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To elucidate determinants of morbidity in schistosomiasis mansoni, a community-based study was undertaken involving 2,451 subjects (mean age, 18.8 ± 15.3 [SD] years) from four endemic sites in Ethiopia. Overall prevalence of infection was 65.9%, reported blood in stools was 35.8%, and schistosomal periportal thickening/fibrosis (PPT/F) was 4.6%. Similarly, 43.2% were positive for at least one marker of hepatitis B virus (HBV), 5.3% were HBsAg positive, and 1.3% were anti-hepatitis C virus (HCV) positive. Prevalence of PPT/F increased significantly with increasing community prevalence and intensity of S. mansoni infection. In a multiple logistic regression analysis, intensity of egg excretion, markers of HBV infection, age, and male sex were significantly associated with PPT/F, whereas co-infection with other intestinal helminths was associated with lower odds for PPT/F. HCV was not associated with S. mansoni infection or with schistosomal PPT/F. In conclusion, integrated helminth control targeting school-aged children, who have the highest burden infection, should be used to substantially reduce the risk of periportal fibrosis.
Received May 2, 2007. Accepted for publication August 31, 2007.
Acknowledgments: We thank Endashaw Habte, Mulugeta Ginchile, and Abraham Redda for excellent laboratory work; Girmay Medhin for statistical advice; the staff of Kemisse Health Centre, Cheretee, and Sille clinics for unreserved assistance in our fieldwork; and the administrative and technical staff of Aklilu Lemma Institute of Pathobiology for encouragement and support.
Financial support: This study was financially supported by Centre for Imported and Tropical Diseases, Ullevål University Hospital, Norway, and the Norwegian Research Council through the project entitled "Control of schistosomiasis by local production and use of the Ethiopian soapberry Endod." NB is a recipient of a PhD scholarship through the Norwegian Statens lånekasse.
Disclosure: The authors have no conflict of interest. NB, SGG, and BM were responsible for the study concept and design. NB was responsible for the acquisition of clinical, parasitologic, and ultrasonographic data. NB analyzed the data and prepared the manuscript. All authors had access to the data, verified the data analysis, and contributed to the critical revision of the manuscript for important intellectual content.
* Address correspondence to Nega Berhe, Ullevål University Hospital, Department of Infectious Diseases, Centre for Imported and Tropical Diseases, 0407 Oslo, Norway. E-mail: nega_berhe{at}yahoo.com
Authors’ addresses: Nega Berhe, Aklilu Lemma, Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis Ababa, Ethiopia, Telephone: 251-11-2763091, Fax: 251-11-2755296, E-mail: nega_berhe{at}yahoo.com and Institute for International Health, University of Oslo, PO Box. 1130, N-0318 Oslo, Norway, E-mail: nega.berhe{at}samfunnsmed.uio.no. Bjørn Myrvang, Ullevål University Hospital, Department of Infectious Diseases, Centre for Imported and Tropical Diseases, 0407 Oslo, Norway, Telephone: 47-22119097, Fax: 47-23016020, E-mail: Bjorn.Myrvang{at}ulleval.no. Svein G. Gundersen, Sorlandet Hospital HF/Agder University College, Box 416, 4604 Kristiansand, Norway, Telephone: 47-38074474, Fax: 47-38074173, E-mail: s.g.gundersen{at}sshf.no.
Reprint requests: Nega Berhe, Ullevål University Hospital, Department of Infectious Diseases, Centre for Imported and Tropical Diseases, 0407 Oslo, Norway, Phone: +47 22119097, Fax: +47 23016020. E-mail: nega_berhe{at}yahoo.com.
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