Epidemiology 1, 2, 3: origins, objectives, organization, and implementation.

El-Khoby, T. A; Hussein, Mohamed H.; Galal, N.; Miller, Freeman D.

doi:10.4269/ajtmh.2000.62.2

Cited by 10 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As mentioned in the introductory paper of this supplement, 2 Qena, like the rest of Upper Egypt, has been endemic only for Schistosoma haematobium and was one of the last governorates to be converted to perennial irrigation. Data presented by Wright 3 showed that S. haematobium prevalence was very low in 1955, whereas the prevalence had increased since the 1930s in both Sohag to the north and Aswan to the south.…”

mentioning

confidence: 99%

The epidemiology of schistosomiasis in Egypt: Qena governorate.

Hammam¹,

Zarzour²,

Moftah³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

Abstract. Qena is the southernmost governorate of Egypt included in the Epidemiology 1, 2, 3 national study. A probability sample selected 17,822 individuals from 2,950 households in 34 ezbas and 10 villages from a total rural target population of 1,731,252 (based on the most recent 1986 census of the population by the Egyptian Central Agency for Public Mobilization And Statistics). Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, respectively, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 4.8 Ϯ 0.7% (ϮSE) and geometric mean egg count (GMEC) was 7.0 ova per 10 ml of urine. Considerable variation in prevalence was observed between the villages and ezbas, ranging from 0.0% to 20%, with the smaller ezbas having a slightly higher overall prevalence. The age-and sex-specific patterns of S. haematobium showed typical peak prevalence in early adolescence, with males having a higher prevalence than females. A history of hematuria was associated with current infection (odds ratio ϭ 3.6, 95% confidence interval ϭ 2.32-5.63). Hepatomegaly and splenomegaly determined by physical examination present in 7.9% and 3.0%, respectively. Ultrasonography-determined hepatomegaly of the left liver lobe was found in 10.1%. Ultrasonography-detected hepatomegaly in both the left and right lobes increased in prevalence from approximately 5% in children to 15-20% in adults. The prevalence of ultrasonography-detected splenomegaly increased slightly with age. Grade III periportal fibrosis was detected in only 2 individuals in the sample. Bladder wall lesions and obstructive uropathy were also very infrequent. Other associations with these measures are given. Most villages and ezbas had an S. mansoni prevalence of less than 1%. The exception was Nag'a El-Sheikh Hamad, where the prevalence was 10.3 Ϯ 0.5% (GMEC ϭ 57.4 Ϯ 2.6). Two other communities also had a prevalence Ͼ1% (Ezbet Sarhan and Kom Heitin).The Qena governorate, in Upper Egypt, is best known as the location of some of Egypt's most famous Pharaonic temples, such as Karnek and Dendera, and its Pharaonic tombs, the Valley of the Kings, in Tebes on the west bank of Luxor. The governorate is located about 535-650 km south of Cairo on the Nile River, as shown on the map in Figure 1 of the report in this supplement by El-Khoby and others. 1 Qena is bordered on the north by Sohag and on the south by the Aswan governorate. The Nile valley is at its narrowest in Egypt here and the arable land, a green strip only 1 or 2 km on either side of the river, is bordered by barren desert on both sides. The governorate is perennially irrigated throughout by principal main and distributory canals (Egyptian Ministry of Irrigation, unpublished data). The major crop is sugar cane, which requires large quantities of water drawn by pumps from surrounding canals. Other food crops are grown in small plots adjacent to the villages and are irrigated manually. In this region where the...

show abstract

mentioning

confidence: 99%

The epidemiology of schistosomiasis in Egypt: Qena governorate.

Hammam¹,

Zarzour²,

Moftah³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

show abstract

“…1 The EPI 1, 2, 3 project had three objectives: 1) to measure the prevalence and intensity of infection and study the changing pattern of Schistosoma haematobium and S. mansoni transmission in 9 representative governorates, 2) to identify factors causing variation in prevalence and intensity of schistosomiasis among villages; and 3) to describe the public health impact of schistosomiasis morbidity and identify its determinants. The use of abdominal ultrasonography to study randomly selected subjects provided much of the data for the third objective.…”

mentioning

confidence: 99%

The epidemiology of schistosomiasis in Egypt: Ismailia governorate.

