Exploring the Link between Sociocultural Variables and Schistosomiasis in Minas Gerais, Brazil 公开

Abstract

Background and Goals: Human schistosomiasis caused by the subspecies Schistosoma mansoni is prevalent in Brazil, specifically in the southeastern state of Minas Gerais; despite this, control strategies are incohesive and insufficient to eliminate schistosomiasis in the state. In comparison to other schistosomiasis endemic areas, Minas Gerais has high coverage of adequate sanitation services. Access to sanitation is widely believed to reduce schistosomiasis, implying other factors are contributing to the prevalence in Minas Gerais. The goal of this study was to determine if other sociodemographic factors and knowledge or awareness of the disease may contribute to the prevalence of schistosomiasis in the area. Methods: Data were collected in Minas Gerais between June 2016 and December 2018 as part of a case-control study investigating schistosomiasis and leprosy co-infections. Participants (cases of leprosy and controls) ages 3 and older were recruited and tested for schistosomiasis by a multiplexed beaded assay identifying serum antibody response to soluble egg antigen (SEA). Post-hoc analyses focusing on schistosomiasis alone compared antibody reactivity to demographic, socioeconomic, and WASH variables of interest. Descriptive and bivariate analyses were performed, followed by logistic regression models that compared infection status to the explanatory variables of interest. Results: Of the 256 participants enrolled, 66 (30%) tested positive for S. mansoni IgG. Of these participants, 38 (58%) did not report a history of schistosomiasis. While most (96%) participants had access to improved sanitation services, having a latrine instead of a toilet was significantly associated with schistosomiasis infection, as was participating in freshwater activities. Being unaware of schistosomiasis infection (reporting no history but testing positive) was found to be positively associated with age and marital status. Awareness of schistosomiasis infection (reporting a history of schistosomiasis and testing positive) was found to be significantly associated with urban residence and lower education. Conclusions and future directions: Findings surrounding WASH factors support water contact and poor sanitation services as risk factors for schistosomiasis. Subsequent models suggested that sociocultural factors and educational attainment may influence knowledge of schistosomiasis, with concern that many people continue to unknowingly have infection. More research is needed to explore the relationship between sociocultural factors, especially unmeasured ones, and the continued transmission of schistosomiasis in Minas Gerais. 

Table of Contents

I. Chapter I: Introduction............................................................................................................1

II. Chapter II: Literature Review...................................................................................................3

a. Schistosomiasis.......................................................................................................................3

b. Minas Gerais………………………………………………………………...............................................….7

c. Case Study: A Comparison of Brazil and Sierra Leone, two S mansoni endemic countries ..............8

III. Chapter III: Manuscript formatted for the Journal……...……………...........................................12

a. Abstract……………………………………………………………….........................................................12

b. Background…………………………………………….........................................................................14

c. Methods……………………………………………………………............................................................16

d. Results………………………………………………………….................................................................19

e. Discussion…………………………………………………………............................................................30

IV. Chapter IV: Public Health Implications……………………………..................................................34

V. References………………………………………………………………................................................…..36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	Schistosomiasis
Committee Chair / Thesis Advisor	Jessica Fairley, Emory University

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