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Pediatric Research Feb 2015The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but... (Review)
Review
The global burden of kidney disease is increasing, and several etiologies first begin in childhood. Risk factors for pediatric kidney disease are common in Africa, but data regarding its prevalence are lacking. We completed a systematic review of community-based studies describing the prevalence of proteinuria, hematuria, abnormal imaging, or kidney dysfunction among children in sub-Saharan Africa (SSA). Medline and Embase were searched. Five hundred twenty-three references were reviewed. Thirty-two references from nine countries in SSA were included in the qualitative synthesis. The degree of kidney damage and abnormal imaging varied widely: proteinuria 32.5% (2.2-56.0%), hematuria 31.1% (0.6-67.0%), hydronephrosis 11.3% (0.0-38.0%), hydroureter 7.5% (0.0-26.4%), and major kidney abnormalities 0.1% (0.0-0.8%). Serum creatinine was reported in four studies with insufficient detail to identify the prevalence renal dysfunction. A majority of the studies were performed in Schistosoma haematobium endemic areas. A lower prevalence of kidney disease was observed in the few studies from nonendemic areas. Published data on pediatric kidney disease in SSA are highly variable and dependent on S. haematobium prevalence. More community-based studies are needed to describe the burden of pediatric kidney disease, particularly in regions where S. haematobium infection is nonendemic.
Topics: Africa South of the Sahara; Child; Creatinine; Hematuria; Humans; Kidney Diseases; Prevalence; Proteinuria; Risk Factors; Schistosomiasis haematobia
PubMed: 25420180
DOI: 10.1038/pr.2014.189 -
Journal of Tropical Medicine 2021Schistosomiasis is one of the neglected tropical diseases causing a serious human health problem in Ethiopia. Praziquantel is the only drug that has been used for the... (Review)
Review
BACKGROUND
Schistosomiasis is one of the neglected tropical diseases causing a serious human health problem in Ethiopia. Praziquantel is the only drug that has been used for the treatment of human schistosomiasis in the country. In line with this, the efficacy of praziquantel has been evaluated in a few interventional studies in the country, but there is a lack in systematically gathered and analyzed information for policymakers. The aim of this systematic review and meta-analysis was to provide a summary of the efficacy of praziquantel for the treatment of human schistosomiasis in Ethiopia.
METHODS
We conducted a literature search from ScienceDirect, PubMed/Medlin, and Google Scholar databases. A total of 140 articles published in English from 1980 to June 2021 were accessed and 15 of them were eligible for this meta-analysis. The meta-analysis was conducted using Stata 14 software, "metan command." The heterogeneities among studies were evaluated using test.
RESULTS
A total of 140 articles were reviewed, but only 15 of them fulfilled the inclusion criteria. The polled cure rate of 40 mg/kg praziquantel was 89.2% (95% CI: 85.4-93.1) and 93.6% (95% CI: 80.6-106) among and , respectively. Similarly, the mean egg reduction rates of 40 mg/kg praziquantel were 90.2% and 85% among and infected subjects, respectively. The common adverse events observed after receiving praziquantel include abdominal pain, vomiting, headache, diarrhea, and bloody stool.
CONCLUSION
This systematic review and meta-analysis has indicated that praziquantel is still an appropriate drug for the treatment of human schistosomiasis in Ethiopia.
PubMed: 34966433
DOI: 10.1155/2021/2625255 -
The Cochrane Database of Systematic... Aug 2014Urinary schistosomiasis is caused by an intravascular infection with parasitic Schistosoma haematobium worms. The adult worms typically migrate to the venous plexus of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urinary schistosomiasis is caused by an intravascular infection with parasitic Schistosoma haematobium worms. The adult worms typically migrate to the venous plexus of the human bladder and excrete eggs which the infected person passes in their urine. Chronic infection can cause substantial morbidity and long-term complications as the eggs become trapped in human tissues causing inflammation and fibrosis. We summarised evidence of drugs active against the infection. This is new edition of a review first published in 1997.
OBJECTIVES
To evaluate the efficacy and safety of drugs for treating urinary schistosomiasis.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, CENTRAL, EMBASE and LILACS and reference lists of articles up to 23 May 2014.
SELECTION CRITERIA
Randomized controlled trials (RCTs) of antischistosomal drugs and drug combinations compared to placebo, no intervention, or each other.
