Volume 99, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Schistosomiasis control programs are designed to reduce morbidity by providing mass drug administration (MDA) of praziquantel to at-risk populations. We compared morbidity markers between two cohorts of Kenyan schoolchildren that initially had high prevalence of infections. One cohort ( = 416 at year 1) received four rounds of annual MDA in a community-wide treatment (CWT) strategy. The other cohort ( = 386 at year 1) received school-based treatment (SBT) every other year over the 4-year period. We measured infection with and soil-transmitted helminths (STH) as well as subtle morbidity markers at year 1, year 3, and year 5 and compared cohorts with mixed models after controlling for age and gender. At year 5, neither overall prevalence nor the prevalence of high infection–intensity infection was significantly reduced compared with baseline in either the CWT cohort ( = 277 remaining) or the SBT cohort ( = 235 remaining). Nevertheless, by year 5, children in both cohorts demonstrated significant decreases in wasting, ultrasound-detected organomegaly, and STH infection along with significantly improved pediatric quality-of-life scores compared with year 1. Stunting did not change over time, but children who were egg–positive at year 5 had significantly more stunting than children without schistosomiasis. The only significant difference between arms at year 5 was a lower prevalence of STH infections in the CWT group.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. Colley DG, Bustinduy AL, Secor WE, King CH, , 2014. Human schistosomiasis. Lancet 383: 22532264.
  2. King CH, Dickman K, Tisch DJ, , 2005. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 365: 15611569.
  3. Bustinduy AL, Parraga IM, Thomas CL, Mungai PL, Mutuku F, Muchiri EM, Kitron U, King CH, , 2013. Impact of polyparasitic infections on anemia and undernutrition among Kenyan children living in a Schistosoma haematobium-endemic area. Am J Trop Med Hyg 88: 433440.
  4. Olsen A, Kinung’hi S, Magnussen P, , 2015. Schistosoma mansoni infection along the coast of Lake Victoria in Mwanza region, Tanzania. Am J Trop Med Hyg 92: 12401244.
  5. Verani JR, Abudho B, Montgomery SP, Mwinzi PN, Shane HL, Butler SE, Karanja DM, Secor WE, , 2011. Schistosomiasis among young children in Usoma, Kenya. Am J Trop Med Hyg 84: 787791.
  6. Ezeamama AE, 2016. Gaining and sustaining schistosomiasis control: study protocol and baseline data prior to different treatment strategies in five African countries. BMC Infect Dis 16: 229.
  7. King CH, , 2015. It’s time to dispel the myth of “asymptomatic” schistosomiasis. PLoS Negl Trop Dis 9: e0003504.
  8. Huldah CS, Geoffrey M, Maurice O, Maurice RO, Pauline NM, , 2015. Schistosoma haematobium hotspots in south Nyanza, western Kenya: prevalence, distribution and co-endemicity with Schistosoma mansoni and soil-transmitted helminths. Parasit Vectors 7: 125.
  9. Stothard JR, Kabatereine NB, Tukahebwa EM, Kazibwe F, Mathieson W, Webster JP, Fenwick A, , 2005. Field evaluation of the Meade Readiview handheld microscope for diagnosis of intestinal schistosomiasis in Ugandan school children. Am J Trop Med Hyg 73: 949955.
  10. Won KY, 2017. Multiplex serologic assessment of schistosomiasis in western Kenya: antibody responses in preschool aged children as a measure of reduced transmission. Am J Trop Med Hyg 96: 14601467.
  11. Kabatereine NB, Standley CJ, Sousa-Figueiredo JC, Fleming FM, Stothard JR, Talisuna A, Fenwick A, , 2011. Integrated prevalence mapping of schistosomiasis, soil-transmitted helminthiasis and malaria in lakeside and island communities in Lake Victoria, Uganda. Parasit Vectors 4: 232.
  12. Shen Y, 2017. Protocol and baseline data for a multi-year cohort study of the effects of different mass drug treatment approaches on functional morbidities from schistosomiasis in four African countries. BMC Infect Dis 17: 652.
