Schistosoma mansoni Infection as a Predictor of Low Aerobic Capacity in Ugandan Children

Courtney Smith Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom;

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Georgia McLachlan Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

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Hajri Al Shehri Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

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Moses Adriko Vector Control Division, Ministry of Health, Kampala, Uganda;

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Moses Arinaitwe Vector Control Division, Ministry of Health, Kampala, Uganda;

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Aaron Atuhaire Vector Control Division, Ministry of Health, Kampala, Uganda;

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Edridah Muheki Tukahebwa Vector Control Division, Ministry of Health, Kampala, Uganda;

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E. James LaCourse Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

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Michelle Stanton Lancaster Medical School, Lancaster University, Lancaster, United Kingdom

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J. Russell Stothard Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom;

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Amaya L. Bustinduy Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom;

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Using the 20-meter shuttle run test (20mSRT) as a morbidity metric, we assessed whether Schistosoma mansoni infection was associated with decreased aerobic capacity in Ugandan children across a range of altitudes, either at low (∼600 m) or high (∼1,000 m) altitudes. A total of 305 children were recruited from six schools within the Buliisa District, Lake Albert, Uganda. A subset (n = 96) of these had been previously assessed and treated for schistosomiasis ± malaria 2 weeks prior. Fitness scores on the 20mSRT were translated into VO2max using a standardized equation. Unadjusted and multivariable-adjusted analyses were performed using VO2max as the primary outcome. Analysis of fitness scores from 304 children, inclusive of the subset follow-up cohort, revealed a median VO2max of 45.4 mL kg−1 min−1 (interquartile range: 42.9–48.0 mL kg−1 min−1). Children residing at high altitudes demonstrated increased aerobic capacities (46.3 versus 44.8 mL kg−1 min−1, P = 0.031). The prevalence of stunting, wasting, S. mansoni egg patent infection, malaria, giardiasis, anemia, and fecal occult blood were 36.7%, 16.1%, 44.3%, 65.2%, 21.4%, 50.6%, and 41.2%, respectively. Median VO2max was elevated in those previously treated, compared with those newly recruited (46.3 versus 44 mL kg−1 min−1, P < 0.001). Multivariable-adjusted analysis revealed a strong negative association between S. mansoni egg patent infection and VO2max at low altitude (beta coefficient: −3.96, 95% CI: −6.56 to −137, P = 0.004). This is the first study to document a negative association between S. mansoni infection and aerobic capacity at low altitudes using the 20mSRT.

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Author Notes

Address correspondence to Amaya L. Bustinduy, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK WC1E 7HT. E-mail: ama.bustinduy@lshtm.ac.uk

Financial support: The London School of Tropical Medicine & Hygiene (bench fees), The Liverpool School of Tropical Medicine (bench fees) and the Medical Research Council (nested within project with code ITCRZJ44).

Authors’ addresses: Courtney Smith and Amaya L. Bustinduy, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom, E-mails: courtney.bree@live.com and amaya.bustinduy@lshtm.ac.uk. Georgia McLachlan, Hajri Al Shehri, E. James LaCourse, and J. Russell Stothard, Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom, E-mails: george.mac11@btinternet.com, hajri.alshehri@lstmed.ac.uk, james.lacourse@lstmed.ac.uk, and russell.stothard@lstmed.ac.uk. Moses Adriko, Moses Arinaitwe, Aaron Atuhaire, and Edridah Muheki Tukahebwa, Vector Control Division, Ministry of Health, Kampala, Uganda, E-mails: adrikomoses@gmail.com, moses0772359814@gmail.com, aaronatuhaire@gmail.com, and edmuheki@gmail.com. Michelle Stanton, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom, E-mail: michelle.stanton@lancaster.ac.uk.

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