The Effectiveness of Praziquantel Preventive Chemotherapy on Morbidity in Schistosomiasis: A Systematic Review and Meta-Analysis

Abstract

BackgroundMass treatment with praziquantel is currently the main strategy used to control the morbidity due to schistosomiasis. Many age groups are at risk of the disease; however, the mass treatment focus mainly on school age children.ObjectivesThe objective of this review is to estimate the morbidity in at risk groups and identify key groups that should be targeted for preventive chemotherapy treatment with PZQ to control morbidity for schistosomiasis.Data sourcesPUBMED and SCOPUS were systematically searched from their inception to 23/11/2020.Study eligibility criteria, participants, and interventionWe searched for studies that evaluated PC in the entire population or a subgroup (PSAC, SAC including adolescents, adults and pregnant women). The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of the evidence.Study appraisal and synthesis methodsThe systematic review followed a pre established protocol. Summary ORs were estimated using the random-effects model. Heterogeneity was assessed by inspecting forest plots and quantified using the I-squared statistic. Subgroup /sensitivity analyses explored heterogeneity.Results59 studies met the a priori inclusion criteria and 45 were meta-analyzed. Treatment with PZQ resulted in reductions in right sided hepatomegaly (OR=0.43, 95% CI: 0.22-0.82), hematuria (0.40, 0.25-0.63) hematuria, anaemia (0.70, 0.63-0.79), proteinuria (0.36, 0.22-0.59), and urinary tract pathology (0.37, 0.24-0.56) in SACs; reductions in blood in stool (0.26, 0.14-0.63), splenomegaly (0.56, 0.42-0.55), and urinary bladder lesions (0.26, 0.14-0.49) in entire population were noted. No significant reduction was noted concerning periportal fibrosis, left-sided hepatomegaly, no specific lobe hepatomegaly, and diarrhea prevalence in all age groups. Data were scarce on PSAC.ConclusionPC with PZQ reduces some infection-related morbidity outcomes in SAC. There is suggestive evidence that PSAC and adult populations may benefit from some outcomes. This assertion was based on low certainty evidence.Author summaryPraziquantel (PZQ) is the main drug used for the mass treatment of morbidity related to schistosomiasis. Current treatment has focused on school-aged children. However, other age groups are also at risk of the disease. We conducted a systematic review and a meta-analysis of 59 studies in PUBMED database (published from inception up to November 2020) to identify key age groups that should be targeted for preventive chemotherapy treatment with PZQ to effectively control diseases related to schistosomiasis infections. Our data suggested that treatment with PZQ in school-aged children led to reductions in certain diseases related to schistosomiasis infection. Pre-school aged children and adults may also benefit from treatment with PZQ. Findings from our study were based on studies with low certainty evidence.