Meta-analysis of Urine Heme Dipstick Diagnosis of Schistosoma haematobium Infection, Including Low-Prevalence and Previously-Treated Populations

Abstract

BackgroundUrogenital schistosomiasis remains highly endemic in Africa. Current control is based on drug administration, targeted either to school-age children or to high-risk communities at-large. Urine dipsticks for detection of microhematuria offer an inexpensive means for estimating infection prevalence. However, their diagnostic performance has not been systematically evaluated after community treatment, or in areas with continuing low prevalence. The objective of the present study was to perform meta-analysis of dipstick accuracy for S. haematobium infection in endemic regions, with special attention to performance where infection intensity or prevalence was low.Methodology/Principal FindingsThis review was registered at inception with PROSPERO (CRD42012002165). Included studies were identified by computerized search of online databases and hand search of bibliographies and existing study archives. Eligible studies included published or unpublished population surveys irrespective of date, location, or language that compared dipstick diagnosis of S. haematobium infection to standard egg-count parasitology. For 95 included surveys, variation in dipstick sensitivity and specificity were evaluated according to study size, age- and sex-specific participation, region, local prevalence, treatment status, and other factors potentially affecting test performance. Independent of prevalence, accuracy was greater in surveys of school-age children (vs. adults), whereas performance was less good in North Africa, as compared to other regions. By hierarchical ROC analysis, overall dipstick sensitivity and specificity for detection of egg-positive urine were estimated at 81% and 89%, respectively. Sensitivity was lower among treated populations (72%) and in population subgroups having lower intensity infection (65%). When the insensitivity of egg count testing was considered (and diagnosis inferred instead from combined hematuria and egg-count findings), overall dipstick sensitivity/specificity were 82%/97%, with significantly better sensitivity (92%) in high prevalence settings.Conclusions/SignificanceThis analysis suggests that dipsticks will continue to serve as very useful adjuncts for monitoring community prevalence following implementation of population-based control of urogenital schistosomiasis.

Kidney disease among children in sub-Saharan Africa: systematic review

“…When tests were repeated at the same location in consecutive years after treatment for S. haematobium , a lower prevalence of proteinuria and hematuria was consistently discovered (30,31,33,38,46). The association between S. haematobium and urine abnormalities has been known for some time, and the presence of hematuria on dipstick has been proposed as a fairly reliable and cheap method for diagnosing S. haematobium (59). It is also known that S. haematobium can lead to proteinuria and obstructive uropathy, although the long term progression of urinary schistosomiasis is still debated (60).…”

Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas

“…The global burden of disease in 2004 was estimated at 13 to 15 million disability-adjusted life-years (DALYs) lost as the result of schistosomiasis (King 2010a). These estimates could be an underestimate resulting from the low sensitivity of routinely used diagnostic tests (King 2010a; King 2010b). …”

Menace of Schistosomiasis: Its True Neglected Nature in Nigeria

“…Single dose of Praziquantel per year can help control the disease. This can be best achieved through mass drug administration to school children and high risk communities [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Because most people are often unaware of genital schistosomiasis, less medical attention has been given to it; consequently, misdiagnosis has resulted in false and ineffective therapy .…”

“…It has been re-emphasized by King [30] that schistosomiasis in its nature is truly a chronic inflammatory disease of the intestines, urinary tract or organs since eggs of Schistosoma spp cause inflammation and damage of tissues due to immune-mediated reactions. Schistosomiasis causes economic and health burdens by disabling a sufferer, as well as leads to death of between 14,000 [33] to estimated 200,000 per year [24][25][26][27][28][29][30][31]. Intestinal schistosomiasis causes damage to intestines, liver.…”