[Advanced schistosomiasis chemotherapy and assistance in Xinjian County, 2005-2009].

OBJECTIVE: To understand the status of chemotherapy and assistance for advanced schistosomiasis patients in Xinjian County, 2005-2009. METHODS: The data of chemotherapy and assistance for patients with advanced schistosomiasis in Xinjian County from 2005 to 2009 were collected and analyzed statistically by using The Information Management System for Advanced Schistosomiasis Chemotherapy and Assistance in Jiangxi Province. RESULTS: Among 636 cases, the sex ratio of male to female was 1.19: 1, and the average age was 61.52 +/- 11.2 years old. Ascites was the main symptoms of patients (93.71%), and the percentage of splenectomized ones was 32.38% among them. The IHA-positive rate, HBsAg-positive rate and repeat treatment rate were 31.6%, 24.37% and 44.50%, respectively. The clinical cure rate, recovery rate and death rate were 43.53%, 55.94% and 5.97%, respectively. CONCLUSION: The advanced schistosomiasis chemotherapy and assistance improves the symptoms and life quality of these patients.

Schistosomiasis and neglected tropical diseases: towards integrated and sustainable control and a word of caution.

In May 2001, the World Health Assembly (WHA) passed a resolution which urged member states to attain, by 2010, a minimum target of regularly administering anthelminthic drugs to at least 75% and up to 100% of all school-aged children at risk of morbidity. The refined global strategy for the prevention and control of schistosomiasis and soil-transmitted helminthiasis was issued in the following year and large-scale administration of anthelminthic drugs endorsed as the central feature. This strategy has subsequently been termed 'preventive chemotherapy'. Clearly, the 2001 WHA resolution led the way for concurrently controlling multiple neglected tropical diseases. In this paper, we recall the schistosomiasis situation in Africa in mid-2003. Adhering to strategic guidelines issued by the World Health Organization, we estimate the projected annual treatment needs with praziquantel among the school-aged population and critically discuss these estimates. The important role of geospatial tools for disease risk mapping, surveillance and predictions for resource allocation is emphasised. We clarify that schistosomiasis is only one of many neglected tropical diseases and that considerable uncertainties remain regarding global burden estimates. We examine new control initiatives targeting schistosomiasis and other tropical diseases that are often neglected. The prospect and challenges of integrated control are discussed and the need for combining biomedical, educational and engineering strategies and geospatial tools for sustainable disease control are highlighted. We conclude that, for achieving integrated and sustainable control of neglected tropical diseases, a set of interventions must be tailored to a given endemic setting and fine-tuned over time in response to the changing nature and impact of control. Consequently, besides the environment, the prevailing demographic, health and social systems contexts need to be considered.

Control of schistosomiasis in sub-Saharan Africa: progress made, new opportunities and remaining challenges.

Several other journal supplements have documented progress made in the control of schistosomiasis in Egypt, China and Brazil, however, with more than 97% of the schistosome infections now estimated to occur in Africa, the relevance of this special issue in Parasitology cannot be overemphasized. In total, 18 articles are presented, inclusive of a lead-editorial from the WHO highlighting a seminal resolution at the 54th World Health Assembly in 2001 that advocated de-worming. Facilitated by a US$ 30 million grant from the Bill and Melinda Gates Foundation in 2002, the Schistosomiasis Control Initiative subsequently fostered implementation of large-scale schistosomiasis (and soil-transmitted helminthiasis) control programmes in six selected African countries. From 2005, CONTRAST, a European union-funded consortium, was formed to conduct multi-disciplinary research pertaining to optimisation of schistosomiasis control. Progress made in schistosomiasis control across sub-Saharan Africa since the turn of the new millennium is reviewed, shedding light on the latest findings stemming from clinical, epidemiological, molecular and social sciences research, inclusive of public health interventions with monitoring and evaluation activities. New opportunities for integrating the control of schistosomiasis and other so-called neglected tropical diseases are highlighted, but more importantly, several opportune questions that arise from it frame the remaining challenges ahead for an enduring solution.

