Volume 80, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Substantial uncertainties surround the sensitivities and specificities of diagnostic techniques for urinary schistosomiasis. We used latent class (LC) modeling to address this problem. In this study, 220 adults in three villages northwest of Accra, Ghana were examined using five diagnostic measures: microscopic examination of urine for detection of eggs, dipsticks for detection of hematuria, tests for circulating antigens, antibody tests, and ultrasound scans of the urinary system. Testing of the LC model indicated non-invariance of the performance of the diagnostic tests across different age groups, and measurement invariance held for males and females and for the three villages. We therefore recommend the use of LC models for comparison between and the identification of the most accurate schistosomiasis diagnostic tests. Furthermore, microscopy and hematuria dipsticks were indicated through these models as the most appropriate techniques for detection of infection.


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  1. King CH, 2006. Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya. Mem Inst Oswaldo Cruz 101 (Suppl 1): 299–306.
  2. Koukounari A, Gabrielli AF, Touré S, Bosqué-Oliva E, Zhang Y, Sellin B, Donnelly CA, Fenwick A, Webster JP, 2007. Schistosoma haematobium infection and morbidity before and after large-scale administration of praziquantel in Burkina Faso. J Infect Dis 196 : 659–669.
  3. Midzi N, Sangweme D, Zinyowera S, Mapingure MP, Brouwer KC, Kumar N, Mutapi F, Woelk G, Mduluza T, 2008. Efficacy and side effects of praziquantel treatment against Schistosoma haematobium infection among primary school children in Zimbabwe. Trans R Soc Trop Med Hyg 102 : 759–766.
  4. Rudge JW, Stothard JR, Basáñez MG, Mgeni AF, Khamis IS, Khamis AN, Rollinson D, 2008. Micro-epidemiology of urinary schistosomiasis in Zanzibar: local risk factors associated with distribution of infections among schoolchildren and relevance for control. Acta Trop 105 : 45–54.
  5. Hatz C, Savioli L, Mayombana C, Dhunputh J, Kisumku U, Tanner M, 1990. Measurement of schistosomiasis-related morbidity at community level in areas of different endemicity. Bull World Health Organ 68 : 777–787.
  6. van der Werf MJ, de Vlas SJ, 2004. Diagnosis of urinary schistosomiasis: a novel approach to compare bladder pathology measured by ultrasound and three methods for hematuria detection. Am J Trop Med Hyg 71 : 98–106.
  7. Attallah AM, Ismail H, El Masry SA, Rizk H, Handousa A, El Bendary M, Tabll A, Ezzat F, 1999. Rapid detection of a Schistosoma mansoni circulating antigen excreted in urine of infected individuals by using a monoclonal antibody. J Clin Microbiol 37 : 354–357.
  8. Van Lieshout L, De Jonge N, el Masry NA, Mansour MM, Krijger FW, Deelder AM, 1992. Improved diagnostic performance of the circulating antigen assay in human schistosomiasis by parallel testing for circulating anodic and cathodic antigens in serum and urine. Am J Trop Med Hyg 47 : 463–469.
  9. el Missiry AG, el Serougi AO, Salama MM, Kamal AM, 1990. Evaluation of dot ELISA technique in the serodiagnosis of schistosomiasis in Egypt. J Egypt Soc Parasitol 20 : 639–645.
  10. van Lieshout L, Polderman AM, Deelder AM, 2000. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Trop 77 : 69–80.
  11. Ruiz R, Candia P, Garassini M, Tombazzi C, Certad G, Bruces AC, Noya O, Alarcón de Noya B, 2002. Schistosomiasis mansoni in low transmission areas. Abdominal ultrasound. Mem Inst Oswaldo 97 : 153–159.
  12. Amis ES, Cronan JJ, Pfister RC, Yoder IC, 1982. Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 9 : 101–105.
  13. Degremont A, Burki A, Burnier E, Schweizer W, Meudt R, Tanner M, 1985. Value of ultrasonography in investigating morbidity due to Schistosoma haematobium infection. Lancet 23 : 662–665.
  14. Etard JF, 2004. Modélisation de la sensibilité, spécificité et valeurs prédictives de la recherche d’une hématurie par bandelettes réactives dans le diagnostic de l’infection par Schistosoma haematobium. Bull Soc Pathol Exot 97 : 24–28.
