Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana
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Date
2020-04-27
Journal Title
Journal ISSN
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Publisher
PLOS NEGLECTED TROPICAL DISEASES
Abstract
Background
This paper reports on the baseline prevalence and associated risk factor findings of a pilot,
longitudinal study exploring community-wide treatment of schistosomiasis and soil-transmitted
helminthiasis, using albendazole plus praziquantel in the Greater Accra region of
Ghana.
Method
From three communities, at least, 658 individuals were enrolled into the study via random
household selection. Prevalence and intensity of schistosomiasis and STH infection were
determined from stool and urine samples with a questionnaire being administered in order
to explore other morbidities and risk factors. Factor analysis of household demographic variables
was undertaken to generate a socioeconomic score; this was then further categorised
into tertiles. Proportional-odds cumulative logit generalised estimating equation (GEE) models
were used to investigate categorical ordinal intensity of infection associations with morbidity.
Separately, logistic GEE models were used to investigate risk factor associations with
infection prevalence.Results
Both Schistosoma haematobium and S. mansoni were prevalent in the three communities,
with the prevalence of S. haematobium ranging from 3.3% (24/679; 95% CI = 1.9–4.7) to
19% (114/632; 95% CI = 15.8–22.2) and S. mansoni ranging from 30% (202/679; 95% CI =
26.5–33.5) to 78.3% (409/536; 95% CI = 74.7–81.9). The total prevalence of STH across all
three sites was negligible at 1.3% (24/1847; 95% CI = 0.8–1.9) comprising mainly hookworm
(10/1847). Multivariable statistical models indicated males to be 2.3 (95% CI = 1.7–3.3)
times more likely to have a high intensity S. mansoni infection and 1.5 (95% CI = 1.1–2)
times more likely to have a high intensity of S. haematobium infection compared to females.
There was no significant difference in the likelihood of infection with S. mansoni between
adults and school age children (SAC), however S. haematobium infections were found to be
2.5 (95% CI = 1.8–3.5) times more likely to occur in school age children than in adults.
Multivariable statistical models (adjusted for age and sex) indicated an association
between schistosomiasis and a number of self-reported morbidity indicators (notably diarrhoea
and blood in stool and urine). Low socio-economic status was also associated with
SCH infection (OR: 2; 95% CI = 1.3–3.2).Conclusion
The communities targeted by this study showed a range of Schistosoma prevalence’s of
infection, from hypo-endemic through to meso-endemic and hyper-endemic. The prevalence
of SCH across the different age groups in the study locations highlights the large number
of individuals currently being left out of the standard morbidity control method of annual
treatment of the SAC.
Description
Research Article
Keywords
S. haematobium, generalised estimating equation (GEE), STH infection, schistosomiasis
Citation
Cunningham LJ, Campbell SJ, Armoo S, Koukounari A, Watson V, Selormey P, et al. (2020) Assessing expanded community wide treatment for schistosomiasis: Baseline infection status and self-reported risk factors in three communities from the Greater Accra region, Ghana. PLoS Negl Trop Dis 14(4): e0007973. https://doi.org/10.1371/ journal.pntd.0007973