Identifying and evaluating field indicators of urogenital schistosomiasis-related morbidity in preschool-aged children

Wami, W. M., Nausch, N., Midzi, N., Gwisai, R., Mduluza, T., Woolhouse, M. and Mutapi, F. (2015) Identifying and evaluating field indicators of urogenital schistosomiasis-related morbidity in preschool-aged children. PLoS Neglected Tropical Diseases, 9(3), e0003649. (doi: 10.1371/journal.pntd.0003649) (PMID:25793584) (PMCID:PMC4368198)

Abstract

Background: Several studies have been conducted quantifying the impact of schistosome infections on health and development in school-aged children. In contrast, relatively little is known about morbidity levels in preschool-aged children (≤5 years) who have been neglected in terms of schistosome research and control. The aim of this study was to compare the utility of available point-of-care (POC) morbidity diagnostic tools in preschool versus primary school-aged children (6–10 years) and determine markers which can be used in the field to identify and quantify Schistosoma haematobium-related morbidity. Methods/Principal Findings: A comparative cross-sectional study was conducted to evaluate the performance of currently available POC morbidity diagnostic tools on Zimbabwean children aged 1–5 years (n=104) and 6–10 years (n=194). Morbidity was determined using the POC diagnostics questionnaire-based reporting of haematuria and dysuria, clinical examination, urinalysis by dipsticks, and urine albumin-to-creatinine ratio (UACR). Attributable fractions were used to quantify the proportion of morbidity attributable to S. haematobium infection. Based on results of attributable fractions, UACR was identified as the most reliable tool for detecting schistosome-related morbidity, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination. The results of urine dipstick attributes showed that proteinuria and microhaematuria accounted for most differences between schistosome egg-positive and negative children (T=-50.1; p<0.001). These observations were consistent in preschool vs. primary school-aged children. Conclusions/Significance: Preschool-aged children in endemic areas can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. UACR for detecting albuminuria is recommended as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in children in the field. The use of dipstick microhaematuria and proteinuria as additional indicators of schistosome-related morbidity would improve the estimation of disease burden in young children.

• Item Type: Articles
• Additional Information: This work was supported by the Wellcome Trust (Grant number WT082028MA, http://www.wellcome.ac.uk/funding/) and by Thrasher Research Funds (Grant number 9150, https://www. thrasherresearch.org/default.aspx).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wami, Welcome
• Authors: Wami, W. M., Nausch, N., Midzi, N., Gwisai, R., Mduluza, T., Woolhouse, M., and Mutapi, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: PLoS Neglected Tropical Diseases
• Publisher: Public Library of Science
• ISSN: 1935-2727
• ISSN (Online): 1935-2735
• Copyright Holders: Copyright © 2015 Wami et al.
• First Published: First published in PLoS Neglected Tropical Diseases 9(3):e0003649
• Publisher Policy: Reproduced under a Creative Commons License