Nooman¹,

Hasan²,

Waheeb³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Abstract. A multi-stage stratified sample of 12,515 individuals from 1,941 households in 42 villages in the Ismailia governorate of Egypt were surveyed for schistosomal infection. A subset of 2,390 subjects were surveyed for morbidity by physical and ultrasonographic examination. The prevalence of Schistosoma mansoni infection in rural Ismailia was 42.9% and the geometric mean egg count (GMEC) was 93.3 eggs/gram of stool, with considerable variability between communities. Prevalence and intensity peaked in the 20-30-year-old age group and was higher in males than in females. Prevalence and intensity of S. haematobium was very low: 1.8% and 3.5 ova/10 ml of urine GMEC, respectively. Canal water exposure risk factors for S. mansoni infection were males bathing (odds ratio [OR] ϭ 2.2), females washing clothes (OR ϭ 1.9), and children playing or swimming (OR ϭ 2.3). Presence of inhouse piped water supply and latrine lowered infection rates (P Ͻ 0.001 and P ϭ 0.002, respectively). Histories of S. mansoni infection (OR ϭ 1.6) or treatment (OR ϭ 1.5) and blood in feces (OR ϭ 3.5) were associated with infection. Hepatomegaly (16.0%) was more frequently detected than splenomegaly (3.6%) by physical examination, with both being more frequent in older age groups. Splenomegaly, but not hepatomegaly, was associated with presence of S. mansoni ova in stools (OR ϭ 1.4) and the community burden of infection (P ϭ 0.02). Ultrasonographically detected hepatomegaly, splenomegaly, and periportal fibrosis (PPF) were detected in 43.0%, 17.4%, and 39.7% of the subjects, respectively. The higher grades of PPF were rare. Ultrasonographically detected splenomegaly, not hepatomegaly, was associated with S. mansoni infection, community burden of infection, and PPF. Risk factors for PPF were the same as for S. mansoni infection. There was a marginal association of PPF with infection and none (P ϭ 0.33) with the intensity of infection in individuals or in the community. We conclude that in rural Ismailia, S. haematobium infection is rare but the prevalence and intensity of infection with S. mansoni is high. The risk of infection is associated with environmentally detected factors and behaviors. Hepatosplenic morbidity attributable to S. mansoni infection is low, presumably because of the favorable effect of wide application of praziquantel therapy.

show abstract

“…All methods were fully tested and unforeseen problems were identified beforehand by conducting a fullscale pilot study in 1990. 1 One village was selected by each of the investigators from their respective governorate. A systemic sample of village houses was drawn of sufficient number to include 500 or more household members.…”

Section: Clinical Forms (English) One Clinical Form For Recording Thmentioning

confidence: 99%

“…The study methodology was designed and developed specifically to address the 3 EPI 1, 2, 3 objectives. 1 Rather than examine an entire rural population, a sample of the defined target population was needed for the study. In turn, the sample estimates were used to make inferences about the whole target population.…”

mentioning

confidence: 99%

“…The 3 EPI study objectives were originally conceived as independent nationwide studies. As mentioned in the introduction of this supplement, 1 there were strong logistical and administrative justifications for combining the 3 objectives into 1 overall multi-center project. An overall sample design was developed to maximize the integration of the 3 different objectives with an emphasis on EPI 1.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology 1, 2, 3: study and sample design.

Hussein

Elsayed²,

Talaat³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

Self Cite

View full text Add to dashboard Cite

Abstract. Bad sample designs and selection bias have plagued studies on schistosomiasis, and as a result some believe that schistosomiasis is too focal, making it difficult to draw reliable samples. The Epidemiology 1, 2, 3 (EPI 1, 2, 3) sample design, although complex, demonstrates that sampling theory is readily applicable to epidemiologic studies of schistosomiasis. The EPI 1, 2, 3 sampling scheme was designed to achieve the smallest feasible standard errors given EPI 1, 2, 3 objectives and certain logistical constraints. The sample design is a multi-stage selection of villages (ezbas, which were stratified by size) and households within each of 9 purposely selected Egyptian governorates. Villages and households were systemically selected from census frames. The sampling of ezbas was especially difficult because of the lack of complete sampling frames and their wide variation in population size. Ultimately, ezbas were stratified by size and then randomly selected from each stratum. Sample sizes for villages and ezbas and individuals within ezbas were calculated based on EPI 1 and 2 objectives, respectively. No re-selection was made for non-respondents. A 20% subsample of the full sample was drawn for clinical and ultrasonographic examinations. The sample selected from individual governorates closely parallel the age structure of the 1986 census of the respective rural populations. Details of the study design and related methods are given below.Epidemiology 1, 2, 3 (EPI 1, 2, 3) was an epidemiologic investigation of Schistosoma haematobium and/or S. mansoni infections in humans. The study methodology was designed and developed specifically to address the 3 EPI 1, 2, 3 objectives.

show abstract

Epidemiology 1, 2, 3: origins, objectives, organization, and implementation.

Cited by 10 publications

References 23 publications

The epidemiology of schistosomiasis in Egypt: Qena governorate.

The epidemiology of schistosomiasis in Egypt: Qena governorate.

The epidemiology of schistosomiasis in Egypt: Ismailia governorate.

Epidemiology 1, 2, 3: study and sample design.

Contact Info

Product

Resources

About