Podoconiosis in East and West Gojam Zones, Northern Ethiopia

Background: Podoconiosis is a neglected tropical disease (NTD) that is prevalent in red clay soil-covered highlands of tropical Africa, Central and South America, and northern India. It is estimated that up to one million cases exist in Ethiopia. This study aimed to estimate the prevalence of podoconiosis in East and West Gojam Zones of Amhara Region in northern Ethiopia. Methodology/Principal Findings: A cross-sectional household survey was conducted in Debre Eliyas and Dembecha woredas (districts) in East and West Gojam Zones, respectively. The survey covered all 17,553 households in 20 kebeles (administrative subunits) randomly selected from the two woredas. A detailed structured interview was conducted on 1,704 cases of podoconiosis identified in the survey. Results: The prevalence of podoconiosis in the population aged 15 years and above was found to be 3.3% (95% CI, 3.2% to 3.6%). 87% of cases were in the economically active age group (15–64 years). On average, patients sought treatment five years after the start of the leg swelling. Most subjects had second (42.7%) or third (36.1%) clinical stage disease, 97.9% had mossy lesions, and 53% had open wounds. On average, patients had five episodes of acute adenolymphangitis (ALA) per year and spent a total of 90 days per year with ALA. The median age of first use of shoes and socks were 22 and 23 years, respectively. More men than women owned more than one pair of shoes (61.1% vs. 50.5%; x2 = 11.6 p = 0.001). At the time of interview, 23.6% of the respondents were barefoot, of whom about two-thirds were women. Conclusions: This study showed high prevalence of podoconiosis and associated morbidities such as ALA, mossy lesions and open wounds in northern Ethiopia. Predominance of cases at early clinical stage of podoconiosis indicates the potential for reversing the swelling and calls for disease prevention interventions

Potential for transmission of schistosomiasis in Kayonza district

Introduction: Schistosomiasis, also known as bilharzia or snail fever, is a tropical parasitic disease caused by a trematode platyhelminthes called Schistosoma sp. Schistosoma species are transmitted by cercariae penetrating the skin when a person is bathing, washing clothes, fishing or engaged in agricultural activities; involving contact with fresh water that has fecal or urinary contamination, and contains the parasites’ snail host. The present study aimed to survey freshwater snails in Kayonza District (Rwanda) especially Lake Muhazi and surrounding water bodies, stream and swamps to assess the potential for transmission of two species of Schistosoma: S. mansoni and S. haematobium . Methods: Six sites were selected to assess the potential for transmission of schistosomiasis. The intermediate hosts of schistosomes, namely the snails Biomphalaria , Bulinus sp. and Lymnaea sp., were collected and brought to the laboratory and investigated to see if trematode cercaria responsible for the disease were present. Results: Snails dissected were not only infected with trematode cercaria but also with annelids and flatworms (Platyhelminths). Cercaria found therein were of two types: furcocercous, probably responsible for schistosomiasis; and gymnocephalous cercaria for fasciolasis: an infection of cattle, goats and sheep. Conclusion: Biomphalaria sp were the major hosts for schistosome cercaria, and most snails collected of this species were infected. Moreover, they were found in large number from all sites. Lymnaea sp, hosts snails for Fasciola cercaria , were also found in a considerable number compared to the low number of Bulinus sp in the region. District and national authorities may wish to further investigate this infestation and identify potential interventions to disrupt the disease transmission.Introduction: La schistosomiase également connue sous le nom de bilharziose est une maladie parasitaire tropicale causée par des plathelminthes trématodes appelés schistosomes. Les Schistosomes sont transmises par des cercaires pénétrant la peau quand une personne se baigne, lave des vêtements, pêche ou pendant des activités agricoles en contact avec l’eau douce contaminée par des matières fécales ou urinaires, et contenant les mollusques hôtes intermédiaires des parasites. La présente étude visait à examiner les mollusques d’eau douce dans le district de Kayonza (Rwanda) particulièrement le lac Muhazi et les eaux environnantes: les ruisseaux et les marais; pour évaluer le potentiel de la transmission de deux espèces de schistosome: Schistosoma mansoni et Schistosoma haematobium . Méthodes: Six endroits ont été choisis pour évaluer le potentiel pour la transmission de la schistosomiase. Des mollusques hôtes intermédiaires des schistosomes, à savoir les espèces de Biomphalaria , Bulinus sp. et Lymnaea sp. ont été collectés, amenés au laboratoire et étudiés pour voir si les cercaires de trématodes responsables de la maladie étaient présentes. Résultats: Des mollusques disséqués ont été atteints par les cercaires de trématodes mais également par des annélides et des vers plats (Plathelminthes). Les Cercaires trouvées là-dedans étaient de deux types: furcocercaires, probablement responsable de la schistosomiase et cercaires gymnocéphales probablement responsables du fasciolose: une infection du bétail, des chèvres et des moutons. Conclusion: Les espèces Biomphalaria étaient les principaux hôtes des cercaires des schistosomes, les plus infectés parmi les espèces des mollusques collectés. Ces espèces de Biomphalaria ont été trouvées en grand nombre dans tous les sites. Les espèces de Lymnaea, mollusques hôtes intermédiaires pour les cercaires de Fasciola cercaria , ont été également trouvés en nombre considérable comparé à un nombre peu élevé des espèces Bulinus dans la région. Les autorités de district et ainsi que nationales devraient étudier davantage cette infestation et identifier les interventions potentielles pour interrompre sa transmission

