Browsing by Author "Adjei, M.N."
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Item Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors(Acta Tropica, 2019-03) Kulinkina, A.V.; Kosinski, K.C.; Adjei, M.N.; Osabutey, D.; Gyamfi, B.O.; Biritwum, N.K.; Bosompem, K.M.; Naumova, E.N.Objectives The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions. Methods Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities. Logistic regression was also used to assess associations between community water characteristics, self-reported water-related behaviors and S. haematobium infection. Communities were subsequently categorized as candidates for three types of interventions: provision of additional safe water sources, provision of groundwater treatment, and health education about water-related disease risk, depending on their water profile. Results Microhematuria presence measured with a reagent strip was a good proxy of eggs in urine at individual (Kendall’s τb = 0.88, p < 0.001) and at school-aggregated (Spearman’s rs = 0.96, p < 0.001) levels. Self-reported macrohematuria and swimming were significantly associated (p < 0.05) with egg presence, but self-reported fetching was not. Of the community water characteristics, greater surface water access and presence of groundwater quality problems were significantly associated with increased likelihood of fetching, swimming, and S. haematobium infection. Access to improved water sources did not exhibit an association with any of these outcomes. Conclusions The study illustrates that in presence of regular school-based treatment with praziquantel, microhematuria assessed via reagent strips remains an adequate proxy for S. haematobium infection in primary schoolchildren. Community water profiles, in combination with self-reported water-related behaviors, can help elucidate reasons for some endemic communities continuing to experience ongoing transmission and tailor interventions to these local contexts to achieve sustainable control.Item Effective control of Schistosoma haematobium infection in a Ghanaian community following installation of a water recreation area(Public Library of Science, 2012) Kosinski, K.C.; Adjei, M.N.; Bosompem, K.M.; Crocker, J.J.; Durant, J.L.; Osabutey, D.; Plummer, J.D.; Stadecker, M.J.; Wagner, A.D.; Woodin, M.; Gute, D.M.Background: Urogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact. Methods: We designed a water recreation area (WRA) to prevent transmission to school-aged children. The WRA features a concrete pool supplied by a borehole well and a gravity-driven rainwater collection system; it is 30 m 2 and is split into shallow and deep sections to accommodate a variety of age groups. The WRA opened in 2009 and children were encouraged to use it for recreation as opposed to the local river. We screened children annually for S. haematobium eggs in their urine in 2008, 2009, and 2010 and established differences in infection rates before (2008-09) and after (2009-10) installation of the WRA. After each annual screening, children were treated with praziquantel and rescreened to confirm parasite clearance. Principal Findings: Initial baseline testing in 2008 established that 105 of 247 (42.5%) children were egg-positive. In 2009, with drug treatment alone, the pre-WRA annual cumulative incidence of infection was 29 of 216 (13.4%). In 2010, this incidence rate fell significantly (p<0.001, chi-squared) to 9 of 245 (3.7%) children after installation of the WRA. Logistic regression analysis was used to determine correlates of infection among the variables age, sex, distance between home and river, minutes observed at the river, low height-for-age, low weight-for-age, low Body Mass Index (BMI)-for-age, and previous infection status. Conclusion/Significance: The installation and use of a WRA is a feasible and highly effective means to reduce the incidence of schistosomiasis in school-aged children in a rural Ghanaian community. In conjunction with drug treatment and education, such an intervention can represent a significant step towards the control of schistosomiasis. The WRA should be tested in other water-rich endemic areas to determine whether infection prevalence can be substantially reduced. © 2012 Kosinski et al.Item A novel community-based water recreation area for schistosomiasis control in rural Ghana(Journal of Water Sanitation and Hygiene for Development, 2011-12) Kosinski, K.C.; Crocker, J.J.; Durant, J.L.; Osabutey, D.; Adjei, M.N.; Gute, D.M.Primary prevention of schistosome infection has received little attention of late. We describe a novel water recreation area (WRA) to reduce Schistosoma haematobium infection rates in Adasawase, Ghana. Urogenital schistosomiasis is a water-based parasitic disease that affects over 100 million people worldwide, primarily children in the rural tropics. The disease is contracted via dermal contact with contaminated water. Widespread distribution of praziquantel is presently used to control morbidity, but chemotherapy does not confer immunity and reinfection can have severe health impacts. In 2008, an estimated 44% of school-aged children in Adasawase had S. haematobium eggs in their urine. Recreational contact with water was the primary transmission route. In collaboration with community members, a novel WRA was constructed. The WRA is groundwater and rainwater fed and serves more than 100 children at any given time. It was constructed from local materials and labor, designed to last more than 30 years, and minimizes exposure to S. haematobium. One year after construction, the annual incidence of S. haematobium infection dropped from 18.6% in 2009 to 4.6% in 2010, respectively (p < 0.001). Given the promising evidence, the data will be examined more rigorously to characterize factors that influence water contact and infection risk. © IWA Publishing 2011.