Surveillance of intestinal schistosomiasis during control: a comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region

Hajri Al-Shehri; Artemis Koukounari; Michelle C. Stanton; Moses Adriko; Moses Arinaitwe; Aaron Atuhaire; Narcis B. Kabatereine; J. Russell Stothard

doi:10.1017/s003118201800029x

journal article Open Access Mar 21, 2018

Surveillance of intestinal schistosomiasis during control: a comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region

Hajri Al-Shehri Artemis Koukounari Michelle C. Stanton Moses Adriko Moses Arinaitwe Aaron Atuhaire Narcis B. Kabatereine J. Russell Stothard

Parasitology Vol. 145 No. 13 pp. 1715-1722 · Cambridge University Press (CUP)

View at Publisher Save 10.1017/s003118201800029x

Abstract

AbstractProgrammatic surveillance of intestinal schistosomiasis during control can typically use four diagnostic tests, either singularly or in combination, but these have yet to be cross-compared directly. Our study assembled a complete diagnostic dataset, inclusive of infection intensities, from 258 children from five Ugandan primary schools. The schools were purposely selected as typical of the endemic landscape near Lake Albert and reflective of high- and low-transmission settings. Overall prevalence was: 44.1% (95% CI 38.0–50.2) by microscopy of duplicate Kato-Katz smears from two consecutive stools, 56.9% (95% CI 50.8–63.0) by urine-circulating cathodic antigen (CCA) dipstick, 67.4% (95% CI 61.6–73.1) by DNA-TaqMan® and 75.1% (95% CI 69.8–80.4) by soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA). A cross-comparison of diagnostic sensitivities, specificities, positive and negative predictive values was undertaken, inclusive of a latent class analysis (LCA) with a LCA-model estimate of prevalence by each school. The latter ranged from 9.6% to 100.0%, and prevalence by school for each diagnostic test followed a static ascending order or monotonic series of Kato-Katz, urine-CCA dipstick, DNA-TaqMan® and SEA-ELISA. We confirm that Kato-Katz remains a satisfactory diagnostic standalone in high-transmission settings but in low-transmission settings should be augmented or replaced by urine-CCA dipsticks. DNA-TaqMan® appears suitable in both endemic settings though is only implementable if resources permit. In low-transmission settings, SEA-ELISA remains the method of choice to evidence an absence infection. We discuss the pros and cons of each method concluding that future surveillance of intestinal schistosomiasis would benefit from a flexible, context-specific approach both in choice and application of each diagnostic method, rather than a single one-size fits all approach.

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Details

Published: Mar 21, 2018
Vol/Issue: 145(13)
Pages: 1715-1722
License: View

Authors

Narcis B. Kabatereine

Ministry of Health 5 Division of Vector Bourne Diseases , , Kampala ,

J

J. Russell Stothard

Cite This Article

Hajri Al-Shehri, Artemis Koukounari, Michelle C. Stanton, et al. (2018). Surveillance of intestinal schistosomiasis during control: a comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region. Parasitology, 145(13), 1715-1722. https://doi.org/10.1017/s003118201800029x

Surveillance of intestinal schistosomiasis during control: a comparison of four diagnostic tests across five Ugandan primary schools in the Lake Albert region

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