ASSOCIATION OF SCHISTOSOMIASIS WITH IMPAIRED FERTILITY IN EAST AFRICA Open Access
Woodall, Trish (2017)
Many case reports and pathology series have suggested associations of Female Genital Schistosomiasis of the Fallopian tubes with infertility and ectopic pregnancy. Geographic distribution of infertility (which in Africa is most commonly due to tubal disease) has been reported but not explained. In this cross-sectional study, interpolated prevalence maps for S. haematobium and S. mansoni in East Africa were created using data from two open-access Neglected Tropical Diseases databases. Prevalence was extracted to georeferenced survey sample points for Demographic and Health Surveys for Ethiopia, Kenya, Tanzania and Uganda for 2009-2011 and 1999-2001. Outcomes included primary and secondary infertility (no births) and infecundity (no pregnancies) and history of pregnancy loss. Exploratory spatial analyses of outcomes (Moran's I, univariate and bivariate Local Indices of Spatial Autocorrelation) showed that outcomes were not spatially random and mapped clustering, hotspots, and areas of co-location of outcomes and exposures. Weighted multilevel logistic regression analysis found that women living in high compared to absent S. haematobium locations had significantly higher odds of secondary infertility (1999-2001: OR 1.8 [CI95 1.4, 2.3]; 2009-2011: OR 1.23 [1.1, 1.5]) and of primary infertility (1999-2001: OR 1.8 [1.3, 2.7]; 2001-2011: OR 1.58 [1.1, 2.3]). Living in high compared to absent S. mansoni locations did not affect the odds of any outcome. Women living in high S. haematobium compared to high S. mansoni locations had significantly higher odds of secondary infertility (1999-2001: OR 1.7 [1.3, 2.3]; 2009-2011: OR 1.6 [1.1, 2.0]), and of primary infertility (2010: OR 2.7 [1.5, 4.9]). For 1999-2001, history of pregnancy loss was significantly associated with high compared to absent S. haematobium (OR 1.3 [1.1, 1.6]) and with high S. haematobium compared to high S. mansoni (OR 1.4 [1.0, 1.8]). There is increasing evidence of the clinical and public health consequences of schistosomiasis to women's health and the importance of inclusion of girls and women in control strategies.
Table of Contents
1 Chapter I: Background/Literature Review
11 Chapter II: Manuscript: Abstract
34 Chapter III: Future Directions
35 Table 1. Published reports of infertility associated with schistosomiasis.
36 Table 2. Published reports of ectopic pregnancy associated with schistosomiasis.
37 Table 3. Population description, DHS East Africa 1999-2001
38 Table 4. Population description, DHS East Africa 2009-2011
39 Table 5. Measures of autocorrelation of outcome variables, Moran's I East Africa 1999- 2001 & 2009-2011
40 Table 6. Association of impaired fertility with schistosomiasis prevalence, East Africa 1999-2001
41 Table 7. Association of impaired fertility with schistosomiasis prevalence, East Africa 2009-2011
42 Table 8. Association of impaired fertility with schistosomiasis prevalence, East Africa 1999-2001. Sensitivity analysis.
44 Table 9. Association of impaired fertility with schistosomiasis prevalence, East Africa 2009-2011. Sensitivity analysis.
46 Figure 1: Map of schistosomiasis distribution in East Africa.
Figure 2: Potential effects of schistosomiasis in pregnancy.
48 Figure 3. Predicted (interpolated) schistosomiasis distribution in East Africa,
49 Figure 4. Local clustering of impaired fertility outcomes, Getis-Ord Gi*
50 Figure 5. Bivariate LISA, impaired fertility outcomes and schistosomiasis prevalence
64 Appendix: additional maps
Figure 6. Local clustering of impaired fertility outcomes, Local Moran's I
65 Figure 7. Measures of impaired fertility, box maps.
66 Figure 8. Measures of impaired fertility, univariate LISA
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