  13. Samuels AM, Matey E, Mwinzi PN, Wiegand RE, Muchiri G, Ireri E, Hyde M, Montgomery SP, Karanja DM, Secor WE, , 2013. Schistosoma mansoni morbidity among school-aged children: a SCORE project in Kenya. Am J Trop Med Hyg 87: 874882.
  14. WHO, 2013. Schistosomiasis: Progress Report 2001–2011 and Strategic Plan 2012–2020. WHO/HTM/NTD/PCT/2013.2. Geneva, Switzerland: World Health Organization.
  15. Sullivan KM, Grummer-Strawn L, Parvanta I, , 2008. Haemoglobin adjustments to define anaemia. Trop Med Int Health 13: 12671271.
  16. WHO, 2010. WHO Anthro for Personal Computers, Version 3.2.2, 2011: Software for Assessing Growth and Development of the World’s Children. Geneva, Switzerland: World Health Organization.
  17. Bustinduy AL, Thomas CL, Fiutem JJ, Parraga IM, Mungai PL, Muchiri EM, Mutuku F, Kitron U, King CH, , 2011. Measuring fitness of Kenyan children with polyparasitic infections using the 20-meter shuttle run test as a morbidity metric. PLoS Negl Trop Dis 5: e1213.
  18. Kinung’hi S, Magnussen P, Kaatano G, Olsen A, , 2016. Infection with Schistosoma mansoni has an effect on quality of life, but not on physical fitness in schoolchildren in Mwanza region, north-western Tanzania: a cross-sectional study. PLoS Negl Trop Dis 10: e0005257.
  19. Richter J, Botelho MC, Holtfreter MC, Akpata R, El Scheich T, Neumayr A, Brunetti E, Hatz C, Dong Y, Dietrich CF, , 2000. Ultrasound in schistosomiasis: A Practical Guide to the Standardized Use of Ultrasonography for the Assessment of Schistosomiasis-related Morbidity. Second International Workshop, October 22–26, 1996, Niamey, Niger.
  20. Aanensen DM, Huntley DM, Feil EJ, al-Own F, Spratt BG, , 2009. EpiCollect: linking smartphones to web applications for epidemiology, ecology and community data collection. PLoS One 4: e6968.
  21. Felligi IP, , 1980. Approximate tests of independence and goodness of fit based on stratified multistage samples. J Am Stat Assoc 75: 261268.
  22. Binder D, , 1983. On the variance of asymptotically normal estimators from complex surveys. Int Stat Rev 51: 279292.
  23. Onkanga IO, Mwinzi PN, Muchiri G, Andiego K, Omedo M, Karanja DM, Wiegand RE, Secor WE, Montgomery SP, , 2016. Impact of two rounds of praziquantel mass drug administration on Schistosoma mansoni infection prevalence and intensity: a comparison between community wide treatment and school based treatment in western Kenya. Int J Parasitol 46: 439445.
  24. Andrade G, Bertsch DJ, Gazzinelli A, King CH, , 2017. Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: a systematic review and meta-analysis. PLoS Negl Trop Dis 11: e0005372.
  25. Olveda DU, 2017. Biennial versus annual treatment for schistosomiasis and its impact on liver morbidity. Int J Infect Dis 54: 145149.
  26. Botelho MC, Machado A, Carvalho A, Vilaça M, Conceição O, Rosa F, Alves H, Richter J, Bordalo AA, , 2016. Schistosoma haematobium in Guinea-Bissau: unacknowledged morbidity due to a particularly neglected parasite in a particularly neglected country. Parasitol Res 115: 15671572.
  27. Terer CC, Bustinduy AL, Magtanong RV, Muhoho N, Mungai PL, Muchiri EM, Kitron U, Kingh CH, Mutuku FM, , 2013. Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study. PLoS Negl Trop Dis 7: e2106.
  28. Gharahbaghian L, Anderson K, Lobo V, Huang R, Poffenberger CM, , 2017. Point-of-care ultrasound in austere environments: a complete review of its utilization, pitfalls and technique for common applications in austere settings. Emerg Med Clin North Am 35: 409441.

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  • Received : 24 Jan 2018
  • Accepted : 22 Mar 2018

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