example specific morbidity assessment of anemia in S. mansoni infection is challenging because in many areas where individuals are at risk for schistosomiasis, they are at risk for malaria and both infections cause anemia. The synergistic effect of co-infection and potential interaction outcome of schistosomiasis and malaria infections on anemia may affect the usefulness of anemia as a marker of schistosomiasis [18, 19]

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