DATA COLLECTION AND ANALYSIS
Two researchers independently screened the records, extracted the data and assessed risk of bias. The primary efficacy outcomes were parasitological failure (defined as the continued presence of S. haematobium eggs in the urine at time points greater than one month after treatment), and percent reduction of egg counts from baseline. We presented dichotomous data as risk ratios (RR), and continuous data as mean difference (MD), alongside their 95% confidence intervals (CIs). Where appropriate we combined trials in meta analyses or tables. We assessed the quality of evidence using the GRADE approach.
MAIN RESULTS
We included 30 RCTs enrolling 8165 participants in this review. Twenty-four trials were conducted in children in sub-Saharan Africa, and 21 trials were over 20 years old. Many studies were assessed as being at unclear risk of bias due to inadequate descriptions of study methods. PraziquantelOn average, a single 40 mg/kg dose of praziquantel reduced the proportion of people still excreting eggs in their urine by around 60% compared to placebo at one to two months after treatment (treatment failure: RR 0.42, 95% CI 0.29 to 0.59, 864 participants, seven trials, high quality evidence). The proportion of people cured with praziquantel varied substantially between trials, from 22.5% to 83.3%, but was higher than 60% in five of the seven trials. At one to two months following praziquantel treatment at 40 mg/kg, the mean number of schistosome eggs in the urine was reduced by over 95% in five out of six trials (678 participants, six trials, high quality evidence).Splitting praziquantel 40 mg/kg into two doses over 12 hours probably has no benefits over a single dose, and in a single trial of 220 participants the split dose caused more vomiting (RR 0.5, 95% CI 0.29 to 0.86) and dizziness (RR 0.39, 95% CI 0.16 to 0.94). MetrifonateA single dose of metrifonate 10 mg/kg reduced egg excretion (210 participants, one trial, at eight months), but was only marginally better than placebo at achieving cure at one month (RR 0.83, 95% CI 0.74 to 0.94, 142 participants, one trial). In a single trial comparing one, two and three doses, the absolute number of participants cured improved from 47% after one dose to 81% after three doses (93 participants, one trial, low quality evidence).Two small trials compared 40 mg/kg single dose praziquantel with two or three doses of 10 mg/kg metrifonate and found no clear evidence of differences in cure (metrifonate 2 x 10 mg/kg at one month: RR 1.03, 95% CI 0.8 to 1.34, 72 participants, one trial; metrifonate 3 x 10 mg/kg at three months: RR 0.33, 95% CI 0.07 to 1.57, 100 participants, one trial. In one trial both drugs performed badly and in one trial both performed well. Other drugsThree trials have evaluated the antimalarial artesunate; with inconsistent results. Substantial antischistosomal effects were only seen in one of the three trials, which was at unclear risk of bias due to poor reporting of the trial methods. Similarly, another anti-malarial mefloquine has been evaluated in two small trials with inconsistent effects.Adverse events were described as mild for all evaluated drugs, but adverse event monitoring and reporting was generally of low quality.
AUTHORS' CONCLUSIONS
Praziquantel 40 mg/kg is the most studied drug for treating urinary schistosomiasis, and has the strongest evidence base.Potential strategies to improve future treatments for schistosomiasis include the combination of praziquantel with metrifonate, or with antimalarial drugs with antischistosomal properties such as artesunate and mefloquine. Evaluation of these combinations requires rigorous, adequately powered trials using standardized outcome measures.
Topics: Adult; Anthelmintics; Artemisinins; Artesunate; Child; Humans; Mefloquine; Praziquantel; Randomized Controlled Trials as Topic; Schistosomiasis haematobia; Trichlorfon
PubMed: 25099517
DOI: 10.1002/14651858.CD000053.pub3 -
Pathogens and Global Health Oct 2023Praziquantel (PZQ) has been extensively used as the drug of choice for the treatment of schistosomiasis on account of its safety and effectiveness against all major...
Praziquantel (PZQ) has been extensively used as the drug of choice for the treatment of schistosomiasis on account of its safety and effectiveness against all major forms of schistosomiasis. However, low cure rate, reduced susceptibility of to PZQ and treatment failures in . infections have been reported, raising concerns about its efficacy. Using the search terms, 'praziquantel efficacy, schistosomiasis, school children, reinfection' as well as defined inclusion criteria, and guided by the PRISMA guidelines, articles from 2001 to 2022 were selected from the PubMed and Google Scholar databases and reviewed to assess their importance to the research question. This review assessed the efficacy of PZQ against schistosomiasis and reinfection rates following treatment of infections in children. Majority of both intestinal and urinary schistosomiasis studies reported comparable egg reduction rates (ERRs) of 94.2% to 99.9% and 91.9% to 98%, respectively. However, ERRs suggestive of sub-optimal PZQ efficacy as well as generally high and comparable cure rates for intestinal (81.2%-99.1%) and urinary (79%-93.7%) schistosomiasis studies were reported. Schistosomiasis reinfection rates varied widely for urinary (8.1%-39.6%) and intestinal (13.9%-63.4%) studies within eight to 28 weeks following PZQ treatment. Praziquantel treatment of urinary and intestinal schistosomiasis should be accompanied by the provision of potable water, toilet, and recreational facilities to reduce reinfection and egg reduction rates and increase cure rate to expedite schistosomiasis elimination.