Schistosomiasis and soil-transmitted helminthiasis control in Cameroon and Côte d'Ivoire: implementing control on a limited budget.

Schistosomiasis and soil-transmitted helminthiasis occur throughout the developing world and remain a major public health problem in the poorest communities with enormous consequences for development. The extent of the problem has long been neglected because these diseases rarely kill at a young age and also because of their insidious nature. Today there exists a momentum and an unprecedented opportunity for a cost-effective control of these neglected tropical diseases. The control of these diseases has become a priority on the agenda of many governments, donors and international agencies. This paper highlights the progress made and future control activities in Cameroon and Côte d'Ivoire, where schistosomiasis and soil-transmitted helminthiasis control measures have been implemented over the past decade with limited budgets. In Cameroon, deworming activities were increased to encompass all ten regions in 2007 as a result of a co-ordinated effort of the Ministry of Health and the Ministry of Education with national and international partners. In Côte d'Ivoire, focal control activities were achieved with support from various partners. Prospects, opportunities and challenges for the control of neglected tropical diseases in these two countries are discussed.

Social science perspectives on schistosomiasis control in Africa: past trends and future directions.

New ways of integrating and scaling up control of neglected tropical diseases (including schistosomiasis) are presently underway. In this context consideration of social science perspectives is essential. In this article, we review social science publications of relevance to sustained control of schistosomiasis in Africa including diagnosis and screening, treatment, supply of clean water and improved sanitation, as well as health communication. Studies of community involvement and links between schistosomiasis control programmes and broader health care systems are also explored. Directions for future social science of relevance to sustainable schistosomiasis control are outlined, including ways of ensuring equitable access to health services as well as involvement of endemic communities and local health care systems based on equal partnership.

Efficacy of artesunate in the treatment of urinary schistosomiasis, in an endemic community in Nigeria.

The efficacy and tolerability of oral artesunate for the treatment of urinary schistosomiasis was assessed among schoolchildren aged 5-18 years in Adim community, Nigeria. Overall, 500 children, randomly selected from those attending the Presbyterian primary school, were each invited to provide two consecutive urine samples. Using standard parasitological procedures, Schistosoma haematobium ova were found in the samples from 145 (29.0%) of the subjects. Most (87) of the infected subjects were then treated orally with artesunate, using two doses, each of 6 mg/kg, given 2 weeks apart. When the treated children were re-examined 4 weeks after the second dose of artesunate, 61 (70.1%) appeared egg-negative and were therefore considered cured. Post-treatment, the geometric mean egg count (GMEC) for the treated subjects who were not cured was significantly lower than the pre-treatment GMEC for all the treated subjects, with log10[(eggs/10 ml urine) + 1] values of 0.9 v. 1.75 (t = 4.45; P < 0.05). The cure 'rate' for the subjects aged > or = 10 years was slightly higher than that among the younger subjects. It was lowest for the heavier subjects (70% for those weighing 41-50 kg) and highest (79%) for the subjects who weighed 31-40 kg. The artesunate was well tolerated. This observation of a therapeutic effect of artesunate against S. haematobium in Nigeria confirms recent observations from Senegal. In the Adim community at least, it would be more cost-effective to treat urinary schistosomiasis with artesunate than with praziquantel. The wide-spread use of artesunate against schistosomiasis has to be considered carefully, however, if it is not to compromise the efficacy of the drug as an antimalarial, by increasing the risk of resistance developing in local Plasmodium.

Is equity being sacrificed? Willingness and ability to pay for schistosomiasis control in China.

