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      Can direct smear results that are routinely collected at health centre level be used for monitoring the impact of mass drug administration with praziquantel on schistosomiasis in Burundi? A preliminary assessment

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          Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel has been rolled out in 11 endemic districts. The national programme relies on school-based surveys with kato-katz to monitor the impact of mass drug administration. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears at health centre level could be used.


          From the Burundian National Health Information System, we collected routine incidence data on intestinal schistosomiasis as determined by direct smear examination in all 45 sanitary districts during 2011–2015. A temporal trends analysis was performed using a mixed negative binomial regression. Sanitary districts with mass drug administration campaigns with praziquantel ( n = 11) were compared with those without ( n = 34). In addition, prevalence data on intestinal schistosomiasis based on kato-katz results from a school-based national mapping in 2014 were compared with the incidence data in health centres based on direct smear results, in the same 45 sanitary districts.


          In the 11 sanitary districts applying mass drug administration with praziquantel, the incidence rate decreased significantly for the years 2014 ( β 2014 = − 0.826, P = 0.010) and 2015 ( β 2015 = − 1.294, P < 0.001) and for the five-year period ( β = − 0.286, P < 0.001), whereas in the 34 districts where mass drug administration was not delivered, there was no significant decrease over time ( β = − 0.087, P = 0.219). In most of the 45 sanitary districts, the low prevalence based on kato-katz in school children was confirmed by low incidence rates based on direct smears in the health centres.


          National Health Information System surveillance data, based on routinely collected direct smear results at health centre level, may be able to monitor the impact of mass drug administration with praziquantel on intestinal schistosomiasis in Burundi. Control and elimination of intestinal schistosomiasis call for integration of adequate diagnosis and treatment into routine activities of primary health care facilities, as recommended by the World Health Organization since more than 20 years. When moving towards elimination, more sensitive tests, such as the point-of-care circulating cathodic antigen assay are desirable.

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          Most cited references 18

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          Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk.

          An estimated 779 million people are at risk of schistosomiasis, of whom 106 million (13.6%) live in irrigation schemes or in close proximity to large dam reservoirs. We identified 58 studies that examined the relation between water resources development projects and schistosomiasis, primarily in African settings. We present a systematic literature review and meta-analysis with the following objectives: (1) to update at-risk populations of schistosomiasis and number of people infected in endemic countries, and (2) to quantify the risk of water resources development and management on schistosomiasis. Using 35 datasets from 24 African studies, our meta-analysis showed pooled random risk ratios of 2.4 and 2.6 for urinary and intestinal schistosomiasis, respectively, among people living adjacent to dam reservoirs. The risk ratio estimate for studies evaluating the effect of irrigation on urinary schistosomiasis was in the range 0.02-7.3 (summary estimate 1.1) and that on intestinal schistosomiasis in the range 0.49-23.0 (summary estimate 4.7). Geographic stratification showed important spatial differences, idiosyncratic to the type of water resources development. We conclude that the development and management of water resources is an important risk factor for schistosomiasis, and hence strategies to mitigate negative effects should become integral parts in the planning, implementation, and operation of future water projects.
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            The global status of schistosomiasis and its control.

            Schistosomiasis is being successfully controlled in many countries but remains a major public health problem, with an estimated 200 million people infected, mostly in Africa. Few countries in this region have undertaken successful and sustainable control programmes. The construction of water schemes to meet the power and agricultural requirements for development have lead to increasing transmission, especially of Schistosoma mansoni. Increasing population and movement have contributed to increased transmission and introduction of schistosomiasis to new areas. Most endemic countries are among the least developed whose health systems face difficulties to provide basic care at the primary health level. Constraints to control include, the lack of political commitment and infrastructure for public health interventions. Another constraint is that available anti-schistosomal drugs are expensive and the cost of individual treatment is a high proportion of the per capita drug budgets. There is need for increased support for schistosomiasis control in the most severely affected countries.
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              Comparison of Schistosoma mansoni Prevalence and Intensity of Infection, as Determined by the Circulating Cathodic Antigen Urine Assay or by the Kato-Katz Fecal Assay: A Systematic Review

              The relationship between results from Kato-Katz (KK) fecal microscopy and urine-based point-of-care circulating cathodic antigen (POC-CCA) assays for Schistosoma mansoni infection remains a critical issue. This systematic literature review of 25 published papers compares prevalence of S. mansoni infection by KK with that by the POC-CCA assay. Nineteen published studies met our inclusion criteria for data extraction and analysis. Above a prevalence of 50% by KK, KK and POC-CCA results yielded essentially the same prevalence. Below 50% prevalence by KK, the prevalence by the POC-CCA assay was between 1.5- and 6-fold higher and increased as prevalence by KK decreased. Five of nine publications met inclusion criteria for extractable data on intensity of S. mansoni infection by KK assay and visual band density using the POC-CCA assay. A clear positive relationship exists between intensity by the KK and POC-CCA assays. This systematic review indicates that below 50% prevalence, the POC-CCA assay is much more sensitive than the KK assay. However, the existing data are inadequate to precisely define the relationship between POC-CCA and KK at lower levels of KK prevalence. More studies directly comparing the two assays in low-prevalence areas are essential to inform decision-making by national schistosomiasis control programs.

                Author and article information

                pbizimana2010@gmail.com , bizap2006@yahoo.fr
                Parasit Vectors
                Parasit Vectors
                Parasites & Vectors
                BioMed Central (London )
                21 April 2020
                21 April 2020
                : 13
                [1 ]GRID grid.5284.b, ISNI 0000 0001 0790 3681, Global Health Institute, Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, , University of Antwerp, ; Antwerp, Belgium
                [2 ]Département des Sciences de la Santé Publique, Direction de la Formation, Institut National de Santé Publique, Bujumbura, Burundi
                [3 ]GRID grid.7749.d, ISNI 0000 0001 0723 7738, Département de Médecine Communautaire, Faculté de Médecine de Bujumbura, , Université du Burundi, ; Bujumbura, Burundi
                [4 ]Département des Sciences de la Santé Publique, Institut Universitaire des Sciences de la Santé et de Développement Communautaire, Bujumbura, Burundi
                [5 ]GRID grid.442687.b, Faculté de Médecine, , Université de Ngozi, ; Ngozi, Burundi
                [6 ]GRID grid.11505.30, ISNI 0000 0001 2153 5088, Medical Helminthology Unit, Department of Biomedical Sciences, , Institute of Tropical Medicine, ; Antwerp, Belgium
                [7 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Section of Infectious Diseases, Department of Health Sciences, , VU Amsterdam, ; Amsterdam, The Netherlands
                [8 ]Global Health Consultant, London, UK
                [9 ]GRID grid.11505.30, ISNI 0000 0001 2153 5088, Biostatistics and Epidemiology Unit, Department of Biomedical Sciences, , Institute of Tropical Medicine, ; Antwerp, Belgium
                [10 ]GRID grid.7749.d, ISNI 0000 0001 0723 7738, Département de Médecine Interne, Faculté de Médecine de Bujumbura, , Université du Burundi, ; Bujumbura, Burundi
                [11 ]Bureau de la Municipalité Sanitaire de Bujumbura, Ministère de la Santé Publique et de la Lutte contre le Sida, Bujumbura, Burundi
                © The Author(s) 2020

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                Funded by: Schistosomiasis Control Initiative
                Funded by: VLIR-UOS
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