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Surveillance of intestinal schistosomiasis during control: A comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region.

Alshehri, Hajri, Koukounari, Artemis, Stanton, Michelle ORCID:, Adriko, Moses, Arinaitwe, Moses, Atuhaire, Aaron, Kabatereine, Narcis B. and Stothard, Russell ORCID: (2018) 'Surveillance of intestinal schistosomiasis during control: A comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region.'. Parasitology, Vol 145, Issue 13, pp. 1715-1722.

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Programmatic surveillance of intestinal schistosomiasis during control can typically use four diagnostic tests, either singularly or in combination, but these have yet to be cross-compared directly. Our study assembled a complete diagnostic dataset, inclusive of infection intensities, from 258 children from five Ugandan primary schools. The schools were purposely selected as typical of the endemic landscape near Lake Albert and reflective of high- and low-transmission settings. Overall prevalence was: 44.1% (95% CI 38.0–50.2) by microscopy of duplicate Kato-Katz smears from two consecutive stools, 56.9% (95% CI 50.8–63.0) by urine-circulating cathodic antigen (CCA) dipstick, 67.4% (95% CI 61.6–73.1) by DNA-TaqMan® and 75.1% (95% CI 69.8–80.4) by soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA). A cross-comparison of diagnostic sensitivities, specificities, positive and negative predictive values was undertaken, inclusive of a latent class analysis (LCA) with a LCA-model estimate of prevalence by each school. The latter ranged from 9.6% to 100.0%, and prevalence by school for each diagnostic test followed a static ascending order or monotonic series of Kato-Katz, urine-CCA dipstick, DNA-TaqMan® and SEA-ELISA. We confirm that Kato-Katz remains a satisfactory diagnostic standalone in high-transmission settings but in low-transmission settings should be augmented or replaced by urine-CCA dipsticks. DNA-TaqMan® appears suitable in both endemic settings though is only implementable if resources permit. In low-transmission settings, SEA-ELISA remains the method of choice to evidence an absence infection. We discuss the pros and cons of each method concluding that future surveillance of intestinal schistosomiasis would benefit from a flexible, context-specific approach both in choice and application of each diagnostic method, rather than a single one-size fits all approach.

Item Type: Article
Additional Information: Special Issue 13 (2017 Autumn Symposium of the British Society for Parasitology The multi-disciplinarity of parasitology: Host-parasite evolution in an ever changing world)
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 810 Schistosomiasis
WS Pediatrics > By Age Groups > WS 430 Infancy
WS Pediatrics > By Age Groups > WS 440 Preschool child
Faculty: Department: Biological Sciences > Department of Tropical Disease Biology
Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 28 Mar 2018 10:41
Last Modified: 02 Dec 2019 12:53


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