BackgroundOver 240 million people have schistosomiasis. Mass drug administration (MDA) with the anthelmintic praziquantel is the cornerstone of control. Treatment side effects are commonly observed and may be associated with dying worms. Side effects have also been reported as a reason for reduced MDA uptake, potentially resulting in those most in need refusing repeated treatment. An improved understanding of the association between side effects and infection intensity, pre-treatment health, and drug efficacy, may help inform education campaigns to facilitate increased MDA uptake.MethodsUsing latent class analyses, Beta regression, and dose response curves, we analysed egg and antigen parasitological data alongside health and side-effects survey data pre- and post-praziquantel-treatment from two primary schools (Bugoto Lake View (LV) and Musubi Church of God (CoG)) in Schistosoma mansoni high endemicity Ugandan villages to understand whether pre-treatment infection status or intensity were related to 1) pre-treatment symptoms, 2) post-treatment side effects, and 3) whether parasite clearance after treatment was associated with side effects.Principal findingsAt Bugoto LV: Abdominal pain, blood-in-stool, and itching/rash symptoms were non-linearly associated with infection intensity; Diarrhoea, headache and vomiting side effects were non-linearly associated with infection intensity. At Musubi CoG: Blood-in-stool, headache, and pain-when-urinating symptoms were non-linearly associated with infection intensity; Abdominal pain, diarrhoea, and vomiting side effects were non-linearly associated with infection intensity. There was no relationship between infection status (infected/ uninfected) and symptoms or side effects at either school. No association was found between infection clearance and the presence of side effects at either school.ConclusionsWe show no evidence that being infected predisposes someone to side effects, nor that side effects are related to treatment efficacy. Relationships between pre-treatment infection intensity and pre-treatment symptoms or post-treatment side effects varied by school suggesting unmeasured factors such as co-infections or other health conditions could impact symptom and side effect reporting.

Background Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool. Methods We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAK G2 ). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species ( Ascaris lumbricoides , Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select ( SS ); screen, select and retest ( SSR ) and no selection ( NS )) and number of subjects enrolled (100–5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design. Principal findings Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAK G2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAK G2 ) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity. Conclusions/significance We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO ( SS ) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs. Trial Registration ClinicalTrials.gov NCT03465488

Background: Childhood anaemia affects 1.8 billion people globally. Little is known about the long-term impact of mass drug administration (MDA) for the control of soil-transmitted helminthiases (STH) on the spatiotemporal variation of anaemia prevalence and severity. We describe the long-term spatiotemporal impact of a 5-year STH MDA programme (2007–2011) on the prevalence of anaemia and anaemia severity in school-aged children (SAC) in Burundi. Methodology/Principal Findings: We used annual haemoglobin concentration and STH data collected during 2007–2011 in 31 schools in Burundi. Spatial dependence in prevalence and severity of anaemia was assessed using semivariograms. Bayesian geostatistical models were developed to (a) quantify the role of STH (adjusted for other anaemia determinants) in the spatiotemporal distribution of anaemia prevalence/severity, and (b) predict the geographical variation of both outcomes across Burundi. Adjusted population data were used to estimate the geographical distribution of the number of SAC at risk of anaemia and with low and moderate/severe anaemia. Infections with Ascaris lumbricoides and Trichuris trichiura were positively and significantly associated with childhood anaemia; hookworm infections were not. A significant decrease in anaemia prevalence, from 40–50% (2008) to 10–20% (2011) was predicted in western areas. The predicted prevalence of low-severity anaemia decreased from 40–50% (2008) to <20% (2011) in southern and eastern areas. Moderate/high-severity anaemia was concentrated in western regions of Burundi, with pockets of moderate/high-severity anaemia in central and northern regions in 2008. The overall number of predicted anaemic children decreased from 443,657 (2008) to 232,304 (2011), with a resurgence after MDA disruption in 2010 (to 480,605). Prevalence of low- and moderate-severity anaemia was higher in boys than in girls. Conclusions/Significance: Despite ongoing MDA, the prevalence of anaemia in SAC remained high and increased in certain parts of the country. It is recommended that MDA programmes targeting STH are complemented with specific anaemia interventions.

This book chapter details the life of the author after retirement.

AbstractThe history of the neglected tropical disease movement is seen through the lens of authors who worked during the last 4 decades in different roles and in different settings, from Western-based laboratories to clinical roles in endemic countries and in critical policy roles in the World Health Organization (WHO). The authors seek to identify key players from the introduction of the word ‘neglected’ by the late Kenneth Warren in his Rockefeller Foundation–supported Great Neglected Diseases of Mankind movement through to the more recent developments after the London Declaration of 2012. The role of the various actors—endemic countries, major pharmaceutical companies, the WHO, non-government development organizations, bilateral donors and academia—are discussed. The critical events and decisions are highlighted that were essential enabling factors in creating a viable and successful movement and with a resultant massive global public health and antipoverty impact. The importance of advocacy is emphasized in creating the momentum to establish a globally recognized public health ‘brand’ as a target in the United Nations Sustainable Development Goals.

This book chapter describes the most successful program of national control coincided with a change in the overall philosophy of philanthropy as well as with praziquantel relatively cheap.

Few can deny that a nation's health is inextricably linked with its economic condition. Therefore, it is not surprising to find that those who live with less than two dollars a day is ravaged by illness and can hope to make a living. This book chapter focuses on the six countries selected to support SCI in 2003 demonstrating poorest of the poor.