  15. Taylor P, Chandiwana SK, Matnhire D, 1990. Evaluation of the reagent strip test for haematuria in the control of Schistosoma haematobium infection in school children. Acta Trop 47 : 91–100.
  16. Webb JAW, 1990. Ultrasonography in the diagnosis of renal obstruction: sensitive but not very specific. BMJ 301 : 944–946.
  17. Bosompem KM, Owusu O, Okanla EO, Kojima S, 2004. Applicability of a monoclonal antibody-based dipstick in diagnosis of urinary schistosomiasis in the central region of Ghana. Trop Med Int Health 9 : 991–996.
  18. Doenhoff MJ, Chiodini PL, Hamilton JV, 2004. Specific and sensitive diagnosis of schistosome infection: can it be done with antibodies? Trends Parasitol 20 : 35–39.
  19. Begg CB, 1987. Biases in the assessment of diagnostic tests. Stat Med 6 : 411–423.
  20. Formann AK, 1994. Measurement errors in caries diagnosis: some further latent class models. Biometrics 50 : 865–871.
  21. Oheneba-Sakyi Y, Heaton TB, 1993. Effects of socio-demographic variables on birth intervals in Ghana. J Comp Fam Stud 24 : 113–135.
  22. Bosompem KM, Arishima T, Yamashita T, Ayi I, Anyan WK, Kojima S, 1996. Extraction of Schistosoma haematobium antigens from infected human urine and generation of potential diagnostic monoclonal antibodies to urinary antigens. Acta Trop 62 : 91–103.
  23. Bosompem KM, Asigbee J, Otchere J, Haruna A, Kpo KH, Kojima S, 1998. Accuracy of diagnosis of urinary schistosomiasis: comparison of parasitological and a monoclonal antibody-based dip-stick method. Parasitol Int 47 : 211–217.
  24. Weber MC, Blair DM, Clarke VV, 1967. The pattern of schistosome egg distribution in a micturition flow. Cent Afr J Med 13 : 75–88.
  25. Bartholomew DJ, Knott M, 1999. Latent Variable Models and Factor Analysis. London: Edward Arnold.
  26. Rindskopf D, Rindskopf W, 1986. The value of latent class analysis in medical diagnosis. Stat Med 5 : 21–27.
  27. Formann AK, Kohlmann T, 1996. Latent class analysis in medical research. Stat Methods Med Res 5 : 179–211.
  28. Clogg CC, Goodman LA, 1984. Latent structure analysis of a set of multidimensional contingency tables. J Am Stat Assoc 79 : 762–771.
  29. Wilson RA, van Dam GJ, Kariuki TM, Farah IO, Deelder AM, Coulson PS, 2006. The detection limits for estimates of infection intensity in Schistosomiasis mansoni established by a study in non-human primates. Int J Parasitol 36 : 1241–1244.
  30. Bosompem KM, Bentum IA, Otchere J, Anyan WK, Brown CA, Osada Y, Takeo S, Kojima S, Ohta N, 2004. Infant schistosomiasis in Ghana: a survey in an irrigation community. Trop Med Int Health 9 : 917–922.
  31. Alvord WG, Drummond JE, Arthur LO, Biggar RJ, Goedert JJ, Levine PH, Murphy EL Jr, Weiss SH, Blattner WA, 1988. A method for predicting individual HIV infection status in the absence of clinical information. AIDS Res Hum Retroviruses 4 : 295–304.
  32. Engels EA, Sinclair MD, Biggar RJ, Whitby D, Ebbesen P, Goedert JJ, Gastwirth JL, 2000. Latent class analysis of human herpesvirus 8 assay performance and infection prevalence in sub-Saharan Africa and Malta. Int J Cancer 53 : 852–862.
  33. Hebert MR, Rose JS, Rosengard C, Clarke JG, Stein MD, 2007. Levels of trauma among women inmates with HIV risk and alcohol use disorders: behavioral and emotional impacts. J Trauma Dissociation 8 : 27–46.
  34. Kudel I, Farber SL, Mrus JM, Leonard AC, Sherman SN, Tsevat J, 2006. Patterns of responses on health-related quality of life questionnaires among patients with HIV/AIDS. J Gen Intern Med 21 (Suppl 5): S48–S55.