Topics: Child; Humans; Praziquantel; Schistosomiasis mansoni; Anthelmintics; Reinfection; Treatment Outcome; Schistosomiasis haematobia
PubMed: 36394218
DOI: 10.1080/20477724.2022.2145070 -
PloS One 2023Schistosomiasis is a parasitic infection that causes significant public health problems in tropical countries. Schistosoma haematobium species are blamable for causing...
BACKGROUND
Schistosomiasis is a parasitic infection that causes significant public health problems in tropical countries. Schistosoma haematobium species are blamable for causing urinary schistosomiasis. The infected person, specifically children, may be carrying the disease. This systematic review aimed to identify the current knowledge of urinary Schistosmiasis in children or USC on its epidemiology, risk factors, and challenges to spread the understanding of controlling the disease and reducing the complications.
METHOD
In November 2021, a systematic computer-aided literature review was conducted using PubMed, SCOPUS and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The results were updated in February 2022. We only used papers that have at least the abstract available in English. Relevant articles were screened, duplicates were deleted, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords Human Schistosoma infections, prevalence, risk factors and challenges were included. The protocol for the review was registered with PROSPERO (registration number CRD42022311609). Pooled prevalence rates were calculated using the programme R version 4.2.1. Heterogeneity was assessed using the I2 statistic and p-value. A narrative approach was used to describe risk factors and challenges. Studies were selected and finalised based on the review question to prioritise. The quality of the included studies was assessed using the Mixed-Method Appraisal Tool (MMAT).
RESULTS
A total of 248 publications met the requirements for inclusion. Fifteen articles were included in this review, with the result showing high heterogeneity. The pooled prevalence of urinary schistosomiasis in children is 4% (95% confidence interval (CI)). Age, poor socioeconomic status, education, exposure to river water, and poor sanitation are the risk factors identified in this review. Challenges are faced due to limitations of clean water, lack of water resources, and poor hygiene.
CONCLUSION
Modifiable risk factors such as poor knowledge and practices must be addressed immediately. Healthcare providers and schools could accomplish engaging in practical promotional activities. Communicating the intended messages to raise community awareness of urinary schistosomiasis is critical.
Topics: Humans; Child; Prevalence; Schistosomiasis haematobia; Risk Factors; Educational Status; Eligibility Determination
PubMed: 37590252
DOI: 10.1371/journal.pone.0285533 -
Pathogens and Global Health Mar 2020, a major pathogen of urogenital schistosomiasis, has been reported to be affecting an estimated 30 million people in Nigeria. Current national estimates of and its... (Meta-Analysis)
Meta-Analysis
, a major pathogen of urogenital schistosomiasis, has been reported to be affecting an estimated 30 million people in Nigeria. Current national estimates of and its cercariae, in humans and snail vectors respectively, are lacking in Nigeria, hence systematic meta-analyses were conducted to understand the disease dynamics in the endemic country over a period of 35 years based on publications from five databases (AJOL, Ovid MEDLINE, Google Scholar, PubMed and Web of Science). The preferred reporting items for systematic reviews and meta-analyses (PRIMSA) checklist were used as the standard guide for the analyses. The prevalence of in human hosts in Nigeria using quality effects model was 32.1% (27.3-37.2), while schistosome cercariae were observed at 3.5% (0.0-11.9), 18.2% (4.7-36.8) and 18.7% (0.0-46.1) and for and , respectively. The high report of schistosome cercariae indicates the continuous transmission of in humans especially with individuals who have frequent contact with freshwater. Heterogeneity of subgroup analyses (regions, zones, sex, age groups, diagnostic techniques) and risk factors (pathological signs, occupation, water sources, anthropogenic activities, treatment) were determined. The result showed prevalence of an endemic moderate class infection that has been linked to several risk factors. Therefore, there is need for increased awareness on the prevalence, transmission routes and treatment strategies to mitigate the disease in this endemic area.
