Schistosoma mansoni Infection as a Predictor of Low Aerobic Capacity in Ugandan Children

Abstract

Using the 20-meter shuttle run test (20mSRT) as a morbidity metric, we assessed whether Schistosoma mansoni infection was associated with decreased aerobic capacity in Ugandan children across a range of altitudes, either at low (∼600 m) or high (∼1,000 m) altitudes. A total of 305 children were recruited from six schools within the Buliisa District, Lake Albert, Uganda. A subset (n = 96) of these had been previously assessed and treated for schistosomiasis ± malaria 2 weeks prior. Fitness scores on the 20mSRT were translated into VO2max using a standardized equation. Unadjusted and multivariable-adjusted analyses were performed using VO2max as the primary outcome. Analysis of fitness scores from 304 children, inclusive of the subset follow-up cohort, revealed a median VO2max of 45.4 mL kg −1 min −1 (interquartile range: 42.9-48.0 mL kg −1 min −1 ). Children residing at high altitudes demonstrated increased aerobic capacities (46.3 versus 44.8 mL kg −1 min −1 , P = 0.031). The prevalence of stunting, wasting, S. mansoni egg patent infection, malaria, giardiasis, anemia, and fecal occult blood were 36.7%, 16.1%, 44.3%, 65.2%, 21.4%, 50.6%, and 41.2%, respectively. Median VO2max was elevated in those previously treated, compared with those newly recruited (46.3 versus 44 mL kg −1 min −1 , P < 0.001). Multivariable-adjusted analysis revealed a strong negative association between S. mansoni egg patent infection and VO2max at low altitude (beta coefficient: −3.96, 95% CI: −6.56 to −137, P = 0.004). This is the first study to document a negative association between S. mansoni infection and aerobic capacity at low altitudes using the 20mSRT.

The Cardiorespiratory fitness of children and adolescents in Tibet at altitudes over 3,500 meters

“…The two studies published on the plateau area report inconsistent findings. Smith et al [ 67 ] showed aerobic endurance increases at high altitude (600–1,000 m); however, their altitude range is much lower than our study. In contrast, Chen [ 68 ] found that, at altitudes (3,417–4,300 m) similar to the present study, maximum oxygen uptake was inversely correlated with altitude in children and adolescents.…”

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

“…To do so, we recommend a combination of both rapid urine and faecal sampling methods with inspection of a more extensive range of point-of-contact morbidity markers to provide a better insight into individual disease progression(s) [24]. Future use of 20 m shuttle-run tests to assess children's aerobic capacity in relation to S. mansoni infection could be insightful, as recently shown elsewhere [25]. However, with coronavirus disease 2019 (COVID- 19) suspending annual MDA, we should expect and better prepare for increasing severity of intestinal schistosomiasis in following years.…”

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

“…To do so, we recommend a combination of both rapid urine and faecal sampling methods with inspection of a more extensive range of point-of-contact morbidity markers to provide a better insight into individual disease progression(s) [24]. Future use of 20 m shuttle-run tests to assess children's aerobic capacity in relation to S. mansoni infection could be insightful, as recently shown elsewhere [25]. However, with coronavirus disease 2019 (COVID-19) suspending annual MDA, we should expect and better prepare for increasing severity of intestinal schistosomiasis in following years.…”