Control of Neglected Tropical Diseases in Burundi: Partnerships, Achievements, Challenges, and Lessons Learned after Four Years of Programme Implementation

Ndayishimiye, Onésime; Ortu, Giuseppina; Magalhães, Ricardo J. Soares; Clements, Archie C. A.; Willems, Johan; Whitton, Jane M.; Lancaster, Warren; Hopkins, Adrian; Fenwick, Alan

doi:10.1371/journal.pntd.0002684

Cited by 33 publications

(50 citation statements)

References 16 publications

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“…In an increasing number of endemic countries, national schistosomiasis control programs have provided mass distribution of praziquantel to at-risk populations for multiple years 1,7. In some countries, such as in Burundi, control strategies have successfully reduced the prevalence of clinical schistosomiasis.…”

Section: Discussionmentioning

confidence: 99%

Countrywide Reassessment of Schistosoma mansoni Infection in Burundi Using a Urine-Circulating Cathodic Antigen Rapid Test: Informing the National Control Program

Ortu

Ndayishimiye

Clements

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Following implementation of the national control program, a reassessment of Schistosoma mansoni prevalence was conducted in Burundi to determine the feasibility of moving toward elimination. A countrywide cluster-randomized cross-sectional study was performed in May 2014. At least 25 schools were sampled from each of five eco-epidemiological risk zones for schistosomiasis. Fifty randomly selected children 13–14 years of age per school were included for a single urine-circulating cathodic antigen (CCA) rapid test and, in a subset of schools, for duplicate Kato-Katz slide preparation from a single stool sample. A total of 17,331 children from 347 schools were tested using CCA. The overall prevalence of S. mansoni infection, when CCA trace results were considered negative, was 13.5% (zone range [zr] = 4.6–17.8%), and when CCA trace results were considered positive, it was 42.8% (zr = 34.3–49.9%). In 170 schools, prevalence of this infection determined using Kato-Katz method was 1.5% (zr ==0–2.7%). The overall mean intensity of S. mansoni infection determined using Kato-Katz was 0.85 eggs per gram (standard deviation = 10.86). A majority of schools (84%) were classified as non-endemic (prevalence = 0) using Kato-Katz; however, a similar proportion of schools were classified as endemic when CCA trace results were considered negative (85%) and nearly all (98%) were endemic when CCA trace results were considered positive. The findings of this nationwide reassessment using a CCA rapid test indicate that Schistosoma infection is still widespread in Burundi, although its average intensity is probably low. Further evidence is now needed to determine the association between CCA rapid test positivity and low-intensity disease transmission.

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Section: Discussionmentioning

confidence: 99%

Countrywide Reassessment of Schistosoma mansoni Infection in Burundi Using a Urine-Circulating Cathodic Antigen Rapid Test: Informing the National Control Program

Ortu

Ndayishimiye

Clements

et al. 2017

The American Society of Tropical Medicine and Hygiene

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“…10,18,31,32 While integrated preventive chemotherapy guidelines do exist, improving country-level coordination of these programmes would benefit cost-efficiency. 18,33 The prevalence threshold itself is lower for adding another medicine in addition to an existing treatment programme compared to a standalone programme due to reduced delivery cost, and since the majority of cost is from delivery and not the drugs themselves.…”

Section: Preventive Chemotherapymentioning

confidence: 99%

“…10,31 For example, programmatic delivery of praziquantel should include albendazole or mebendazole, as done by the Schistosomiasis Control Initiative, since STH is most often co-endemic and co-administration is safe. 32 The integration of these programmes should work within the constraints of the drug supply and the relevant ecological zone (e.g., national, sub-national, community) that addresses the focal nature of schistosomiasis, which is in contrast with the more homogenous nature of STH.…”

Section: Preventive Chemotherapymentioning

confidence: 99%

A call to strengthen the global strategy against schistosomiasis and soil-transmitted helminthiasis: the time is now

Addiss

Hotez

et al. 2017

The Lancet Infectious Diseases

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144

124

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Summary In 2001, the World Health Assembly (WHA) passed the landmark WHA 54.19 resolution for global scale up of mass administration of anthelminthic drugs for morbidity control of schistosomiasis and soil-transmitted helminthiasis (STH), which affect over 1.5 billion of the world's poorest people. Since then, over a decade of research and experience has yielded critical new knowledge on the control and elimination of these helminthiases. However, the global strategy has remained largely unchanged since the original 2001 WHA resolution and associated World Health Organization (WHO) guidelines on preventive chemotherapy. Here, we highlight recent advances that, taken together, support a call to revise the global strategy and guidelines for preventive chemotherapy and complementary interventions against schistosomiasis and STH. This includes the development of guidance that is specific to goals of “morbidity control” and “elimination of transmission.” We quantify the result of forgoing this opportunity by computing the yearly disease burden, mortality, and lost economic productivity associated with maintaining status quo. Without change, we estimate that the population of sub-Saharan Africa will likely lose 2.3 million disability-adjusted life years and US$3.5 billion of economic productivity every year, which is comparable to recent acute epidemics, including the 2014 Ebola and 2015 Zika epidemics. We propose that the time is now to strengthen the global strategy to address the substantial disease burden of schistosomiasis and STH.

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“…According to a nationwide school-based survey performed in 2007, based on the Kato-Katz (KK) test [9], 11 out of the 45 sanitary districts (SD) in Burundi were considered at risk of intestinal schistosomiasis. Since 2008, these 11 SD have been targeted for annual mass drug administration (MDA) with praziquantel (PZQ) to school-age children between five and 15 years old.…”

Section: Introductionmentioning

confidence: 99%

“…Although the epidemiological surveys in sentinel sites and the national mapping provide a good estimation of the prevalence of schistosomiasis, it is a very laborious and costly undertaking [11,12], and often requires external financial support, especially in resource-limited countries such as Burundi [9,10]. It is therefore important to look for other cost-effective and sustainable strategies to monitor the impact of MDA campaigns.…”

Section: Introductionmentioning

confidence: 99%

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.

BIZIMANA¹,

Polman

Ortu³

et al. 2020

Preprint

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Background : Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel have 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. Methods : 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 between 2011 and 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. Findings : 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 prevalences based on Kato-Katz in schoolchildren were confirmed by low incidence rates based on direct smear in the health centres. Conclusions : 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. Keywords : Burundi; direct smear; health centre; mass drug administration; monitoring; routine data; praziquantel; schistosomiasis

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Control of Neglected Tropical Diseases in Burundi: Partnerships, Achievements, Challenges, and Lessons Learned after Four Years of Programme Implementation

Cited by 33 publications

References 16 publications

Countrywide Reassessment of Schistosoma mansoni Infection in Burundi Using a Urine-Circulating Cathodic Antigen Rapid Test: Informing the National Control Program

Countrywide Reassessment of Schistosoma mansoni Infection in Burundi Using a Urine-Circulating Cathodic Antigen Rapid Test: Informing the National Control Program

A call to strengthen the global strategy against schistosomiasis and soil-transmitted helminthiasis: the time is now

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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