Improving Diagnostic Ability and Assessing Prevalence of Schistosomiasis in Lusaka, Zambia Público
Livingston, Paul Donald (2012)
Published
Abstract
Background: Of the 207 million cases of schistosomiasis
worldwide, 90% are in Africa,
causing hundreds of thousands of deaths annually. Urogenital
schistosomiasis (Schistosoma
haematobium) has been implicated as a cofactor affecting HIV-1
transmission in many countries
of sub-Saharan Africa through the creation of lesions, bleeding and
other genital abnormalities.
Yet in Zambia, a country experiencing high prevalence of both HIV-1
(13.5%) and
schistosomiasis (estimates of 10-40%), few studies have examined
prevalence of active
schistosomiasis in a population of HIV+ and HIV- urban men and
women.
Methods: Participants from the Zambia Emory HIV Research
Project heterosexual cohort were
included: HIV+ men and women who had tested positive for
schistosomiasis antibodies (n=68)
and HIV+ and HIV- men and women who came over the period of one
month (n=99). Egg
excretion was tested utilizing urine filtration and Kato-Katz fecal
smear analysis. Plasma
samples were analyzed through enzyme linked immunosorbent assays
(ELISA) and Western blot
for antibodies and to distinguish between schistosome species.
Bivariate tests for association
were conducted and a multivariate logistic regression model
constructed to predict presence of
active schistosomiasis infection.
Results: 21% of HIV+ individuals, selected with positive ELISA
serologies, had active excretion
of schistosome eggs, 19.1% positive for S. haematobium and 7.4 %
positive for S. mansoni. In
comparison, 13% of unselected HIV+ and HIV- men and women had
active excretion of
schistosome eggs with 10 % positive for S. haematobium. Logistic
regression produced a model
predictive of active schistosomiasis infection (AUROC=0.80) that
contained variables for age,
high ELISA antibody titer (>50), water contact as a child,
positive Western blot result for S.
haematobium, years in Lusaka and A. lumbricoides positivity.
Discussion: This study shows significant prevalence of active
infection in both HIV+ and HIV-
Zambians and the need to conduct routine parasitological testing
and treatment in countries
coendemic for HIV-1 and schistosomiasis. In developing countries,
efforts need to be made to
provide praziquantel and train laboratory technicians in better
diagnostic methods. Future
research should examine how male genital schistosomiasis affects
HIV-1 transmission and
utilize urine reagent strips to test larger numbers of people in
high transmission areas of Zambia.
Table of Contents
TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION AND BACKGROUND 1
Definitions of Terms/Acronyms 5
CHAPTER 2: LITERATURE REVIEW
The Lifecycle of Bilharzia/Snail Fever 6
Schistosomiasis as a Genital Condition 7
Diagnosing Schistosomiasis 8
Treating Schistosomiasis 9
Schistosomiasis in Zambia 10
HIV-1 and Schistosomiasis 12
Poverty and Socio-determinants of Infection 15
The Role of Dams 16
Criticisms of the Literature 18
CHAPTER 3: METHODS AND RESULTS
Methods 20
Study Background 20
Sample Population 21
Research Design 22
Procedures 22
Treatment 25
Antibody Testing 26
Questionnaires 27
Data Analysis 28
Limitations and Delimitations 29
Results 35
CHAPTER 4: DISCUSSION, CONCLUSIONS, RECOMMENDATIONS
Discussion 41
Conclusions/Implications 43
Recommendations 46
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