AJTMH Transactions of the Royal Society of Tropical Medicine and Hygiene
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Am. J. Trop. Med. Hyg., 75(6), 2006, pp. 1042-1052
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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ASSESSMENT OF ULTRASOUND MORBIDITY INDICATORS OF SCHISTOSOMIASIS IN THE CONTEXT OF LARGE-SCALE PROGRAMS ILLUSTRATED WITH EXPERIENCES FROM MALIAN CHILDREN

ARTEMIS KOUKOUNARI*, MOUSSA SACKO, ADAMA D. KEITA, ALBIS F. GABRIELLI, ALY LANDOURÉ, ROBERT DEMBELÉ, ARCHIE C. CLEMENTS, SARAH WHAWELL, CHRISTL A. DONNELLY, ALAN FENWICK, MAMADOU TRAORÉ, AND JOANNE P. WEBSTER
Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, United Kingdom; Institut National de Recherche en Santé Publique, Ministère de la Santé, Bamako, Mali; Service de Radiologie, Hôpital National du Point G, Bamako, Mali; Programme National de Lutte contre la Schistosomiase et les Géohelminthiases, Direction Nationale de la Santé, Ministère de la Santé, Bamako, Mali; Direction Nationale de la Santé, Ministère de la Santé, Bamako, Mali; Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom

We assessed morbidity indicators for both Schistosoma haematobium and Schistosoma mansoni infections and evaluated the appropriateness of the World Health Organization (WHO) guidelines for ultrasound in schistosomiasis in the context of large-scale control interventions. Abdominal and urinary tract ultrasonography was performed on 2,247 and 2,822 school children, respectively, from 29 randomly selected schools in Mali before the implementation of mass anthelminthic drug administration. Using two-level logistic regression models, we examined associations of potential factors with the risk of having a positive ultrasound global score (morbidity indicative of S. haematobium infection), abnormal image pattern scores, dilatation of the portal vein, and/or enlarged liver (morbidity indicative of S. mansoni infection). The WHO protocol was found useful for detection of S. haematobium pathology but overestimated the risk of portal vein dilatation and left liver lobe enlargement associated with S. mansoni infection. We conclude that ultrasonography should be included in large-scale control interventions, where logistics allow, but cautiously.

Received February 28, 2006. Accepted for publication June 22, 2006.

Acknowledgments: We thank the field and technical staff of the Malian Ministry of Health (Institut National de Recherche en Santé Publique and Programme National de Lutte contre la Schistosomiase et les Géohelminthiases) for their collaboration. A special thank to the headteachers, staff, and children for their willingness to participate in the survey. We also thank Dr. Birgitte J. Vennervald for comments on the manuscript and Caoimhe O. Sullivan for advice on statistical issues.

Financial support: The SCI was generously supported by a grant from the Bill and Melinda Gates Foundation.

* Address correspondence to Artemis Koukounari, Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, St. Mary’s Campus, Norfolk Place, London W2 1PG, United Kingdom. E-mail: artemis.koukounari{at}imperial.ac.uk

Authors’ addresses: Artemis Koukounari, Albis Francesco Gabrielli, Archie C. Clements, Sarah Whawell, Alan Fenwick and Joanne P. Webster, Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, St. Mary’s Campus, Norfolk Place, London W2 1PG, United Kingdom, Telephone: 44-20-7594-3820, Fax: 44-20-7262-8140, E-mails: artemis.koukounari{at}imperial.ac.uk, artemis.koukounari{at}imperial.ac.uk, a.clements{at}imperial.ac.uk, a.fenwick{at}imperial.ac.uk, and joanne.webster{at}imperial.ac.uk. Moussa Sacko and Aly Landouré, Institut National de Recherche en Santé Publique, Ministère de la Santé, Bamako BP 1771, Mali, E-mails: msacko{at}dblnet.dk and aland{at}afribonemali.net. Adama D. Keita, Service de Radiologie, Hôpital National du Point G, Bamako BP 333, Mali, E-mail: gadkeita{at}hotmail.com. Robert Dembelé, Programme National de Lutte contre la Schistosomiase et les Géohelminthiases, Direction Nationale de la Santé, Ministère de la Santé, Bamako BP 232, Mali BP, E-mail: rdembele2000{at}yahoo.fr. Christl A. Donnelly, Department of Infectious Disease Epidemiology, Imperial College Faculty of Medicine, St. Mary’s Campus, Norfolk Place, London W2 1PG, United Kingdom, E-mail: c.donnelly{at}imperial.ac.uk. Mamadou Traoré, Direction Nationale de la Santé, Ministère de la Santé, Bamako BP 232, Mali BP, E-mail: mstraore{at}dnsmali.org.






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Copyright © 2006 by the American Society of Tropical Medicine and Hygiene.