Abstract
.The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis—better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas. This article summarizes the SCORE studies that aimed to gauge the impact of MDA-based treatment on schistosomiasis-related morbidities. Morbidity cohort studies were embedded in the SCORE’s larger field studies of gaining control of schistosomiasis in Kenya and Tanzania. Following MDA, cohort children had less undernutrition, less portal vein dilation, and increased quality of life in Year 5 compared with baseline. We also conducted a pilot study of the Behavioral Assessment System for Children (BASC-2) in conjunction with the Kenya gaining control study, which demonstrated beneficial effects of treatment on classroom behavior. In addition, the SCORE’s Rapid Answers Project performed systematic reviews of previously available data, providing two meta-analyses related to morbidity. The first documented children’s infection-related deficits in school attendance and achievement and in formal tests of learning and memory. The second showed that greater reductions in egg output following drug treatment correlates significantly with reduced odds of most morbidities. Overall, these SCORE morbidity studies provided convincing evidence to support the use of MDA to improve the health of school-aged children in endemic areas. However, study findings also support the need to use enhanced metrics to fully assess and better control schistosomiasis-associated morbidity.
Highlights
The Schistosomiasis Consortium for Operational Research (SCORE) was funded in 2008 to improve the evidence base for control and elimination of schistosomiasis—better understanding of the systemic morbidities experienced by children in schistosomiasis-endemic areas and the response of these morbidities to treatment, being essential for updating WHO guidelines for mass drug administration (MDA) in endemic areas
As part of its mission, the SCORE sought to develop a better understanding of the anatomic and systemic functional morbidities experienced by people at risk in schistosomiasis-endemic areas and their response to antischistosomal praziquantel treatment
People living in schistosomiasis-endemic areas may spend onethird to a half of their lives carrying Schistosoma parasitic worms because their continuing environmental exposure leads to overlapping schistosome infections.[2]
Summary
Because there were few clinical research studies evaluating the long-term benefits of praziquantel in terms of prevention of new disease or amelioration of existing disease, SCORE partners incorporated nested comparison studies of the impact of MDA on Schistosoma infection–associated morbidity in school-aged children in each of the SCORE prospective randomized gaining control studies.[26]. The Kenya and Tanzania gaining control studies were able to successfully complete their Year 3 and Year 5 cohort reexaminations.[41,42,43] In a secondary analysis of their pooled S. mansoni longitudinal data, overall infection intensity and odds of infection were significantly reduced in both treatment arms of the study.[44] both annual CWT and every-other-year SBT were associated with reduced odds of undernutrition in Year 5 (at the time, the children were aged 12–13 years) They had reduced odds of portal vein dilation on ultrasound, as compared with their baseline when they were 7 or 8 years old. These SCORE findings suggested that programs implementing annual CWT are likely to achieve better overall S. mansoni morbidity control than those implementing biennial SBT alone.[44]
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