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Improving control of African schistosomiasis: towards effective use of rapid diagnostic tests within an appropriate disease surveillance model.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Apr; 103(4):325-32.Contemporary control of schistosomiasis is typically reliant upon large-scale administration of praziquantel (PZQ) to school age children. Whilst PZQ treatment of each child is inexpensive, the direct and indirect costs of preventive chemotherapy for the whole school population are more substantive and, at the national level where many schools are targeted, maximising cost effectiveness and the health impact are essential requirements for ensuring longer-term sustainability (i.e. >5 years). To this end, the WHO has issued a set of treatment guidelines, inclusive of re-treatment schedules, such that, where possible, treatment decisions by school are based upon local disease prevalence as determined by parasitological and/or questionnaire methods. As each diagnostic method has known shortcomings, presumptive treatment of at-risk schools may initially be preferred, especially if the existing infrastructure for disease surveillance is poor. It is against this background of school-based preventive chemotherapy that a rapid diagnostic test (RDT) for schistosomiasis is most urgently needed, not only to improve initial disease surveillance but also to focus drug delivery better through time. In this paper, the development, evaluation and application of selected diagnostic tests are reviewed to identify barriers that impede progress, foremost of which is that a new disease surveillance and evaluation model is required where the in-country price of each RDT ideally needs to be less than US$1 to be cost effective both in the short- and long-term perspective.
The WHO dose pole for the administration of praziquantel is also accurate in non-African populations.
Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005; 99:78-81.In 2001, WHO developed a pole for the administration of praziquantel without the use of weighing scales, with encouraging results in African populations. In the present study, the pole was tested on height/weight data from 9354 individuals from 11 non-African countries. In more than 98% of the individuals (95% CI 97.8—98.4) the pole estimated an acceptable dosage (30—60 mg/kg), a performance statistically similar to that observed in African populations. Reproducing the present pole in the form of a strip of paper and including it in each container of praziquantel would greatly facilitate the administration of the drug in large-scale interventions. (author's)
Lancet. 2003 Dec 6; 362(9399):1932-1934.Schistosomiasis, a chronic and debilitating disease, is draining the economic and social development in much of the tropics, especially in sub-Saharan Africa, where 85% of its global burden is concentrated. An estimated 200 million people are infected and more than 600 million live in endemic areas. Sustained heavy infection leads to morbidity, contributes to anaemia, and often results in retarded growth and reduced physical and cognitive function in children. Recent estimates suggest that the yearly death rate of schistosomiasis in sub-Saharan Africa exceeds 200 000, which is largely attributable to renal failure or haematemesis. WHO has proposed a dual strategy to control schistosomiasis. The strategy rests on morbidity control in high-burden regions and consolidation of control measures where the endemicity has been greatly reduced.2,3 Safe, effective, single-dose antischistosomal drugs—eg, praziquantel—have been available for 25 years. The large reduction in cost to less than US$0·30 per treatment3 has been the leverage for chemotherapy-based morbidity control. However, a serious limitation of chemotherapy alone is its indefinite dependence (dependence for an unlimited period of time) on praziquantel, potentially reducing the useful life-span of this drug. Preventive measures, focused on clean water, adequate sanitation, and health education, are essential features of any long-term strategy for reduction and elimination of schistosomiasis.7,8 The absence of such measures in many past programmes stems from a severe lack of resources plus inadequate capacity and political commitment to emphasise clean water and sanitation as a basic human need. We are now witnessing a sea of change in the political landscape that should facilitate provision of clean water and sanitation. High priority has been given to this task in the United Nations Millennium Development Goals, embodied in the Millennium Declaration set forth in September, 2000. Further, it was one of the top priorities at the World Summit on Sustainable Development, held in September, 2002, in Johannesburg, South Africa, and during the 3rd World Water Forum, convened in Japan in March, 2003. The specific provision is to halve the number of people without access to clean water supply and sanitation by 2015.9,10 Linking schistosomiasis control to these initiatives has the potential to ensure long-term control and, in many instances, elimination of the disease. (author's)