  35. Langhi DM Jr, Bordin JO, Castelo A, Walter SD, Moraes-Souza H, Stumpf RJ, 2002. The application of latent class analysis for diagnostic test validation of chronic Trypanosoma cruzi infection in blood donors. Braz J Infect Dis 6 : 181–187.
  36. Strauss SM, Rindskopf DM, Astone-Twerell JM, Des Jarlais DC, Hagan H, 2006. Using latent class analysis to identify patterns of hepatitis C service provision in drug-free treatment programs in the U.S. Drug Alcohol Depend 83 : 15–24.
  37. Booth M, Vounatsou P, N’Goran EK, Tanner M, Utzinger J, 2003. The influence of sampling effort and the performance of the Kato-Katz technique in diagnosing Schistosoma mansoni and hookworm co-infections in rural Côte d’Ivoire. Parasitology 127 : 525–531.
  38. Utzinger J, Vounatsou P, N’Goran EK, Tanner M, Booth M, 2002. Reduction in the prevalence and intensity of hookworm infections after praziquantel treatment for Schistosomiasis infection. Int J Parasitol 32 : 759–765.
  39. Carabin H, Balolong E, Joseph L, McGarvey ST, Johansen MV, Fernandez T, Willingham AL, Olveda R, 2005. Estimating sensitivity and specificity of a faecal examination method for Schistosoma japonicum infection in cats, dogs, water buffaloes, pigs and rats in Western Samar and Sorsogon Provinces, The Philippines. Int J Parasitol 35 : 1517–1524.
  40. World Health Organization, 2006. Preventive Chemotherapy in Human Helminthiasis. Geneva: World Health Organization.
  41. Koukounari A, Sacko M, Keita AD, Gabrielli AF, Landouré A, Dembelé R, Clements AC, Whawell S, Donnelly CA, Fenwick A, Traoré M, Webster JP, 2006. Assessment of ultrasound morbidity indicators of schistosomiasis in the context of large-scale programs illustrated with experiences from Malian children. Am J Trop Med Hyg 75 : 1042–1052.
  42. Dunyo SK, Appawu M, Nkrumah FK, Baffoe-Wilmot A, Pedersen EM, Simonsen PE, 1996. Lymphatic filariasis on the coast of Ghana. Trans R Soc Trop Med Hyg 90 : 634–638.
  43. Doenhoff MJ, Butterworth AE, Hayes RJ, Sturrock RF, Ouma JH, Koech D, Prentice M, Bain J, 1993. Seroepidemiology and serodiagnosis of schistosomiasis in Kenya using crude and purified egg antigens of Schistosoma mansoni in ELISA. Trans R Soc Trop Med Hyg 87 : 42–48.
  44. Xue CG, Taylor MG, Bickle QD, Savioli L, Renganathan EA, 1993. Diagnosis of Schistosoma haematobium infection: evaluation of ELISA using keyhole limpet haemocyanin or soluble egg antigen in comparison with detection of eggs or haematuria. Trans R Soc Trop Med Hyg 87 : 654–658.
  45. Hamilton JV, Klinkert M, Doenhoff MJ, 1998. Diagnosis of schistosomiasis: antibody detection, with notes on parasitological and antigen detection methods. Parasitology 117 (Suppl): S41–S57.
  46. Albert PS, Dodd LE, 2004. A cautionary note on the robustness of latent class models for estimating diagnostic error without a gold standard. Biometrics 60 : 427–435.
  47. Vacek PM, 1985. The effect of conditional dependence on the evaluation of diagnostic tests. Biometrics 41 : 959–968.
  48. Nsowah-Nuamah NN, Mensah G, Aryeetey ME, Wagatsuma Y, Bentil G, 2001. Urinary schistosomiasis in southern Ghana: a logistic regression approach to data from a community-based integrated control program. Am J Trop Med Hyg 65 : 484–490.
  49. Amankwa JA, Bloch P, Meyer-Lassen J, Olsen A, Christensen NO, 1994. Urinary and intestinal schistosomiasis in the Tono irrigation scheme, Kassena/Nankana District, upper east region, Ghana. Trop Med Parasitol 45 : 319–323.

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  • Received : 18 Jun 2008
  • Accepted : 22 Oct 2008

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