Treatment of intestinal schistosomiasis in Ugandan preschool children: best diagnosis, treatment efficacy and side-effects, and an extended praziquantel dosing pole

Abstract

SummaryThe Ugandan national control programme for schistosomiasis has no clear policy for inclusion of preschool-children (≤5 years old) children. To re-balance this health inequality, we sought to identify best diagnosis of intestinal schistosomiasis, observe treatment safety and efficacy of praziquantel (PZQ), and extend the current WHO dose pole for chemotherapy. We examined and treated 363 preschool children from shoreline villages of Lakes Albert and Victoria, and found that 62·3% (CI95 57·1–67·3) of the children were confirmed to have intestinal schistosomiasis. One day after treatment, children were reported as having headaches (3·6%), vomiting (9·4%), diarrhoea (10·9%) and urticaria/rash (8·9%) with amelioration at 21-day follow-up, where the parasitological cure rate was found to be 100·0%. Height and weight data were collected from a further 3303 preschool children to establish and validate an extended PZQ dose pole that now includes two new height-intervals: 60–84 cm for one-half tablet and 84–99 cm for three-quarter tablet divisions; which would result in 97·6% of children receiving an acceptable dose (30–60 mg/kg). To conclude, preschool children in lakeshore communities of Uganda are at significant risk of intestinal schistosomiasis; we now strongly advocate for their immediate inclusion within the national control programme to eliminate this health inequity.

Performance of POC-CCA® in diagnosis of schistosomiasis mansoni in individuals with low parasite burden

“…The highest prevalence of S. mansoni infection was found by both parasitological and immunological techniques among children and teenagers aged 10-19 years. This supports previous findings and may be due to cumulative infections and increased water contact (36) . The agreements observed between the immunological (POC-CCA®) and parasitological techniques (Kato-Katz and saline gradient) were good.…”

Schistosomiasis Sustained Control Program in Ethnic Groups Around Ninefescha (Eastern Senegal)

“…The prevalence rate we found was comparable with that found by Sousa-Figueiredo, who described that 62.3% of PSAC were infected with S. mansoni. 12 Our results are also in line with several studies showing that children under 2 years of age have active infection with this helminth. [16][17][18][19] Because of the efforts of the WHO authorities in Senegal, the medical regional authorities accepted to treat children under 6 years of age but only on an individual basis and under PNLB supervision in 2014.…”

“…9 Prevalence before the start of the study was around 44%, a percentage also found in other studies, such as in Uganda in the "Schistosomiasis in Mothers and Infants" cohort. 12 The strong overall decrease in schistosomiasis infestation rates in children aged 6-14 years highlights that the control program has a real, positive impact and that it should therefore be continued.…”

Epidemiology of Schistosomiasis in Two High-Risk Communities of South Côte d'Ivoire with Particular Emphasis on Pre-School–Aged Children

“…[12][13][14]28,29 It has also been discussed whether preventive chemotherapy should be extended from schoolaged to pre-school-aged children. 27,[30][31][32] However, there are a number of issues that must be addressed before policy recommendations can be made regarding the inclusion of preschoolers in preventive chemotherapy. First, what is the true extent of Schistosoma infection in pre-school-aged children in different epidemiologic settings?…”