Comparing parasitological vs serological determination of Schistosoma haematobium infection prevalence in preschool and primary school-aged children: implications for control programmes

Welcome M Wami, Norman Nausch, Katharina Bauer, Nicholas Midzi, Reggis Gwisai, Peter Simmonds, Takafira Mduluza, Mark Woolhouse, Francisca Mutapi, Welcome M Wami, Norman Nausch, Katharina Bauer, Nicholas Midzi, Reggis Gwisai, Peter Simmonds, Takafira Mduluza, Mark Woolhouse, Francisca Mutapi

Abstract

To combat schistosomiasis, the World Health Organization (WHO) recommends that infection levels are determined prior to designing and implementing control programmes, as the treatment regimens depend on the population infection prevalence. However, the sensitivity of the parasitological infection diagnostic method is less reliable when infection levels are low. The aim of this study was to compare levels of Schistosoma haematobium infection obtained by the parasitological method vs serological technique. Infection levels in preschool and primary school-aged children and their implications for control programmes were also investigated. Infection prevalence based on serology was significantly higher compared with that based on parasitology for both age groups. The difference between infection levels obtained using the two methods increased with age. Consequentially, in line with the WHO guidelines, the serological method suggested a more frequent treatment regimen for this population compared with that implied by the parasitological method. These findings highlighted the presence of infection in children aged ⩽5 years, further reiterating the need for their inclusion in control programmes. Furthermore, this study demonstrated the importance of using sensitive diagnostic methods as this has implications on the required intervention controls for the population.

Figures

Fig. 1.
Fig. 1.
Infection prevalence derived using parasitological and serological diagnostic methods by age group. The indicated bars are the 95% confidence intervals of the observed prevalence and the P values test for the differences in prevalence between the diagnostic methods for each age group. White bars = prevalence based on parasitology and grey bars = prevalence based on serology.
Fig. 2.
Fig. 2.
Percentage proportion positive (+) vs negative (−) children diagnosed using parasitological and serological methods by age group. White stack: (− −) = negative for both diagnostic methods (1–5 years, n = 51; 6–10 years, n = 58), light grey stack (− +) = negative for parasitology but positive for serology (1–5 years, n = 28; 6–10 years, n = 137), grey stack (+ −) = positive for parasitology but negative for serology (1–5 years, n = 1; 6–10 years, n = 15) and dark grey stack (+ +) = positive for both diagnostic methods (1–5 years, n = 17; 6–10 years, n = 131).
Fig. 3.
Fig. 3.
Predicted age-related infection prevalence profiles derived from parasitological (dashed line) and serological (solid line) diagnostic methods. The grey shadings around the prevalence curves indicate the 95% confidence intervals. The horizontal dashed lines indicate the moderate (10%) and high (50%) infection-risk cut-offs for control regimens as defined by the World Health Organization (WHO, 2002).
Fig. 4.
Fig. 4.
Infection prevalence derived using parasitological, serological and dipstick microhaematuria diagnostic methods by age group for a subset of the study population (n = 190). The indicated bars are the 95% confidence intervals of the observed prevalence and the P-values test for the differences in prevalence between the diagnostic methods for each age group. White bars = prevalence based on parasitology, grey bars = prevalence based on serology and dark grey bars = prevalence based on dipstick microhaematuria.

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