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. 2023 Apr 25;12(1):44.
doi: 10.1186/s40249-023-01094-z.

Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study

Sarah Katharina Gruninger  1   2 , Tahinamandranto Rasamoelina  3 , Rivo Andry Rakotoarivelo  4 , Anjarasoa Ravo Razafindrakoto  3 , Zaraniaina Tahiry Rasolojaona  3 , Rodson Morin Rakotozafy  5 , Patrick Richard Soloniaina  5 , Njary Rakotozandrindrainy  5 , Pia Rausche  1   2 , Cheick Oumar Doumbia  1   2   6 , Anna Jaeger  1   2 , Alexandre Zerbo  1   2 , Heidrun von Thien  2   7 , Philipp Klein  1   2 , Govert van Dam  7 , Egbert Tannich  8 , Norbert Georg Schwarz  1   2 , Eva Lorenz  1   2   9 , Jürgen May  1   2   10 , Raphael Rakotozandrindrainy  5 , Daniela Fusco  11   12
Affiliations

Prevalence and risk distribution of schistosomiasis among adults in Madagascar: a cross-sectional study

Sarah Katharina Gruninger et al. Infect Dis Poverty. .

Abstract

Background: The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for sustainable development goals, including universal health coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC.

Methods: In a cross-sectional study performed between March 2020 and January 2021 at three primary health care centers in Andina, Tsiroanomandidy and Ankazomborona in Madagascar, we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1482 adult participants. Univariable and multivariable logistic regression were performed to evaluate odd ratios.

Results: The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, in Andina and Ankazomborona respectively. Higher prevalence was observed among males (52.4%) and main contributors to the family income (68.1%). Not working as a farmer and higher age were found to be protective factors for infection.

Conclusions: Our findings provide evidence that adults are a high-risk group for schistosomiasis. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.

Keywords: Madagascar; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis; Universal health coverage.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Map of Madagascar showing the crude prevalence of Schistosoma species and co-infection status based on PCR at the study sites, n = 1482. Map was adapted using a template from https://yourfreetemplates.com
Fig. 2
Fig. 2
Risk factor analysis for PCR positivity of participants enrolled at (a) Schistosoma mansoni (n = 981) and (b) S. haematobium (n = 464) endemic study sites. Positivity rates, univariable and multivariable logistic regression with effect estimates in terms of crude and adjusted ORs and 95% CI. Variables that were controlled for in the multivariable regression, included: study site (when applicable), sex, age groups, education level, ever treated with praziquantel, working as a farmer and being main contributor to the family income. CI confidence interval, n sample size, OR odds ratio, PCR polymerase chain reaction, Pos. positivity frequencies, % Pos. positivity percentages
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