Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study

Lamberti, Olimpia; Kayuni, Sekeleghe; Kumwenda, Dingase; Ngwira, Bagrey; Singh, Varsha; Moktali, Veena; Dhanani, Neerav; Wessels, Els; Van Lieshout, Lisette; Fleming, Fiona M.; Mzilahowa, Themba; Bustinduy, Amaya L.

doi:10.1371/journal.pntd.0012102

Cited by 4 publications

References 26 publications

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Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis

Li,

Guo

et al. 2024

Preprint

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BackgroundAs the deadline for eliminating schistosomiasis approaches, more targeted and effective interventions should be proposed. We aimed to understand the burden among various gender, ages, countries, and continents and to analyze the trends in the burden of schistosomiasis from 1990 to 2041.MethodsThis study utilizes data from the Global Burden of Disease (GBD) 2021 to analyze the schistosomiasis burden trends from 1990 to 2021, including age-standardized rates of prevalence, Disability-Adjusted Life Years (DALYs), and death of different genders, ages, and regions. Data of schistosomiasis related anemia was also extracted and analyzed. Bayesian age-period-cohort (BAPC) models were used to assess and project the age standardized rates of prevalence, DALYs and death till 2041.ResultsGlobally, the age-standardized rates of prevalence, DALYs, and death of schistosomiasis all present a declining trend. Individuals aged 15 to 29 years old present the highest age-standardized rates of prevalence and DALYs. The burden of schistosomiasis varies inversely with socio-economic development. The Years Lived with Disability (YLDs) rate for schistosomiasis-related anemia increases with the burden of schistosomiasis. The age-standardized rates of prevalence, DALYs, and death might tend to decline until 2041 in the world, Africa, Asia, and the Americas.ConclusionsThe burden of schistosomiasis is clustered in the 15 to 29 age group, which represents the strongest labor force. Additionally, reproductive-aged women also experience a significant disease burden. Targeted interventions including preventive chemotherapy, health behavior change, and communications should be proposed and covered this risk population.Author summarySchistosomiasis primarily affects more than 200 million people in Africa, Asia, and the Americas. To achieve the World Health Organization’s (WHO) 2030 target of eliminating schistosomiasis as a public health problem globally, understanding the distribution of schistosomiasis burden is crucial. In this study, we employed data from the Global Burden of Disease Study 2021 to analyze the burden of schistosomiasis across different regions, countries, genders, and age groups. Our analysis reveals that both the age standardized rates of prevalence and Disability-Adjusted Life Years (DALYs) of schistosomiasis reach the peak among individuals aged 15-29 years, who represent the highest potential for labor force participation and reproduction. The disease burden increases with the decline of Socio-demographic Index (SDI). However, countries with higher levels of healthcare level exhibit lower schistosomiasis-related anemia Years Lived with Disability (YLDs) rates. Most endemic areas in Asia and the Americas are supposed to achieve the target of schistosomiasis elimination before 2030, but Africa faces challenges in meeting it. Therefore, we advised endemic countries with lower SDIs to implement targeted interventions for the 15 to 29 age group. Meanwhile, improving healthcare level also be important to decrease the impact of schistosomiasis.

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Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis

Li,

Guo

et al. 2024

Preprint

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A health decision analytical model to evaluate the cost‐effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework

Lamberti,

Terris‐Prestholt,

Bustinduy

et al. 2024

Tropical Med Int Health

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Female genital schistosomiasis is a chronic gynaecological disease caused by the waterborne parasite Schistosoma (S.) haematobium. It affects an estimated 30–56 million girls and women globally, mostly in sub‐Saharan Africa where it is endemic, and negatively impacts their sexual and reproductive life. Recent studies found evidence of an association between female genital schistosomiasis and increased prevalence of HIV and cervical precancer lesions. Despite the large population at risk, the burden and impact of female genital schistosomiasis are scarcely documented, resulting in neglect and insufficient resource allocation. There is currently no standardised method for individual or population‐based female genital schistosomiasis screening and diagnosis which hinders accurate assessment of disease burden in endemic countries. To optimise financial allocations for female genital schistosomiasis screening, it is necessary to explore the cost‐effectiveness of different strategies by combining cost and impact estimates. Yet, no economic evaluation has explored the value for money of alternative screening methods. This paper describes a novel application of health decision analytical modelling to evaluate the cost‐effectiveness of different female genital schistosomiasis screening strategies across endemic settings. The model combines a decision tree for female genital schistosomiasis screening strategies, and a Markov model for the natural history of cervical cancer to estimate the cost per disability‐adjusted life‐years averted for different screening strategies, stratified by HIV status. It is a starting point for discussion and for supporting priority setting in a data‐sparse environment.

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Challenges in the diagnosis and control of female genital schistosomiasis in sub-Saharan Africa: an exemplar case report associated with mixed and putative hybrid schistosome infection in Nsanje District, Southern Malawi

Kayuni,

Cunningham,

Kumwenda

et al. 2024

Front. Trop. Dis

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Female genital schistosomiasis (FGS) remains an often overlooked chronic complication of urogenital schistosomiasis in adolescent girls and women. Moreover, the role of zoonotic or hybrid schistosome infection(s) is poorly appreciated, but is increasingly becoming an emerging public health concern in sub-Saharan Africa. In Southern Malawi, during the “Hybridization in UroGenital Schistosomiasis (HUGS)” study visit, we describe the case of a 33-year-old woman with suspected FGS who partook in a detailed external assessment with internal cervical examination using a portable colposcope. She provided several biological samples for analysis with traditional and molecular parasitological methods—urine, cervicovaginal lavage (CVL), cervical swabs, and external mass and cervical biopsies—alongside provision of detailed demographic information after a thorough medical history questionnaire and an in-depth interview. These samples were screened for the presence of Schistosoma ova on microscopy and DNA genotyping using a novel real-time PCR assay in parallel to pre-published probe-based PCR assays capable of identifying and discriminating up to six named Schistosoma species. A further molecular screen of sexually transmitted infections (STIs) including Trichomonas vaginalis, Chlamydia spp., and human papilloma virus (HPV) was conducted on her genital swab and CVL. Overt FGS was diagnosed on clinical colposcopy alongside inspection of the cervical biopsy by microscopy, real-time PCR, and histopathology. The urine filtration, microscopy and real-time PCR of the CVL and swab were negative. This evidences the typical diagnostic challenge, and cases such as this will pose an unmet need in satisfactory patient management. In addition to Schistosoma haematobium, the presence of the zoonotic species Schistosoma mattheei and concurrent STIs raise questions as to the long-term effectiveness of the current control strategies of the National Control Programme to eliminate schistosomiasis as a public health problem. Improved availability of and regular accessibility to praziquantel treatment for women at risk such as this are urgently needed. Furthermore, targeted health education, increased community awareness, and dovetailing of synergistic activities and strategies with other health stakeholders such as those in sexual and reproductive health, as well as HIV/AIDS programs in the Ministry of Health, are needed here and in neighboring countries.

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Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study

Cited by 4 publications

References 26 publications

Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis

Schistosomiasis in Humans, 1990-2041: Findings from the Global Burden of Disease 2021 Study and Predictions by Bayesian Age-Period-Cohort Analysis

A health decision analytical model to evaluate the cost‐effectiveness of female genital schistosomiasis screening strategies: The female genital schistosomiasis SCREEN framework

Challenges in the diagnosis and control of female genital schistosomiasis in sub-Saharan Africa: an exemplar case report associated with mixed and putative hybrid schistosome infection in Nsanje District, Southern Malawi

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