Biostatistical Analysis of the Schistosomiasis Control Initiative Programme on Schistosoma Prevalence, Intensity and Associated Morbidity
Author(s)
Koukounari, Artemis
Type
Thesis
Abstract
Background: Schistosomiasis remains one of the most prevalent parasitic diseases in developing
countries. Goal and objectives: The potential relationship between Schistosoma mansoni and
anaemia, was examined using Schistosomiasis Control Initiative (SCI) data on Ugandan children
and a randomized clinical trial implemented by colleagues from the London School of Hygiene
and Tropical Medicine (LSHTM) in Western Kenya. The impact of large-scale administration of
chemotherapy on Schistosoma haematobium infection and associated morbidity was also
evaluated using SCI data on Burkinabe children. Evaluation and validation of field applicable
tools, such as ultrasound, for the cost-effective diagnosis of schistosomiasis morbidity using SCI
baseline data from Malian children was another aim of this thesis. Furthermore, in combination
with the ultrasound scans, microscopic examination of urine for detection of S. haematobium
eggs, dipsticks for detection of haematuria, tests for circulating antigens and serology tests were
examined for the cost-effective assessment of S. haematobium prevalence in an adult’s dataset
from Ghana. Methods: Biostatistical analysis of afore mentioned data was applied. Principal
findings: Results from SCI and LSHTM studies suggest that anaemia is associated with
schistosomiasis in African children, and that such anaemia shows a significant improvement
following chemotherapy. Results from the SCI study in Burkina Faso suggested that even a
single round of mass chemotherapy can have a substantial impact on S. haematobium infection
and its associated morbidity in children. Microscopy and haematuria dipsticks were suggested as
sensitive and specific indicators of prevalence of S. haematobium infection in Ghanaian adults.
Furthermore, ultrasound global scores were demonstrated to be valuable markers in children for
morbidity caused by S. haematobium infection, but ultrasonographic examination is not a
reasonable substitute for microscopy or dipsticks for determining the prevalence of this infection.
Significance: Finally, the key findings from all the studies presented, emphasizing how these
relate to one another, are discussed.
countries. Goal and objectives: The potential relationship between Schistosoma mansoni and
anaemia, was examined using Schistosomiasis Control Initiative (SCI) data on Ugandan children
and a randomized clinical trial implemented by colleagues from the London School of Hygiene
and Tropical Medicine (LSHTM) in Western Kenya. The impact of large-scale administration of
chemotherapy on Schistosoma haematobium infection and associated morbidity was also
evaluated using SCI data on Burkinabe children. Evaluation and validation of field applicable
tools, such as ultrasound, for the cost-effective diagnosis of schistosomiasis morbidity using SCI
baseline data from Malian children was another aim of this thesis. Furthermore, in combination
with the ultrasound scans, microscopic examination of urine for detection of S. haematobium
eggs, dipsticks for detection of haematuria, tests for circulating antigens and serology tests were
examined for the cost-effective assessment of S. haematobium prevalence in an adult’s dataset
from Ghana. Methods: Biostatistical analysis of afore mentioned data was applied. Principal
findings: Results from SCI and LSHTM studies suggest that anaemia is associated with
schistosomiasis in African children, and that such anaemia shows a significant improvement
following chemotherapy. Results from the SCI study in Burkina Faso suggested that even a
single round of mass chemotherapy can have a substantial impact on S. haematobium infection
and its associated morbidity in children. Microscopy and haematuria dipsticks were suggested as
sensitive and specific indicators of prevalence of S. haematobium infection in Ghanaian adults.
Furthermore, ultrasound global scores were demonstrated to be valuable markers in children for
morbidity caused by S. haematobium infection, but ultrasonographic examination is not a
reasonable substitute for microscopy or dipsticks for determining the prevalence of this infection.
Significance: Finally, the key findings from all the studies presented, emphasizing how these
relate to one another, are discussed.
Date Issued
2009
Date Awarded
2009-03
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Donnelly, Christl
Webster, Joanne
Creator
Koukounari, Artemis
Publisher Department
Infectious Disease Epidemiology
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)