A Recent Update Of Schistomiasis Mansoni Endemicity Around Lake Rweru

Background: Schistosomiasis remains a global public health challenge with an estimated 200 million cases reported each year. In Rwanda, the prevalence of schistosomiasis was recently examined by a countrywide mapping conducted by the Neglected Tropical Disease (NTD) Control Programme of the Rwandan Ministry of Health in partnership with The Access Project. Unfortunately, that study failed to consider one area of endemicity -- Lake Rweru, located in Bugesera District, Eastern Province, Rwanda. This screening aimed to evaluate Lake Rweru and its environs in order to determine next steps for disease control. Methods: The lake’s shore inhabitants, including children and adults, were invited to be screened for intestinal schistosomiasis. The stool examination was performed by Kato-Katz technique. Results: A total of 270 children and adults were parasitologically screened. Fifty seven (57) cases of schistosomiasis mansoni were confirmed (21.1%). The highest proportion of S. mansoni infection was observed at Mazane Island (30.1% of 93 island inhabitants screened). Conclusion: The present results confirm that Lake Rweru is a significant source of S. mansoni infection in the country. We recommend further future investigations in order to know the true disease prevalence. While the mass de-worming campaign against schistosomiasis in addition to soil-transmitted helminthiasis is being regularly conducted by the Ministry of Health in all endemic areas, the population surrounding Lake Rweru should receive special attention.Contexte: La schistosomiase demeure un problème important de santé publique globalement avec environ 200 millions de cas rapportés chaque année. Au Rwanda, la situation de la schistosomiase a été récemment mise à jour par une cartographie nationale conduite par le Programme de Contrôle des Maladies Tropicales Négligées (MTN) du Ministère de la Santé en collaboration avec The Access Project. Cependant, le lac Rweru situé dans le District de Bugesera, Province de l’Est, Rwanda, a été incorrectement manqué parmi les foyers les plus endémiques. L’investigation visait à confirmer le foyer afin de déterminer de prochaines étapes pour le contrôle de l’infestation à Schistosoma mansoni. Méthodes: La population habitant aux alentours du lac Rweru comprenant des enfants et des adultes a été invitée à fournir leurs échantillons de selles en vue d’être examinés pour la schistosomiase intestinale. L’examen de selles a été réalisé par la technique de Kato-Katz. Résultats: Un total de 270 individus (des enfants et des adultes) ont été examinés parasitologiquement. Cinquante-sept (57) cas de schistosomiase mansoni ont été confirmés (21.1%). On a observé la proportion la plus élevée de l’infection à S. mansoni à l’île de Mazane (30.1% de 93 habitants insulaires testés). Conclusion: Les résultats actuels confirment que le lac Rweru est une source importante de S. mansoni dans le pays. Nous recommandons des enquêtes postérieures afin de connaître la vraie prévalence de la maladie dans cette zone. Pendant que la campagne de déparasitage de masse contre la schistosomiase en plus des géo-helminthiases est régulièrement organisée par le Ministère de la Santé dans toutes les zones endémiques, la population environnant le lac Rweru devrait recevoir une attention particulière

