An outbreak of intestinal schistosomiasis, alongside increasing urogenital schistosomiasis prevalence, in primary school children on the shoreline of Lake Malawi, Mangochi District, Malawi

Abstract

Background: Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of Biomphalaria pfeifferi were first reported; in May 2018, emergence of intestinal schistosomiasis was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed. Methods: During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbiditymarkers; 1) schistosomiasis dynamics were assessed at Samama (n = 80) and Mchoka (n = 80) schools, where Schistosoma mansoni was first reported, 2) occurrence of S. mansoni was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (n = 60) and Koche (n = 60) schools, where B. pfeifferi was nearby, and 3) rapid mapping of schistosomiasis, and B. pfeifferi, conducted across a further 8 shoreline schools (n = 240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations.

High prevalence of Schistosoma mansoni infection among adults with chronic non – communicable diseases in Malawi – a cross-sectional study at Mangochi District Hospital

“…This is the first study in Malawi to estimate the prevalence of S. mansoni infection in adults with NCDs. There was high prevalence of S. mansoni infection in this population which is consistent with estimates in school going children in the district of 10 -56.7% (12). This is also consistent reports of an epidemic of both S. mansoni and S. haematobium in the district.…”

“…This shift is no less dramatic than along the shores of Lake Malawi where the prevalence has gone from 0% before 2014 to 34.3% (95% CI 27.9 -41.3) among school children in Mangochi in 2017 (6) (11). Follow up studies done after this period establish the emergence of S. mansoni as an epidemic in Mangochi district with prevalence among school children ranging from 10 -56.7% (12).…”

“…It has an NCD clinic that operates twice a week on Tuesdays (diabetes clinic) and Thursdays (hypertension clinic). Recent studies in Mangochi district have demonstrated an emerging epidemic of S. mansoni infection amid the increasing prevalence of S. haematobium infections in this setting (12).…”

Schistosomiasis with a Focus on Africa

“…Cases have continued to increase, especially in schistosomiasis and other NTD endemic areas [385]. This has resulted in the suspension of many MDA programs, leading inevitably to future outbreaks of schistosomiasis [386] and other NTDs [387]. Additionally, it has been suggested that interactions between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and parasitic infections may result in increased viral susceptibility and more severe outcomes in patients to COVID-19 in NTD-endemic regions [388].…”

Male Genital Schistosomiasis Along the Shoreline of Lake Malawi: Baseline Prevalence and Associated Knowledge, Attitudes and Practices Among Local Fishermen in Mangochi District, Malawi

“…Malawi is one of the SSA countries where both S. haematobium and Schistosoma mansoni are prevalent and highly focal around most water bodies, especially Lake Malawi (18)(19)(20). In addition, HIV prevalence among adult population (15-49 years) is considered high at 10.6% in SSA region, despite the control efforts including provision of antiretroviral treatment (ART) (21)(22)(23).…”