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A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection amongst school aged children in a hard-to-reach area of Madagascar


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Russell, Hannah J., Penney, James M. St, Linder, Cortland, Joekes, Elizabeth, Bustinduy, Amaya L., Stothard, Russell ORCID:, Rakotomampianina, Daniel A. L., Andriamasy, Emmanuel H., Mahary, Lalarizo R., Ranjanoro, Elodie P., Rahetilahy, Alain M. and Spencer, Stephen A. (2020) 'A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection amongst school aged children in a hard-to-reach area of Madagascar'. Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol 114, Issue 4, pp. 315-322.

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Background: A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo District of the Atsinanana Region of Madagascar. This is a remote area known to have a high prevalence
of intestinal schistosomiasis.
Methods: School-aged children (5-14 years) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video clips of liver views were recorded with a SonoSite i-
Viz and interpreted in the UK by comparison with standardised images (WHO protocol).
Results: The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were six years old. Fibrosis was more
common in older children (p=0.03) but was not associated with infection intensity category(p= 0.07) or gender (p=0.67).
Conclusions: Findings of periportal fibrosis amongst children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate
morbidity in neglected communities in order to understand the true extent of disease burden in endemic countries.

Item Type: Article
Subjects: QX Parasitology > Helminths. Annelida > QX 355 Schistosoma
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WI Digestive System > WI 700 Liver
WS Pediatrics > Diseases of Children and Adolescents > General Diseases > WS 200 General works
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 310 Digestive system
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Digital Object Identifer (DOI):
Depositing User: Cathy Waldron
Date Deposited: 18 Mar 2020 15:50
Last Modified: 16 Apr 2020 15:26


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