Dataset Information

Elimination of schistosomiasis requires multifactorial diagnostics: evidence from high- and low-prevalence areas in the Nile Delta, Egypt.

ABSTRACT: Schistosomiasis is one of the neglected tropical diseases (NTDs) selected for worldwide elimination in the near future. Egypt has made strong progress against its two endemic species of Schistosoma mansoni and S. haematobium. The former is prevalent in the Nile Delta with the latter dominating in the Nile south of Cairo. Innovative efforts are needed to reach the goal as further reduction of the prevalence has stalled due to ongoing transmission. In this study we aimed to explore the difference between low and high prevalence villages with regard to knowledge attitude and practice about schistosomiasis, utilization of health services, infection and transmission indices. A hybrid cross-sectional longitudinal study was conducted with three annual follow-ups conducted during 1994-1996. We used a representative systematic random sampling technique investigating 993 individuals from the high prevalence village and 614 from the low prevalence village. Data were analyzed using SPSS, comparing proportions with the Chi square test and means with the Student t test, and ANOVA. Compliance of faecal sampling and chemotherapy was above 70% in both villages over the whole study period. Selective praziquantel treatment resulted in a significant reduction of prevalence and intensity of infection in both villages, dropping from 35.8% prevalence to 20.6%, in the low-prevalence village, and from 69.5 to 45.9% in the high-prevalence one. Intensity of infection at the base line was 30 eggs per gram (EPG) of stool in the low-prevalence village versus 105 EPG in the high-prevalence village. However, after the second round, reinfection rebounded by 22% in the high-prevalence village, while a slight improvement of the infection indices was demonstrated in the low-prevalence one. The level of knowledge was modest in both villages: people knew about self-protection and treatment, but not much about the role of human excreta for schistosomiasis transmission. While all participants maintained that using the water from the canals was inevitable, inhabitants in the high-prevalence village showed significantly lower scores reflecting higher water contact compared to the low-prevalence one. Many of them (67%) did not utilize the health centre at all compared to 26% of the people in the low-prevalence village. Interestingly, private clinics were seen as the primary source of health care by both villages, but more frequently so in the high-prevalence village (used by 87.2% of the inhabitants) compared to the low-prevalence one (59.8%). Even if chemotherapy works well as reflected by the observed downregulation of intensity of infection in both villages, reinfection continued due to difficulties to avoid water contact. Efforts must be made to make people understand the role of human excreta for transmission. There is also a need to make people better trust the medical services available.

SUBMITTER: Elmorshedy H

PROVIDER: S-EPMC7119160 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Elimination of schistosomiasis requires multifactorial diagnostics: evidence from high- and low-prevalence areas in the Nile Delta, Egypt.

Elmorshedy Hala H Bergquist Robert R Fayed Amel A Guirguis Wafaa W Abdel-Gawwad Ensaf E Eissa Safaa S Barakat Rashida R

Infectious diseases of poverty 20200403 1

<h4>Background</h4>Schistosomiasis is one of the neglected tropical diseases (NTDs) selected for worldwide elimination in the near future. Egypt has made strong progress against its two endemic species of Schistosoma mansoni and S. haematobium. The former is prevalent in the Nile Delta with the latter dominating in the Nile south of Cairo. Innovative efforts are needed to reach the goal as further reduction of the prevalence has stalled due to ongoing transmission. In this study we aimed to expl ...[more]

PMID: 32241298

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Project description:This data is the first comprehensive baseline data on the geochemical composition of soil and sediments along the Nile River and Delta in Egypt that was subjected and analyzed by instrumental neutron activation analysis INAA. These data supported the research articles that were done to evaluate the elemental compositions and pollution sources in 176 sampling locations through 133 soil and 43 sediments samples along the Egyptian section of the Nile River and Delta - Egypt. "Geochemistry of sediments and surface soils from the Nile delta and lower Nile valley studied by epithermal neutron activation analysis" Arafa [1], "Major and trace element distribution in soil and sediments from the Egyptian central Nile valley" Badawy [2], and "Assessment of industrial contamination of agricultural soil adjacent to Sadat city, Egypt" Badawy [3]. The samples were analyzed by means of instrumental neutron activation analysis INAA and the concentrations in mg/kg of 28 major and trace elements are obtained. The quality control of the analytical measurements was carried out using different certified reference materials. Multivariate statistical analyses were applied. A total of eight individual and complex pollution indices were calculated in terms of the quantification of pollution extent and selection of the proper index based on the method and purpose of calculations. The spatial distribution of pollution load index PLI was mapped using GIS-technology. The normalized concentrations of the determined elements show no significant difference between soil and sediments concentrations and this, however, may be explained by the fact that origin of soil mainly is the sediments. To a clear extent, the concentrations of Ti (8017, 9672 mg/kg), V (124, 143 mg/kg), Cr (126, 160 mg/kg), and Zr (296, 318 mg/kg) are observed to be high in soil and sediments, respectively relative to other elements. Zr/Sc ratio shows a reduced sedimentary recycling and this may be explained by the tremendous influence of Aswan High Dam in preventing sediments supply from Ethiopian Highlights. Eventually, the pollution indices prove their suitability for assessing the individual and integrative contamination and show that there is no overall contamination. However, there are some contaminated localities mainly in Delta and mostly due to the dense population and anthropogenic activities. The data can be used as a raw data for constructing the first ecological atlas and evaluation of the ecological situation in terms of geochemistry and pollution.