Abstract This book chapter describes the early and formative years of the doctor.

More than 100 million people are facing a return to extreme poverty because of coronavirus disease 2019 (COVID-19), while new estimates suggest that threenations—India, Nigeria, and the Democratic Republic of the Congo—may suffer the greatest economic contractions. Such findings will have profound consequences in terms of our ability to control or eliminate the most widely prevalent neglected tropical diseases.

Not all cases are extreme, but only a small percentage of the estimate 200 million people infected with schistosomiasis in Africa suffer this fate. Schistosomiasis eggs accumulate and damage organs slowly, day after day, without their function being impaired, up until it's too late. Usually, it is only then that symptoms become apparent and schistosomiasis is diagnosed. This book chapter focuses on campaigns focused on schistosomiasis control and prevention.

Abstract Public health in sub-Saharan Africa, even after COVID-19, has reached a critical mass that promises positive change for nearly a billion poorest in the world. This change is driven by the expansion interested in "neglected tropical diseases" or NTDs, ironically called, and the success of the built-in control programs for them. Now the removal of the disease in 2030, most consumers are in the spotlight due to continued community support: private partnerships for drug funding from pharmaceutical companies, bilateral sponsors (UK and US), fundraising organisations (GiveWell, GWWC, The END Fund), implementing NGOs (RTI, SCI, GAELF) and ministries of education and health care in endemic countries. There's still a lot of work to do resulted in elimination, but the word "forgotten" in the context of the tropics illness may no longer be true. NTD has since been practically unknown in the 20th century outside the poor and rural areas of the world, to a situation where, at the beginning of the 21st century, more than a billion treatments were performed each year.

This book chapter focuses on some known and unknown research gaps: praziquantel dosage, confusing cure rates, belief in praziquantel, potential for praziquantel resistance from worm genetics, and SCORE protocols.

This book chapter focuses on seven areas to consider for the implementation to be success: (1) Who gets sick and who will provide the community/section in? How to diagnose and measure and what tools do they use? (2) What do we offer? (praziquantel and albendazole) How can they measure dosage and ensure supplies? (The drug should be given or inexpensive, still safe and effective, and easy to use) (3) Why deploy praziquantel to prevent transmission but not a vaccine? How? or what can they do if they just use medicine? (4) Who will deliver it? How to sign up and retain people get on the train? (5) Have they raised enough funds for drugs, labor and maintenance program in the next few years? How does the program sustainable? (6) How will they measure success, creating evidence of what works and publish it for others to benefit, bring in sponsors and to increase more? and finally, (7) Is governance intended to help us be honest and true to the goal?

The life cycle and consequences of the disease are estimated at 200 million people infected with one of the three main species of schistosomiasis are spectacular. This book chapter describes the five stages of the Schistosoma life cycle.

This book chapter describes the establishment and implementation of the schistosomiasis infection and control programme.

Background Schistosomiasis is a parasitic disease caused by trematode worms of the genus Schistosoma and belongs to the neglected tropical diseases. The disease has been reported in 78 countries, with around 290.8 million people in need of treatment in 2018. Schistosomiasis is predominantly considered a rural disease with a subsequent focus of research and control activities in rural settings. Over the past decades, occurrence and even expansion of schistosomiasis foci in peri-urban and urban settings have increasingly been observed. Rural–urban migration in low- and middle-income countries and subsequent rapid and unplanned urbanization are thought to explain these observations. Fifty-five percent (55%) of the world population is already estimated to live in urban areas, with a projected increase to 68% by 2050. In light of rapid urbanization and the efforts to control morbidity and ultimately achieve elimination of schistosomiasis, it is important to deepen our understanding of the occurrence, prevalence, and transmission of schistosomiasis in urban and peri-urban settings. A systematic literature review looking at urban and peri-urban schistosomiasis was therefore carried out as a first step to address the research and mapping gap. Methodology Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic computer-aided literature review was carried out using PubMed, ScienceDirect, and the World Health Organization Database in November 2019, which was updated in March 2020. Only papers for which at least the abstract was available in English were used. Relevant publications were screened, duplicates were removed, guidelines for eligibility were applied, and eligible studies were reviewed. Studies looking at human Schistosoma infections, prevalence, and intensity of infection in urban and peri-urban settings were included as well as those focusing on the intermediate host snails. Principal findings A total of 248 publications met the inclusion criteria. The selected studies confirm that schistosomiasis is prevalent in peri-urban and urban areas in the countries assessed. Earlier studies report higher prevalence levels in urban settings compared to data extracted from more recent publications, yet the challenge of migration, rapid uncontrolled urbanization, and resulting poor living conditions highlight the potential for continuous or even newly established transmission to take place. Conclusions The review indicates that schistosomiasis has long existed in urban and peri-urban areas and remains a public health problem. There is, however, a challenge of comparability of settings due to the lack of a clear definition of what constitutes urban and peri-urban. There is a pressing need for improved monitoring of schistosomiasis in urban communities and consideration of treatment strategies.

The World Health Organization has developed guidelines for counseling national ministries on how best to control schistosomiasis using MDA as a main tool. It also seeks to determine how often to perform treatment and for whom depends on the level of infection in the community. In the past, because limited resources (including the availability of praziquantel), each national government is encouraged to broaden its agenda to find a balance between the frequency of treatment and the use and cost of a rare drug. This chapter discusses schistosomiasis control and elimination strategies.