Background Schistosoma haematobium and S.mansoni are endemic in Madagascar,but reliable diagnostic tools are often lacking,contributing to exacerbate transmission and morbidity.This study evaluated the diagnostic accu...Background Schistosoma haematobium and S.mansoni are endemic in Madagascar,but reliable diagnostic tools are often lacking,contributing to exacerbate transmission and morbidity.This study evaluated the diagnostic accuracy of three tests for schistosome infection in Malagasy adults from areas of medium to high endemicity.Methods This cross-sectional study enrolled adults from three primary health care centres in Madagascar.Urine and blood samples were tested for schistosome infection using polymerase chain reaction(PCR),up-converting reporter particle lateral flow for the circulating anodic antigen(UCP-LF CAA),and point-of-care circulating cathodic antigen(POC-CCA)tests.Bayesian latent class models were used to assess diagnostic accuracies and disease prevalence.Results Of 1339 participants,461 were from S.haematobium and 878 from S.mansoni endemic areas.Test detection rates were 52%(POC-CCA),60%(UCP-LF CAA),and 66%(PCR)in the S.haematobium area,and 54%,55%,and 59%respectively in the S.mansoni area.For S.haematobium,PCR and UCP-LF CAA showed high sensitivity(Se,median 95.2%and 87.8%)but moderate specificity(Sp,60.3%and 66.2%),while POC-CCA performed moderately(Se:64.5%;Sp:59.6%).For S.mansoni,PCR and POC-CCA demonstrated high diagnostic accuracy(Se>90%,Sp>80%),while UCP-LF CAA showed good sensitivity(79.9%)but moderate specificity(69.7%).Conclusions While population-level prevalence estimates were similar across tests,individual-level agreement was only low to moderate.Our findings suggest that optimal diagnostic strategies should be tailored to specific endemic settings,continued development of accurate diagnostics suitable for highly endemic settings remains a priority.展开更多
Background The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals,including universal health ...Background The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals,including universal health coverage(UHC).Current control strategies focus on school-aged children,systematically neglecting adults.We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC.Methods In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina,Tsiroanomandidy and Ankazomborona in Madagascar,we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants.Univariable and multivariable logistic regression were performed to evaluate odd ratios.Results The highest prevalence of S.mansoni,S.haematobium and co-infection of both species was 59.5%,61.3%and 3.3%,in Andina and Ankazomborona respectively.Higher prevalence was observed among males(52.4%)and main contributors to the family income(68.1%).Not working as a farmer and higher age were found to be protective factors for infection.Conclusions Our findings provide evidence that adults are a high-risk group for schistosomiasis.Our data suggests that,for ensuring basic health as a human right,current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific,holistic and integrated approaches.展开更多
基金Open Access funding enabled and organized by Projekt DEALThis work was supported by the German Center for Infection Research(Grant number TI 03.907_00).
文摘Background Schistosoma haematobium and S.mansoni are endemic in Madagascar,but reliable diagnostic tools are often lacking,contributing to exacerbate transmission and morbidity.This study evaluated the diagnostic accuracy of three tests for schistosome infection in Malagasy adults from areas of medium to high endemicity.Methods This cross-sectional study enrolled adults from three primary health care centres in Madagascar.Urine and blood samples were tested for schistosome infection using polymerase chain reaction(PCR),up-converting reporter particle lateral flow for the circulating anodic antigen(UCP-LF CAA),and point-of-care circulating cathodic antigen(POC-CCA)tests.Bayesian latent class models were used to assess diagnostic accuracies and disease prevalence.Results Of 1339 participants,461 were from S.haematobium and 878 from S.mansoni endemic areas.Test detection rates were 52%(POC-CCA),60%(UCP-LF CAA),and 66%(PCR)in the S.haematobium area,and 54%,55%,and 59%respectively in the S.mansoni area.For S.haematobium,PCR and UCP-LF CAA showed high sensitivity(Se,median 95.2%and 87.8%)but moderate specificity(Sp,60.3%and 66.2%),while POC-CCA performed moderately(Se:64.5%;Sp:59.6%).For S.mansoni,PCR and POC-CCA demonstrated high diagnostic accuracy(Se>90%,Sp>80%),while UCP-LF CAA showed good sensitivity(79.9%)but moderate specificity(69.7%).Conclusions While population-level prevalence estimates were similar across tests,individual-level agreement was only low to moderate.Our findings suggest that optimal diagnostic strategies should be tailored to specific endemic settings,continued development of accurate diagnostics suitable for highly endemic settings remains a priority.
文摘Background The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals,including universal health coverage(UHC).Current control strategies focus on school-aged children,systematically neglecting adults.We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC.Methods In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina,Tsiroanomandidy and Ankazomborona in Madagascar,we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants.Univariable and multivariable logistic regression were performed to evaluate odd ratios.Results The highest prevalence of S.mansoni,S.haematobium and co-infection of both species was 59.5%,61.3%and 3.3%,in Andina and Ankazomborona respectively.Higher prevalence was observed among males(52.4%)and main contributors to the family income(68.1%).Not working as a farmer and higher age were found to be protective factors for infection.Conclusions Our findings provide evidence that adults are a high-risk group for schistosomiasis.Our data suggests that,for ensuring basic health as a human right,current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific,holistic and integrated approaches.
