Dataset Information

Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance.

ABSTRACT: The World Health Organization (WHO) recommends praziquantel mass drug administration (MDA) to control schistosomiasis in endemic regions. We aimed to quantify recent and lifetime praziquantel coverage, and reasons for non-treatment, at an individual level to guide policy recommendations to help Uganda reach WHO goals. Cross-sectional household surveys (n = 681) encompassing 3208 individuals (adults and children) were conducted in 2017 in Bugoto A and B, Mayuge District, Uganda. Participants were asked if they had received praziquantel during the recent MDA (October 2016) and whether they had ever received praziquantel in their lifetime. A multivariate logistic regression analysis with socio-economic and individual characteristics as covariates was used to determine factors associated with praziquantel uptake. In the MDA eligible population (?5 years of age), the most recent MDA coverage was 48.8%. Across individuals' lifetimes, 31.8% of eligible and 49.5% of the entire population reported having never taken praziquantel. Factors that improved individuals' odds of taking praziquantel included school enrolment, residence in Bugoto B and increasing years of village-residency. Not being offered (49.2%) and being away during treatment (21.4%) were the most frequent reasons for not taking the 2016 praziquantel MDA. Contrary to expectations, chronically-untreated individuals were rarely systematic non-compliers, but more commonly not offered treatment.

SUBMITTER: Adriko M

PROVIDER: S-EPMC6306755 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Low Praziquantel Treatment Coverage for <i>Schistosoma mansoni</i> in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance.

Adriko Moses M Faust Christina L CL Carruthers Lauren V LV Moses Arinaitwe A Tukahebwa Edridah M EM Lamberton Poppy H L PHL

Tropical medicine and infectious disease 20181008 4

The World Health Organization (WHO) recommends praziquantel mass drug administration (MDA) to control schistosomiasis in endemic regions. We aimed to quantify recent and lifetime praziquantel coverage, and reasons for non-treatment, at an individual level to guide policy recommendations to help Uganda reach WHO goals. Cross-sectional household surveys (<i>n</i> = 681) encompassing 3208 individuals (adults and children) were conducted in 2017 in Bugoto A and B, Mayuge District, Uganda. Participan ...[more]

PMID: 30297642

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Project description:BACKGROUND:Cervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the 'gravest threats to women's lives' according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women. METHODS:Using a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-to-door); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25-49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence. DISCUSSION:Results from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization's target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage. TRIAL REGISTRATION:ISRCTN, ISRCTN12767014. Registered 14 May 2019, https://doi.org/10.1186/ISRCTN12767014; clinicaltrials.gov, NCT04000503; Registered 27 June 2019, https://clinicaltrials.gov/ct2/show/NCT04000503 PROTOCOL VERSION: January 8, 2020, version 1.

Project description:IntroductionOffspring of Schistosoma mansoni-infected women in schistosomiasis-endemic areas may be sensitised in-utero. This may influence their immune responsiveness to schistosome infection and schistosomiasis-associated morbidity. Effects of praziquantel treatment of S. mansoni during pregnancy on risk of S. mansoni infection among offspring, and on their immune responsiveness when they become exposed to S. mansoni, are unknown. Here we examined effects of praziquantel treatment of S. mansoni during pregnancy on prevalence of S. mansoni and immune responsiveness among offspring at age five years.MethodsIn a trial in Uganda (ISRCTN32849447, http://www.controlled-trials.com/ISRCTN32849447/elliott), offspring of women treated with praziquantel or placebo during pregnancy were examined for S. mansoni infection and for cytokine and antibody responses to SWA and SEA, as well as for T cell expression of FoxP3, at age five years.ResultsOf the 1343 children examined, 32 (2.4%) had S. mansoni infection at age five years based on a single stool sample. Infection prevalence did not differ between children of treated or untreated mothers. Cytokine (IFN?, IL-5, IL-10 and IL-13) and antibody (IgG1, Ig4 and IgE) responses to SWA and SEA, and FoxP3 expression, were higher among infected than uninfected children. Praziquantel treatment of S. mansoni during pregnancy had no effect on immune responses, with the exception of IL-10 responses to SWA, which was higher in offspring of women that received praziquantel during pregnancy than those who did not.ConclusionWe found no evidence that maternal S. mansoni infection and its treatment during pregnancy influence prevalence and intensity of S. mansoni infection or effector immune response to S. mansoni infection among offspring at age five years, but the observed effects on IL-10 responses to SWA suggest that maternal S. mansoni and its treatment during pregnancy may affect immunoregulatory responsiveness in childhood schistosomiasis. This might have implications for pathogenesis of the disease.

Dataset Information

Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance.

Publications

Low Praziquantel Treatment Coverage for <i>Schistosoma mansoni</i> in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance.

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