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Am. J. Trop. Med. Hyg., 73(5), 2005, pp. 949-955
Copyright © 2005 by The American Society of Tropical Medicine and Hygiene

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FIELD EVALUATION OF THE MEADE READIVIEW HANDHELD MICROSCOPE FOR DIAGNOSIS OF INTESTINAL SCHISTOSOMIASIS IN UGANDAN SCHOOL CHILDREN

J. RUSSELL STOTHARD*, NARCIS B. KABATEREINE, EDRIDAH M. TUKAHEBWA, FRANCIS KAZIBWE, WILLIAM MATHIESON, JOANNE P. WEBSTER, AND ALAN FENWICK
Wolfson Wellcome Biomedical Laboratories, Biomedical Parasitology Division, Department of Zoology, Natural History Museum, London, United Kingdom; Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom; Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vector Control Division, Ministry of Health, Kampala, Uganda

A novel, inexpensive handheld microscope, the Meade Readiview, was evaluated for field diagnosis of intestinal schistosomiasis by comparison of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) against conventional compound microscopy as part of a parasitologic survey in nine sentinel schools and a rapid mapping survey across 22 schools in Uganda. Fecal smears from 685 primary school children were examined and the overall prevalence of Schistosoma mansoni was 45%. However, prevalence by school ranged widely from 0% to 100%. For individual diagnosis the Readiview had a sensitivity of 85%, a specificity of 96%, a PPV of 95%, and an NPV of 88%. Due to the poorer movement control of the glass slide on the Readiview stage, fecal smears with less than four eggs could be overlooked. At the highest magnification (160x), egg-like objects could be confounding. Estimating prevalence by school was usually within ± 7% of that of conventional microscopy. Since the Readiview is more robust and portable, both in size and weight, and one-tenth as expensive as the traditional compound microscope, a change in the logistics and costs associated with field infection surveillance is possible. This inexpensive microscope is a pragmatic alternative to the compound microscope. It could play an important role in the collection of prevalence data to better guide anthelmintic drug delivery and also empower the diagnostic capacity of peripheral health centers where compound microscopes are few or absent.

Received March 1, 2005. Accepted for publication July 12, 2005.

Acknowledgments: We thank the teachers and children in Uganda for taking part in this evaluation; Aida Wamboko, David Ogutu, Daniel Nyonsaba, Leopold Mwembo, and other technical support from other Vector Control Division staff for their diligent assistance while in the field; Dr. Sam Zaramba and the Uganda Ministry of Health for their continuing support and enthusiasm for the Uganda NCP against bilharzia and intestinal worms; John Williams and Clare Swale (London School of Hygiene and Tropical Medicine) for quality control examinations of archived fecal smears; Dr. Simon Brooker (London School of Hygiene and Tropical Medicine), Dr. Pascal Boisier (Centre de Recherches Médical et Sanitaires, Naimey, Niger), and Dr. Juerg Utzinger (Swiss Tropical Institute, Basel, Switzerland) for their helpful comments and suggestions that have improved this manuscript.

Financial support: This work was supported by the Bill and Melinda Gates Foundation.

* Address correspondence to J. Russell Stothard, Wolfson Wellcome Biomedical Laboratories, Biomedical Parasitology Division, Department of Zoology, Natural History Museum, Cromwell Road, London SW7 5BD, United Kingdom. E-mail: r.stothard{at}nhm.ac.uk

Authors’ addresses: J. Russell Stothard, Wolfson Wellcome Biomedical Laboratories, Biomedical Parasitology Division, Department of Zoology, Natural History Museum, Cromwell Road, London SW7 5BD, United Kingdom, Telephone: 44-207-942-5490, Fax: 44-207-942-5518, E-mail: r.stothard{at}nhm.ac.uk. Narcis B. Kabatereine, Edridah M. Tukahebwa, and Francis Kazibwe, Vector Control Division, Ministry of Health, Kampala, Uganda. William Mathieson, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom. Joanne P. Webster and Alan Fenwick, The Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London W2 1PG, United Kingdom.

Reprint requests: J. Russell Stothard, Wolfson Wellcome Biomedical Laboratories, Biomedical Parasitology Division, Department of Zoology, Natural History Museum, Cromwell Road, London SW7 5BD, United Kingdom.






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Copyright © 2005 by the American Society of Tropical Medicine and Hygiene.