Evaluation, Validation, and Recognition of the Point-of-Care Circulating Cathodic Antigen, Urine-Based Assay for Mapping Schistosoma mansoni Infections

Efforts to control Schistosoma mansoni infection depend on the ability of programs to effectively detect and quantify infection levels and adjust programmatic approaches based on these levels and program goals. One of the three major objectives of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) has been to develop and/or evaluate tools that would assist Neglected Tropical Disease program managers in accomplishing this fundamental task. The advent of a widely available point-of-care (POC) assay to detect schistosome circulating cathodic antigen (CCA) in urine with a rapid diagnostic test (the POC-CCA) in 2008 led SCORE and others to conduct multiple evaluations of this assay, comparing it with the Kato–Katz (KK) stool microscopy assay—the standard used for more than 45 years. This article describes multiple SCORE-funded studies comparing the POC-CCA and KK assays, the pros and cons of these assays, the use of the POC-CCA assay for mapping of S. mansoni infections in areas across the spectrum of prevalence levels, and the validation and recognition that the POC-CCA, although not infallible, is a highly useful tool to detect low-intensity infections in low-to-moderate prevalence areas. Such an assay is critical, as control programs succeed in driving down prevalence and intensity and seek to either maintain control or move to elimination of transmission of S. mansoni

Polyparasite Helminth infections and their association to anaemia and undernutrition in Northern Rwanda

Abstract Background Intestinal schistosomiasis and soil-transmitted helminth (STH) infections constitute major public health problems in many parts of sub-Saharan Africa. In this study we examined the functional significance of such polyparasite infections in anemia and undernutrition in Rwandan individuals. Methods Three polyparasite infection profiles were defined, in addition to a reference profile that consisted of either no infections or low-intensity infection with only one of the focal parasite species. Logistic regression models were applied to data of 1,605 individuals from 6 schools in 2 districts of the Northern Province before chemotherapeutic treatment in order to correctly identify individuals who were at higher odds of being anaemic and/or undernourished. Findings Stunted relative to nonstunted, and males compared to females, were found to be at higher odds of being anaemic independently of polyparasite infection profile. The odds of being wasted were 2-fold greater for children with concurrent infection of at least 2 parasites at M+ intensity compared to those children with the reference profile. Males compared to females and anaemic compared to nonanaemic children were significantly more likely to be stunted. None of the three polyparasite infection profiles were found to have significant effects on stunting. Conclusion The present data suggest that the levels of polyparasitism, and infection intensities in the Rwandan individuals examined here may be lower as compared to other recent similar epidemiological studies in different regions across sub-Saharan Africa. Neither the odds of anaemia nor the odds of stunting were found to be significantly different in the three-polyparasite infection profiles. However, the odds of wasting were higher in those children with at least two parasites at M+ intensity compared to those children with the reference profile. Nevertheless, despite the low morbidity levels indicated in the population under study here, we recommend sustainable efforts for the deworming of affected populations to be continued in order to support the economic development of the country

Nationwide remapping of Schistosoma mansoni infection in Rwanda using circulating cathodic antigen rapid test: taking steps toward elimination

