Abstract
In 2012, the World Health Organisation (WHO) set out a roadmap for eliminating schistosomiasis as a public health problem by 2025. To achieve this target, preschool-aged children (PSAC; aged 6 years and below) will need to be included in schistosomiasis treatment programmes. As the global community discusses the tools and approaches for treating this group, one of the main questions that remains unanswered is how to quantify infection in this age group to inform treatment strategies. The aim of this study was thus to determine whether a relationship exists between levels of schistosome infection in PSAC and school-aged children (SAC), that can be used to determine unknown schistosome infection prevalence levels in PSAC. A systematic search of publications reporting schistosomiasis prevalence in African PSAC and SAC was conducted. The search strategy was formulated using the PRISMA guidelines and SPIDER search strategy tool. The published data was subjected to regression analysis to determine if a relationship exists between infection levels in PSAC and SAC. The interaction between SAC and community treatment history was also entered in the regression model to determine if treatment history significantly affected the relationship between PSAC and SAC prevalence. The results showed that a significant positive relationship exists between infection prevalence levels in PSAC and SAC for Schistosoma mansoni (r = 0.812, df (88, 1), p = <0.0001) and S. haematobium (r = 0.786, df (53, 1), p = <0.0001). The relationship was still significant after allowing for diagnostic method, treatment history, and the African sub-region where the study was conducted (S. mansoni: F = 25.63, df (88, 9), p = <0.0001; S. haematobium: F = 10.20, df (53, 10), p = <0.0001). Using the regression equation for PSAC and SAC prevalence, over 90% of the PSAC prevalence studies were placed in the correct WHO classifications category based on the SAC levels, regardless of treatment history. The study indicated that schistosome prevalence in SAC can be extended as a proxy for infection levels in PSAC, extending on its current use in the adult population. SAC prevalence data could identify where there is a need to accelerate and facilitate the treatment of PSAC for schistosomiasis in Africa.
Highlights
Schistosomiasis is a widespread parasitic disease found in tropical and subtropical areas [1]
We investigated the relationship between school-aged children (SAC) and preschool-aged children (PSAC) schistosome prevalence levels within the same community, to determine if data from SAC could be used to predict infection levels in PSAC
Our results show that PSAC prevalence levels are significantly correlated with SAC prevalence levels
Summary
Schistosomiasis is a widespread parasitic disease found in tropical and subtropical areas [1]. The most widely used treatment for schistosomiasis is the antihelminthic drug of choice, praziquantel (PZQ), which is both safe and efficacious against adult worms [3]. Schistosomiasis is controlled through preventative chemotherapy, targeting school-aged children (SAC) who are treated with PZQ through mass drug administration (MDA). The frequency of treatment follows guidelines from the WHO, which are based on the schistosome endemicity of the area rather than individual infection status [4]. The endemicity of the area is determined by quantifying schistosome infection prevalence in SAC, following sampling of a group of the children. The reason SAC are used for determining community schistosome endemicity and are the primary target of MDA is that they have been shown to have the highest prevalence of infection and are accessible in schools [5, 6]
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