Decentralization of the health care system in China has led to an increasing need for income generation at all operational levels, both for curative services and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-seeking behaviour has yet to be assessed. Public health programmes present particular problems in terms of revenue generation, however, because of the less direct impact of these activities on individual health and well-being. In this paper, we report the results of a cross-sectional study of willingness and ability to pay for schistosomiasis control. Questionnaires were administered to household heads of six representative villages in the Dongting Lake Region of Hunan Province, China. A total of 628 valid questionnaires were analyzed. The yearly mean household expenditure on schistosomiasis diagnosis and treatment was RMB 59.50 +/- 146.04 Yuan (US$1 = 8 RMB Yuan), accounting for 0.94% of the total yearly household income. Most household heads (514, 82%) thought schistosomiasis was the greatest health threat in their communities, but only 30.9% of them were willing to pay for screening, diagnosis and treatment of the infection. On the other hand, 72.3% of the respondents were willing to undertake volunteer work for control.

Pattern and cost of medical care for workers with schistosomiasis.

This study describes the pattern of medical care provided to workers with schistosomiasis, estimate the total medical cost and to identify the proportional rates of sickness retirement attributed to schistosomiasis. The observational approach was adopted for this study 170 schistosomiasis workers and a similar number of controls were included in this study. An interviewing schedule and a special format were designed for collecting personal, medical and early retirement data. The results revealed that the mean total cost in the outpatient clinics was significantly higher for schistosomiasis workers than their controls (320.2 " 330.11 versus 210.8 " 260.01 L.E). The hospital cost was also higher for schistosomiasis workers compared with their controls (265.9 " 674.47 vs 195.8 " 629.72 L.E) but this differencewas not statistically significant. More than 80% of the total hospital cost was spent on bed cost. The average operative cost/worker was significantly higher among the schistosomiasis workers than the control workers (7.08 " 22.07 vs 2.35 " 5.2 L.E). The total medical cost (outpatient and hospital) was significantly higher for workers with schistosomiasis compared with their controls (586.02" 845.77 vs 406.57 " 694.34). The total number of workers who retired because of sickness disability other than schistosomiasis increased from 1994 to 1998 with a ratio of 2.54 while those who retired because of schistosomiasis and its complications increased with a ratio of 3.64.

A comparative analysis of the cost-effectiveness of treatment based on parasitological and symptomatic screening for Schistosoma mansoni in Burundi.

OBJECTIVES: To assess the cost-effectiveness of three alternative screening strategies in delivering treatment to patients presenting with symptoms suggestive of S. mansoni, using data collected from 17 PHCCs in the Rusizi Plain, Burundi. The three strategies were: (1) screening all symptomatic patients using a Kato-Katz smear and treating only the ones found positive; (2) treating all symptomatic patients or (3) treating only those presenting with symptoms of severe diarrhoea (blood in stool). METHODS: The database consisted of 41 051 visits of symptomatic patients to the 17 PHCCs during 1990. Effectiveness was measured as the number of infected patients treated (gold standard: 25-mg Kato-Katz smear). Cost-effectiveness ratios (CERs) (cost in US$ per infected patient treated) were used to compare the control strategies. Sensitivity analysis was performed to assess the effect of drug price and prevalence of infection on the CERs. RESULTS: The overall prevalence of S. mansoni infection was 9.5% (95% CI = 9.1%, 9.9%). Treating only those with severe symptoms of infection would have left 92% of infected patients untreated. Performing a Kato-Katz smear to confirm the diagnosis was more cost-effective than treating all symptomatic patients on a presumptive basis, with CERs of 4.2 US$ and 12.43 US$ per infected person treated, respectively. Sensitivity analysis showed that, for a cost of 0.99 US$ per dose of praziquantel, the Kato-Katz option remained the most cost-effective approach for prevalences under 76%. For a drug price of 0.21 US$ per dose, both strategies would have become equivalent. The latter value varied extensively per PHCC (range 0.17 US$ to 0.51 US$), due to the different prevalences of infection (range 0.5% to 34.3%). CONCLUSION: We found that using severe diarrhoea as an indicator for infection was not appropriate, and that screening symptomatic patients with the Kato-Katz method remained the most cost-effective approach in the given setting. The CER of treating all symptomatic patients on a presumptive basis depended very much on the drug price and the endemic level.