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A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection among school-aged children in a hard-to-reach area of Madagascar

2020; Oxford University Press; Volume: 114; Issue: 4 Linguagem: Inglês

10.1093/trstmh/traa009

1878-3503

Hannah J. Russell, James Penney, Cortland Linder, Elizabeth Joekes, Amaya L. Bustinduy, J. Russell Stothard, Daniel A. L. Rakotomampianina, Emmanuel Harizaka Andriamasy, Lalarizo Rakoto Mahary, Elodie P Ranjanoro, Alain Marcel Rahetilahy, Stephen A. Spencer,

Global Maternal and Child Health

A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis. School-aged children (5–14 y) were selected from six villages for parasitological and sonographic examination. Circulating cathodic antigen (CCA) tests and Kato Katz (KK) stool microscopy were performed. Video-clips of liver views were recorded with a SonoSite iViz and interpreted in the UK by comparison with standardised images (WHO protocol). The prevalence of schistosomiasis according to CCA testing was 97.8% (269/275) and 73.8% (203/275) by KK. Sonographic evidence of periportal fibrosis was observed in 11.3% (31/275). The youngest children with fibrosis were aged 6 y. Fibrosis was more common in older children (p=0.03) but was not associated with either infection intensity category (p=0.07) or gender (p=0.67). Findings of periportal fibrosis among children in these hard-to-reach villages suggests chronic Schistosoma mansoni infection from a very young age. This may reflect other similarly remote schistosomiasis-endemic areas and reinforces the need to investigate morbidity in neglected communities to understand the true extent of disease burden in endemic countries.