The field standard for the detection of Schistosoma mansoni infection is Kato-Katz (KK), although it misses many active infections, especially light infections. In 2014, a reassessment of S. mansoni prevalence was conducted in Rwanda using the more sensitive point-of-care circulating cathodic antigen (POC-CCA) rapid assay. A total of 19,371 children from 399 schools were selected for testing for single urine CCA. Of these, 8,697 children from 175 schools were also tested with single stool double-slide KK. Samples from eight of these 175 schools were tested again with CCA and additionally with the highly specific and sensitive up-converting phosphor-lateral flow circulating anodic antigen (UCP-LF CAA) assay. Latent class analysis was applied to all four test results to assess sensitivity and specificity of POC-CCA and estimate the proportion of trace results from Rwanda likely to be true infections. The overall prevalence of S. mansoni infection in Rwanda when CCA trace results were considered negative was 7.4% (school interquartile range [IQR] 0-8%) and 36.1 % (school IQR 20-47%) when trace was considered positive. Prevalence by KK was 2.0% with a mean intensity of infection of 1.66 eggs per gram. The proportion of active infections among children diagnosed with CCA trace was estimated by statistical analysis at 61 % (Bayesian credibility interval: 50-72%). These results indicate that S. mansoni infection is still widespread in Rwanda and prevalence is much underestimated by KK testing. Circulating cathodic antigen is an affordable alternative to KK and more suitable for measuring S. mansoni prevalence in low-intensity regions

Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey

BACKGROUND:Podoconiosis is a type of tropical lymphoedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. Reliable and detailed data on the prevalence and distribution of podoconiosis are scarce. We aimed to fill this data gap by doing a nationwide community-based study to estimate the number of cases throughout Rwanda. METHODS:We did a population-based cross-sectional survey to determine the national prevalence of podoconiosis. A podoconiosis case was defined as a person with bilateral, asymmetrical lymphoedema of the lower limb present for more than 1 year, who tested negative for Wuchereria bancrofti antigen (determined by Filariasis Test Strip) and specific IgG4 (determined by Wb123 test), and had a history of any of the associated clinical signs and symptoms. All adults (aged ≥15 years) who resided in any of the 30 districts of Rwanda for 10 or more years were invited at the household level to participate. Participants were interviewed and given a physical examination before Filariasis Test Strip and Wb123 testing. We fitted a binomial mixed model combining the site-level podoconiosis prevalence with continuous environmental covariates to estimate prevalence at unsampled locations. We report estimates of cases by district combining our mean predicted prevalence and a contemporary gridded map of estimated population density. FINDINGS:Between June 12, and July 28, 2017, 1 360 612 individuals-719 730 (53%) women and 640 882 (47%) men-were screened from 80 clusters in 30 districts across Rwanda. 1143 individuals with lymphoedema were identified, of whom 914 (80%) had confirmed podoconiosis, based on the standardised diagnostic algorithm. The overall prevalence of podoconiosis was 68·5 per 100 000 people (95% CI 41·0-109·7). Podoconiosis was found to be widespread in Rwanda. District-level prevalence ranged from 28·3 per 100 000 people (16·8-45·5, Nyarugenge, Kigali province) to 119·2 per 100 000 people (59·9-216·2, Nyamasheke, West province). Prevalence was highest in districts in the North and West provinces: Nyamasheke, Rusizi, Musanze, Nyabihu, Nyaruguru, Burera, and Rubavu. We estimate that 6429 (95% CI 3938-10 088) people live with podoconiosis across Rwanda. INTERPRETATION:Despite relatively low prevalence, podoconiosis is widely distributed geographically throughout Rwanda. Many patients are likely to be undiagnosed and morbidity management is scarce. Targeted interventions through a well coordinated health system response are needed to manage those affected. Our findings should inform national level planning, monitoring, and implementation of interventions. FUNDING:Wellcome Trust