Project description:Despite significant progress, China faces the challenge of re-emerging schistosomiasis transmission in currently controlled areas due, in part, to the presence of a range of animal reservoirs, notably water buffalo and cattle, which can harbor Schistosoma japonicum infections. Environmental, ecological and social-demographic changes in China, shown to affect the distribution of oncomelanid snails, can also impact future schistosomiasis transmission. In light of their importance in the S. japonicum, lifecycle, vaccination has been proposed as a means to reduce the excretion of egg from cattle and buffalo, thereby interrupting transmission from these reservoir hosts to snails. A DNA-based vaccine (SjCTPI) our team developed showed encouraging efficacy against S. japonicum in Chinese water buffaloes. Here we report the results of a double-blind cluster randomized trial aimed at determining the impact of a combination of the SjCTPI bovine vaccine (given as a prime-boost regimen), human mass chemotherapy and snail control on the transmission of S. japonicum in 12 selected administrative villages around the Dongting Lake in Hunan province. The trial confirmed human praziquantel treatment is an effective intervention at the population level. Further, mollusciciding had an indirect ~50% efficacy in reducing human infection rates. Serology showed that the SjCTPI vaccine produced an effective antibody response in vaccinated bovines, resulting in a negative correlation with bovine egg counts observed at all post-vaccination time points. Despite these encouraging outcomes, the effect of the vaccine in preventing human infection was inconclusive. This was likely due to activities undertaken by the China National Schistosomiasis Control Program, notably the treatment, sacrifice or removal of bovines from trial villages, over which we had no control; as a result, the trial design was compromised, reducing power and contaminating outcome measures. This highlights the difficulties in undertaking field trials of this nature and magnitude, particularly over a long period, and emphasizes the importance of mathematical modeling in predicting the potential impact of control intervention measures. A transmission blocking vaccine targeting bovines for the prevention of S. japonicum with the required protective efficacy would be invaluable in tandem with other preventive intervention measures if the goal of eliminating schistosomiasis from China is to become a reality.

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Project description:BackgroundAlthough the presence of intermediate snails is a necessary condition for local schistosomiasis transmission to occur, using them as surveillance targets in areas approaching elimination is challenging because the patchy and dynamic quality of snail host habitats makes collecting and testing snails labor-intensive. Meanwhile, geospatial analyses that rely on remotely sensed data are becoming popular tools for identifying environmental conditions that contribute to pathogen emergence and persistence.MethodsIn this study, we assessed whether open-source environmental data can be used to predict the presence of human Schistosoma japonicum infections among households with a similar or improved degree of accuracy compared to prediction models developed using data from comprehensive snail surveys. To do this, we used infection data collected from rural communities in Southwestern China in 2016 to develop and compare the predictive performance of two Random Forest machine learning models: one built using snail survey data, and one using open-source environmental data.ResultsThe environmental data models outperformed the snail data models in predicting household S. japonicum infection with an estimated accuracy and Cohen's kappa value of 0.89 and 0.49, respectively, in the environmental model, compared to an accuracy and kappa of 0.86 and 0.37 for the snail model. The Normalized Difference in Water Index (an indicator of surface water presence) within half to one kilometer of the home and the distance from the home to the nearest road were among the top performing predictors in our final model. Homes were more likely to have infected residents if they were further from roads, or nearer to waterways.ConclusionOur results suggest that in low-transmission environments, leveraging open-source environmental data can yield more accurate identification of pockets of human infection than using snail surveys. Furthermore, the variable importance measures from our models point to aspects of the local environment that may indicate increased risk of schistosomiasis. For example, households were more likely to have infected residents if they were further from roads or were surrounded by more surface water, highlighting areas to target in future surveillance and control efforts.

Dataset Information

Elimination of schistosomiasis requires multifactorial diagnostics: evidence from high- and low-prevalence areas in the Nile Delta, Egypt.

Publications

Elimination of schistosomiasis requires multifactorial diagnostics: evidence from high- and low-prevalence areas in the Nile Delta, Egypt.

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