Open AccessEpidemiology of Schistosoma mansoni infection in Ituri Province, north-eastern Democratic Republic of the Congo
Author(s) -
Maurice M Nigo,
Peter Odermatt,
Georgette B. Salieb-Beugelaar,
Oleksii Morozov,
Manuel Battegay,
Patrick Hunziker
Publication year - 2021
Publication title -
plos neglected tropical diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.99
H-Index - 135
eISSN - 1935-2735
pISSN - 1935-2727
DOI - 10.1371/journal.pntd.0009486
Subject(s) - schistosoma mansoni , schistosomiasis , socioeconomic status , epidemiology , environmental health , public health , medicine , mass drug administration , helminthiasis , geography , veterinary medicine , population , demography , helminths , immunology , nursing , sociology
Background Schistosomiasis, caused by Schistosoma mansoni , is of great significance to public health in sub–Saharan Africa. In the Democratic Republic of Congo (DRC), information on the burden of S . mansoni infection is scarce, which hinders the implementation of adequate control measures. We assessed the geographical distribution of S . mansoni infection across Ituri province in north-eastern DRC and determined the prevailing risk factors. Methods/Principal findings Two province–wide, community–based studies were conducted. In 2016, a geographical distribution study was carried out in 46 randomly selected villages across Ituri. In 2017, an in–depth study was conducted in 12 purposively–selected villages, across the province. Households were randomly selected, and members were enrolled. In 2016, one stool sample was collected per participant, while in 2017, several samples were collected per participant. S . mansoni eggs were detected using the Kato–Katz technique. In 2017, a point–of–care circulating cathodic S . mansoni antigen (POC–CCA) urine test was the second used diagnostic approach. Household and individual questionnaires were used to collect data on demographic, socioeconomic, environmental, behavioural and knowledge risk factors. Of the 2,131 participants in 2016, 40.0% were positive of S . mansoni infection. Infection prevalence in the villages ranged from 0 to 90.2%. Of the 707 participants in 2017, 73.1% were tested positive for S . mansoni . Prevalence ranged from 52.8 to 95.0% across the health districts visited. Infection prevalence increased from north to south and from west to east. Exposure to the waters of Lake Albert and the villages’ altitude above sea level were associated with the distribution. Infection prevalence and intensity peaked in the age groups between 10 and 29 years. Preschool children were highly infected (62.3%). Key risk factors were poor housing structure (odds ratio [OR] 2.1, 95% 95% confidence interval [CI] 1.02–4.35), close proximity to water bodies (OR 1.72, 95% CI 1.1–2.49), long-term residence in a community (OR 1.41, 95% CI 1.11–1.79), lack of latrine in the household (OR 2.00, 95% CI 1.11–3.60), and swimming (OR 2.53, 95% CI 1.20–5.32) and washing (OR 1.75, 95% CI 1.10–2.78) in local water bodies. Conclusions/Significance Our results show that S . mansoni is highly endemic and a major health concern in Ituri province, DRC. Infection prevalence and intensity, and the prevailing socioeconomic, environmental, and behavioural risk factors in Ituri reflect intense exposure and alarming transmission rates. A robust plan of action is urgently needed in the province.