Use of a Tablet-Based System to Perform Abdominal Ultrasounds in a Field Investigation of Schistosomiasis-Related Morbidity in Western Kenya

Abstract

Chronic intestinal schistosomiasis can cause severe hepatosplenic disease and is a neglected tropical disease of public health importance in sub-Saharan Africa, including Kenya. Although the goal of control programs is to reduce morbidity, milestones for program performance focus on reductions in prevalence and intensity of infection, rather than actual measures of morbidity. Using ultrasound to measure hepatosplenic disease severity is an accepted method of determining schistosomiasis-related morbidity; however, ultrasound has not historically been considered a field-deployable tool because of equipment limitations and unavailability of expertise. A point-of-care tablet-based ultrasound system was used to perform abdominal ultrasounds in a field investigation of schistosomiasis-related morbidity in western Kenya; during the study, other pathologies and pregnancies were also identified via ultrasound, and participants referred to care. Recent technological advances may make it more feasible to implement ultrasound as part of a control program and can also offer important benefits to the community.

Figure 1.

Examples of schistosomiasis-related ultrasound liver texture patterns, as defined by the WHO’s Niamey protocol, observed during the Morbidity Operational Research for Bilharziasis Implementation Decisions study. (A) normal liver parenchyma; (B) “starry sky”; (C) “rings” (seen here) and “pipe stems,” which correspond to the “rings” seen in a scan perpendicular to the one where pipe stems are seen; (D) highly echogenic “ruff” seen around the portal bifurcation and main stem; (E) highly echogenic “patches” extending from the main portal vein and branches into the parenchyma. This figure appears in color at www.ajtmh.org.