Topics: Animals; Disease Vectors; Humans; Nigeria; Schistosoma haematobium; Schistosomiasis haematobia; Snails
PubMed: 32182201
DOI: 10.1080/20477724.2020.1728164 -
Parasites & Vectors Oct 2011Praziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984. Besides praziquantel, artemether and artesunate have also been used for the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Praziquantel has been used as first-line drug for chemotherapy of schistosomiasis since 1984. Besides praziquantel, artemether and artesunate have also been used for the control of this infectious disease since late 1990s. In this article, we conducted a systematic review and meta-analysis to evaluate the antischistosomal efficacy of different medication strategies including monotherapy or combination therapies of these drugs.
RESULTS
A number of 52 trials from 38 articles published in peer-reviewed journals before July 2011 were selected for analysis after searching the following literature databases: the Cochrane Library, PubMed/Medline, ISI Web of Science, Chinese Biomedicine Literature Database, and China National Knowledge Infrastructure. Our meta-analyses showed that a dosage of 30-60 mg/kg praziquantel compared with placebo produced a protection rate of about 76% (95% CI: 67%-83%) for treating human schistosomiasis, which varied from 70% to 76% with no significant differences among the subspecies S. haematobium, S. japonicum or S. mansoni. Protection rates were higher when praziquantel doses were elevated, as concluded from the nRCTs results: the protection rate of praziquantel at 40 mg/kg was 52% (95% CI: 49%-55%), and it increased to 91% (95% CI: 88%-92%) when the dosages were elevated to 60/80/100 mg/kg divided two or more doses. Multiple doses of artemether or artesunate over 1- or 2-week intervals resulted in protection rates of 65% to 97% for preventing schistosomiasis, and increased doses and shorter medication intervals improved their efficacies. Praziquantel and artemisinin derivatives (artemether or artesunate) in combination resulted in a higher protection rate of 84% (95% CI: 64%-91%) than praziquantel monotherapy for treatment. praziquantel and artesunate in combination had a great protection rate of 96% (95% CI: 78%-99%) for preventing schistosomes infection.
CONCLUSIONS
According to the results, praziquantel remains effective in schistosomiasis treatment, and multiple doses would improve its efficacy; meanwhile, praziquantel is also a good drug for preventing acute schistosomiasis morbidity. It's better to use multiple doses of artemether or artesunate with 1- or 2-week intervals for prevention against schistosome infection. Praziquantel and artemether or artesunate in combination perform better in treatment than praziquantel monotherapy, and they are especially suitable for treating the patients with repeated exposure to infected water.
Topics: Animals; Artemisinins; Dose-Response Relationship, Drug; Humans; Praziquantel; Randomized Controlled Trials as Topic; Schistosoma; Schistosomiasis; Schistosomicides
PubMed: 22004571
DOI: 10.1186/1756-3305-4-201 -
Infection and Drug Resistance 2023Schistosomiasis is a public health problem in more than 78 countries in the world. The disease is most prevalent among children than adults due to their high exposure to... (Review)
Review
The Impact of Targeted Treatment and Mass Drug Administration Delivery Strategies on the Prevalence and Intensity of Schistosomiasis in School Aged Children in Africa: A Systematic Review.
Schistosomiasis is a public health problem in more than 78 countries in the world. The disease is most prevalent among children than adults due to their high exposure to infectious water sources. Various interventions such as mass drug administration (MDA), snail control, safe water provision and health education have been implemented independently or jointly to control, reduce and ultimately eliminate Schistosomiasis. This scoping review focused on studies reporting the impact of different delivery strategies of targeted treatment and MDA on the prevalence and intensity of schistosomiasis infection in school aged children in Africa. The review focused on and species. A systematic search for eligible literature from peer-reviewed articles was done from Google Scholar, Medline, PubMed and EBSCO host databases. The search yielded twenty-seven peer-reviewed articles. All articles found reported a decrease in the prevalence of schistosomiasis infection. Five studies (18.5%) reported a prevalence change below 40%, eighteen studies (66.7%) reported a change between 40% and 80%, and four studies (14.8%) reported a change above 80%. The infection intensity post-treatment was varied: twenty-four studies reported a decrease, while two studies reported an increase. The review showed that the impact of targeted treatment on the prevalence and intensity of schistosomiasis depended on the frequency at which it was offered, complementary interventions, and its uptake by the target population. Targeted treatment can significantly control the infection burden, but cannot eliminate the disease. Constant MDA programs coupled with preventative and health promotional programs are required to reach the elimination stage.
