Use of a Tablet-Based System to Perform Abdominal Ultrasounds in a Field Investigation of Schistosomiasis-Related Morbidity in Western Kenya

Abstract

Chronic intestinal schistosomiasis can cause severe hepatosplenic disease and is a neglected tropical disease of public health importance in sub-Saharan Africa, including Kenya. Although the goal of control programs is to reduce morbidity, milestones for program performance focus on reductions in prevalence and intensity of infection, rather than actual measures of morbidity. Using ultrasound to measure hepatosplenic disease severity is an accepted method of determining schistosomiasis-related morbidity; however, ultrasound has not historically been considered a fielddeployable tool because of equipment limitations and unavailability of expertise. A point-of-care tablet-based ultrasound system was used to perform abdominal ultrasounds in a field investigation of schistosomiasis-related morbidity in western Kenya; during the study, other pathologies and pregnancies were also identified via ultrasound, and participants referred to care. Recent technological advances may make it more feasible to implement ultrasound as part of a control program and can also offer important benefits to the community.

A survey of barriers and facilitators to ultrasound use in low- and middle-income countries

“…With the advent of the COVID-19 pandemic, we have witnessed increased interest and literature around the role of point-of-care ultrasound 35,36 . Use cases with special relevance to LMIC settings include diagnosis and management of infectious diseases such as malaria, tuberculosis, dengue, schistosomiasis, leishmaniasis, and cystic echinococcosis 11,[37][38][39][40][41][42][43][44][45] . In our survey, respondents reported using ultrasound most frequently for procedures; other common applications included evaluations on the lungs, heart/echocardiography, and focused assessments for trauma.…”

Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni

“…haematobium ultrasound indicators being observable sooner than S . mansoni ultrasound indicators and with the availability of more practical ultrasound examination equipment [ 53 ], potential challenges such as this will need to be addressed if such a tool will be programmatically useful. Regardless, the likelihood of S .…”

“…Conversely, multiple studies have shown the risk for S. mansoni morbidity indicators of periportal fibrosis to be higher in adults, as compared to children [50][51][52]. This could be due to S. haematobium ultrasound indicators being observable sooner than S. mansoni ultrasound indicators and with the availability of more practical ultrasound examination equipment [53], potential challenges such as this will need to be addressed if such a tool will be programmatically useful. Regardless, the likelihood of S. mansoni morbidity indicators in these school-age participants was much lower than the likelihood of S. haematobium indicators and likely contributed to the poorer associations between S. mansoni-related morbidity indicators and S. mansoni infection prevalence.…”

Defining elimination as a public health problem for schistosomiasis control programmes: beyond prevalence of heavy-intensity infections

“…30 Another factor that could facilitate more accurate measurement of schistosomiasis morbidity and delineation of EPHP targets is the development of a tablet-based ultrasound system that allows for collection of pathology measurements in the field. 31 Ultrasound has long been the standard for measuring schistosomiasis fibrosis and organomegaly, but the size and expense of available machines has previously constrained the practicality of field-based ultrasonic evaluation for research studies. 32 Newer technology now allows combination of a transducer with standard electronic tablets to collect and electronically store ultrasound images and videos economically.…”