Abstract
.Taeniasis/cysticercosis (CC) is an important disease complex with significant burden. This large-scale cohort study aimed at estimating and exploring individual- and village-level factors associated with the cumulative incidences of seroconversion (SC) and seroreversion (SR) of active human CC in three provinces of Burkina Faso. In 60 villages, blood samples were collected and interviews regarding sociodemographic variables and knowledge, attitude, and practices toward the disease complex were conducted at baseline and 18-month follow-up (N = 2,211), with the presence of active CC being determined using the B158/B60 antigen enzyme-linked immunosorbent assay (Ag-ELISA). The 18-month Ag SC and SR were estimated at 3.3% (95% confidence interval [CI]: 2.6; 4.2%) and 35.8% (95% CI: 24.5; 48.5%), respectively. Marked provincial differences were found for the 18-month Ag SC (Boulkiemde: cumulative incidence ratio [CIR]: 2.41 (95% CI: 1.21; 4.78) and Nayala: CIR: 3.28 (95% CI: 1.37; 7.84), compared with Sanguie), while not being significantly associated with other sociodemographic factors. A continued refraining from pork consumption was associated with a lower 18-month Ag SC (CIR: 0.55 [95% CI: 0.28; 1.07]), whereas at the village level, the percentage of households owning pigs was associated with a higher 18-month Ag SC (CIR: 1.03 [95% CI: 1.01; 1.05]). In conclusion, this is one of few cohort studies and the first to have enough power to assess possible causal links between individual- and village-level variables and CC in humans. Variables linked to province, pig raising, and pork consumption behaviors were found to cause Ag SC in humans. The latter results further support the importance of adopting a One Health approach to the control of CC.
Highlights
The zoonotic disease complex Taenia solium taeniasis/ cysticercosis (CC) causes important monetary and nonmonetary burden in endemic areas[1,2,3,4,5] as well as in countries where the life cycle is unlikely to be completed, such as the United States.[6]
The diagnostic tool used in the present study, the Ag-ELISA, detects circulating antigens of T. solium, indicating the presence of an active CC infection.[15]
The 18-month Ag SC in this study was found to be 3.3%, suggesting that 3.3% of the study participants negative at the baseline seroconverted, that is, became test positive, and developed active CC over the 18-month study period. This value for the 18-month Ag SC is lower than the one found in the cohort study performed in Zambia (12-month Ag SC, 6%),[17] whereas much higher than that is observed in a cohort study conducted in Ecuador (13-month Ag SC, 0.5%).[18]
Summary
The zoonotic disease complex Taenia solium taeniasis/ cysticercosis (CC) causes important monetary and nonmonetary burden in endemic areas[1,2,3,4,5] as well as in countries where the life cycle is unlikely to be completed, such as the United States.[6]. Most epidemiological studies exploring risk factors for human CC have so far used cross-sectional designs.[9,10,11,12,13,14] cross-sectional designs are helpful in determining the present distribution and frequency of an outcome in a population, they cannot be used for causal inference unless the exposure of interest does not change through time (i.e., gender). Associations found between exposures and an outcome in cross-sectional studies may reflect an association with the duration of the outcome rather than its incidence. Despite the important limitations of cross-sectional studies, only three cohort studies have estimated the cumulative incidences of SC and SR of human CC (Table 1). The present study aimed, at estimating the 18month Ag SC and Ag SR of CC and at identifying risk factors for active CC in 60 villages in three provinces in Burkina Faso
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