Abstract
BackgroundSchistosomiasis remains a global public health challenge, with 93% of the ∼237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric.Methodology/Principal FindingsIn our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2–18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5–18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (−4.0%, p<0.001) and among the lower socioeconomic quartiles (−2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid.Conclusions/SignificanceWe conclude that exposure to urogenital schistosomiasis is associated with a 2–4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection.
Highlights
Schistosomiasis remains a public challenge globally with 93% of the estimated 237 million infections occurring in Africa [1]
Because urogenital schistosomiasis is a multi-decadal chronic disease that begins in early childhood, and because it is a disease that may affect nearly everyone in endemic communities, its impact on personal healthrelated quality of life (HrQoL) has been difficult to gauge accurately
In adjusting for age, sex, socioeconomic standing, undernutrition, anemia, and hookworm parasites, we found that relative poverty, stunting, wasting, and S. haematobium infection were significant correlates of health-related quality of life (HrQoL) scores, with differential effects in high- and moderate-prevalence communities
Summary
Schistosomiasis remains a public challenge globally with 93% of the estimated 237 million infections occurring in Africa [1]. Schistosomiasis is rarely fatal but due to its recurring nature is manifested as a persistent chronic disorder in endemic areas, resulting in significant health burden [6,7,8]. Much of the negative health impact is due to less obvious or specific conditions such as anemia, undernutrition, abdominal pain, exercise intolerance, poor school performance, and lowered work capacity [7,8,10]. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric
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