PubMed: 37138838
DOI: 10.2147/IDR.S395382 -
Infectious Diseases of Poverty Jul 2018Schistosomiasis is a serious public health burden in sub-Saharan Africa. Praziquantel is the only drug recommended by the World Health Organization to treat both... (Review)
Review
BACKGROUND
Schistosomiasis is a serious public health burden in sub-Saharan Africa. Praziquantel is the only drug recommended by the World Health Organization to treat both urogenital and intestinal schistosomiasis. The reliance on a single drug to treat a disease with such a huge burden has raised concerns of possible drug resistance mainly in endemic areas. This systematic review was conducted to identify gaps and recent progress on the efficacy of different regimens of praziquantel in treating schistosomiasis among children in sub-Saharan Africa where Schistosoma mansoni and S. haematobium are endemic.
MAIN TEXT
A literature search of peer-reviewed journals was done on Google Scholar, MEDLINE (under EBSCOhost) and PubMed databases using pre-defined search terms and Boolean operators. The search included studies published from 2008 to 2017 (August) with emphasis on the efficacy of praziquantel on S. haematobium and S. mansoni infections among preschool and school children. Nineteen publications satisfied the inclusion criteria for the review. The studies reviewed were from 10 sub-Saharan African countries and 7/19 of the studies (37%) were conducted in Uganda. Seven studies (37%) focused on Schistosoma mansoni, 6/19 (31.5%) on S. haematobium and another 6 on mixed infection. A single standard dose of 40 mg/kg body weight was the most used regimen (9) followed by the repeated single standard dose assessed for efficacy at 3-4 weeks post-treatment.
CONCLUSIONS
A repeated standard dose of 40 mg/kg achieved satisfactory efficacy compared to a single dose against both parasite species. However, findings on efficacy of repeated doses in co-infection of S. mansoni and S. haematobium were not conclusive. Praziquantel administrated at 60 mg/kg was slightly more efficacious than the 40 mg/kg standard dose. Minor and transitory side-effects were reported for both regimens. The review indicates that further investigations are necessary to conclusively determine efficacy of praziquantel on coinfection of S. haematobium and S. mansoni to formulate concrete guidelines on the use of repeated doses at 40 or 60 mg/kg for treating schistosomiasis. We recommend the use of the egg reduction rate (ERR) formula recommended by the WHO for assessing praziquantel efficacy in order for the results to be comparable for different regions.
Topics: Africa South of the Sahara; Animals; Anthelmintics; Child; Child, Preschool; Humans; Praziquantel; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis
PubMed: 29986763
DOI: 10.1186/s40249-018-0448-x -
Infectious Diseases of Poverty Apr 2023Urogenital schistosomiasis is endemic in Mali and is a major cause of serious morbidity in large parts of the world. This disease is responsible for many socio-economic...
BACKGROUND
Urogenital schistosomiasis is endemic in Mali and is a major cause of serious morbidity in large parts of the world. This disease is responsible for many socio-economic and public health issues. The aim of this study was to investigate the impact of the disease on morbidity and to describe demographic and socioeconomic factors in relation to the status of children with urogenital schistosomiasis in Mali.
METHODS
We conducted a cross-sectional study in November 2021 of 971 children aged 6 to 14 years selected at random from six schools in three districts in the Kayes Region of Mali. Demographic and socioeconomic data were collected on survey forms. Clinical data were collected following a medical consultation. Hematuria was systematically searched for through the use of strips. The search for Schistosoma haematobium eggs in urine was done via the filtration method. The urinary tract was examined by ultrasound. Associations between each of these variables and disease infection were tested using multivariate logistic regression.
RESULTS
The overall prevalence of urinary schistosomiasis detected was 50.2%. The average intensity of infection was 36 eggs/10 ml of urine. The associated risk factors for urogenital schistosomiasis showed that children who bathed, used the river/pond as a domestic water source, and who habitually urinated in the river/pond were more affected (P < 0.05). Children with farming parents were most affected (P = 0.032). The collection of clinical signs revealed that boys had more pollakiuria (58.6%) and dysuria (46.4%) than girls. Ultrasound data showed that focal lesion rates were recorded in all villages with the lowest rate in Diakalel (56.1%). Ultrasound and parasitological findings showed that irregularity and thickening were strongly associated with urinary schistosomiasis (P < 0.0001).
CONCLUSIONS
Schistosoma haematobium infection was still endemic in the study site despite more than a decade of mass treatment with praziquantel. However, the high percentage of symptoms associated with high intensity reinforces the idea that further studies in terms of schistosomiasis-related morbidity are still needed.
Topics: Male; Female; Animals; Humans; Child; Schistosomiasis haematobia; Mali; Cross-Sectional Studies; Schistosoma haematobium; Prevalence; Risk Factors; Schools
PubMed: 37081494
DOI: 10.1186/s40249-023-01071-6