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      Time to change implementation units for mass drug administration against schistosomiasis in Uganda: Evidence from Communities levels data validation and its implication in planning

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          Abstract

          Uganda started implementing mass drug administration against schistosomiasis in 2003, with district used as an implementation unit. This resulted into misclassification of communities into wrong risk levels, under-or-over treatment and over request of praziquantel (PZQ) drugs. The objective of the current study was to reviewing the community data available at World Health Organization/ESPEN database to understand the status of schistosomiasis and identify pockets with infection. The decision tree assessment tool was used to analyzed schistosomiasis epidemiological data of 7501 communities. Before validation, the schistosomiasis endemicity status of 79 % of communities was not known. After validation, 58.6 %, 22.6 % and 16.3 % of communities were not endemic, had low and moderate endemicity status. Of 2362 communities classified having high endemicity using a district as implementation unit, 41.6 %, 12.7 % and 17.3 % of them were not endemic, had low and moderate endemicity, while only 22.7 % had high endemicity. Using the new treatment guidelines, 2,875,006 school aged children were adequately treated, 18,235 were under-treated and 2,250,013 were over treated. The results show a considerable change in endemicity status when communities were used as an implementation unit compared to district. Thus, the country control programme is recommended to use communities as implementation unit.

          Graphical abstract

          We present the above study that high lights Schistosomiasis as an endemic disease in Uganda and the country has a total of 7501 communities with different endemicity status (58.6 %, 22.6 % and 16.3 %-not endemic, low and moderate endemicity). The current analysis demonstrates that the use of a district as an implementation unit results into under treatment, overtreatment, and under-and-over request of praziquantel tablets. The analysis shows a considerable change in the endemicity status of communities when communities are used as an implementation unit. The findings call for the country to use communities as an implementation unit in order to reduce or eliminate the problem of under treatment, overtreatment, under and over request of praziquantel tablets.

          Highlights

          • Schistosomiasis is endemic in Uganda and the country has a total of 7501 communities with different endemicity status (58.6 %, 22.6 % and 16.3 %-not endemic, low and moderate endemicity).

          • The current analysis demonstrates that the use of a district as an implementation unit results into under treatment, overtreatment, under-and-over request of praziquantel tablets.

          • The analysis shows a considerable change in the endemicity status of communities when communities are used as an implementation unit.

          • The findings call for the country to use communities as an implementation unit in order to reduce or eliminate the problem of under treatment, overtreatment, under and over request of praziquantel tablets.

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          Most cited references22

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          The global status of schistosomiasis and its control.

          Schistosomiasis is being successfully controlled in many countries but remains a major public health problem, with an estimated 200 million people infected, mostly in Africa. Few countries in this region have undertaken successful and sustainable control programmes. The construction of water schemes to meet the power and agricultural requirements for development have lead to increasing transmission, especially of Schistosoma mansoni. Increasing population and movement have contributed to increased transmission and introduction of schistosomiasis to new areas. Most endemic countries are among the least developed whose health systems face difficulties to provide basic care at the primary health level. Constraints to control include, the lack of political commitment and infrastructure for public health interventions. Another constraint is that available anti-schistosomal drugs are expensive and the cost of individual treatment is a high proportion of the per capita drug budgets. There is need for increased support for schistosomiasis control in the most severely affected countries.
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            Spatial distribution of schistosomiasis and treatment needs in sub-Saharan Africa: a systematic review and geostatistical analysis.

            Schistosomiasis affects more than 200 million individuals, mostly in sub-Saharan Africa, but empirical estimates of the disease burden in this region are unavailable. We used geostatistical modelling to produce high-resolution risk estimates of infection with Schistosoma spp and of the number of doses of praziquantel treatment needed to prevent morbidity at different administrative levels in 44 countries.
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              Relating increasing hantavirus incidences to the changing climate: the mast connection

              Background Nephropathia epidemica (NE), an emerging rodent-borne viral disease, has become the most important cause of infectious acute renal failure in Belgium, with sharp increases in incidence occurring for more than a decade. Bank voles are the rodent reservoir of the responsible hantavirus and are known to display cyclic population peaks. We tried to relate these peaks to the cyclic NE outbreaks observed since 1993. Our hypothesis was that the ecological causal connection was the staple food source for voles, being seeds of deciduous broad-leaf trees, commonly called "mast". We also examined whether past temperature and precipitation preceding "mast years" were statistically linked to these NE outbreaks. Results Since 1993, each NE peak is immediately preceded by a mast year, resulting in significantly higher NE case numbers during these peaks (Spearman R = -0.82; P = 0.034). NE peaks are significantly related to warmer autumns the year before (R = 0.51; P < 0.001), hotter summers two years before (R = 0.32; P < 0.001), but also to colder (R = -0.25; P < 0.01) and more moist summers (R = 0.39; P < 0.001) three years before. Summer correlations were even more pronounced, when only July was singled out as the most representative summer month. Conclusion NE peaks in year 0 are induced by abundant mast formation in year-1, facilitating bank vole survival during winter, thus putting the local human population at risk from the spring onwards of year 0. This bank vole survival is further promoted by higher autumn temperatures in year-1, whereas mast formation itself is primed by higher summer temperatures in year-2. Both summer and autumn temperatures have been rising to significantly higher levels during recent years, explaining the virtually continuous epidemic state since 2005 of a zoonosis, considered rare until recently. Moreover, in 2007 a NE peak and an abundant mast formation occurred for the first time within the same year, thus forecasting yet another record NE incidence for 2008. We therefore predict that with the anticipated climate changes due to global warming, NE might become a highly endemic disease in Belgium and surrounding countries.
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                Author and article information

                Contributors
                Journal
                Parasite Epidemiol Control
                Parasite Epidemiol Control
                Parasite Epidemiology and Control
                Elsevier
                2405-6731
                29 November 2024
                November 2024
                29 November 2024
                : 27
                : e00394
                Affiliations
                [a ]National Malaria Control Division, Ministry of Health, Plot 6 Laudel Road, P.O Box 7272, Kampala, Uganda
                [b ]Vector Borne and NTD Control Division, Ministry of Health, Plot 15 Bombo road, P.O Box 1661, Kampala, Uganda
                [c ]Expanded Support Special Programme Project for Elimination of Neglected Tropical Diseases (ESPEN), WHO African Regional Office, Congo Brazzaville, Congo
                [d ]WHO Department of Control of Neglected Tropical Diseases, Geneva, Switzerland
                [e ]Kenya Medical Research Institute, P.O. Box 54840 00200 Off Raila Odinga Way, Nairobi, Kenya
                [f ]The Catholic University of Health and Allied Sciences, School of Medicine, Department of Medical Parasitology and Entomology, P.O. Box 1464, Mwanza, Tanzania
                Author notes
                [* ]Corresponding author at: National Malaria Control Division, Ministry of Health, Plot 6 Laudel Road, P.O Box 7272, Kampala, Uganda. adrikomoses@ 123456gmail.com
                [** ]Corresponding author at: School of Medicine, Department of Medical Parasitology, The Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania. humphreymazigo@ 123456gmail.com
                Article
                S2405-6731(24)00058-8 e00394
                10.1016/j.parepi.2024.e00394
                11697246
                39758812
                36d4bbc6-f2c8-49cb-b831-613b2c10ee04
                © 2024 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 20 September 2023
                : 27 September 2024
                : 23 November 2024
                Categories
                Original Research article

                schistosomiasis,district,communities,implementation unit,validation,uganda

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