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Morbidity due to Schistosoma mansoni: an epidemiological assessment of distended abdomen syndrome in Ugandan school children with observations before and 1-year after anthelminthic chemotherapy

Balen, Julie ; Stothard, J. Russell ; Kabatereine, Narcis B. ; Tukahebwa, Edridah M. ; Kazibwe, Francis ; Whawell, Sarah ; Webster, Joanne P. ; Utzinger, Jürg ; Fenwick, Alan

In: Transactions of The Royal Society of Tropical Medicine and Hygiene, 2006, vol. 100, no. 11, p. 1039-1048

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    Title
    • Morbidity due to Schistosoma mansoni: an epidemiological assessment of distended abdomen syndrome in Ugandan school children with observations before and 1-year after anthelminthic chemotherapy
    Author
    • Balen, Julie. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
    • Stothard, J. Russell. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
    • Kabatereine, Narcis B.. Vector Control Division, Ministry of Health, Kampala, Uganda
    • Tukahebwa, Edridah M.. Vector Control Division, Ministry of Health, Kampala, Uganda
    • Kazibwe, Francis. Vector Control Division, Ministry of Health, Kampala, Uganda
    • Whawell, Sarah. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
    • Webster, Joanne P.. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
    • Utzinger, Jürg. Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
    • Fenwick, Alan. Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Transactions of The Royal Society of Tropical Medicine and Hygiene, 2006, vol. 100, no. 11, p. 1039-1048. Royal Society of Tropical Medicine and Hygiene
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:298011
    Summary
    The objectives of this study were to determine the prevalence and distribution of distended abdomens among Ugandan school children across a range of eco-epidemiological settings and to investigate the relationship between distended abdomens and helminth infections, in particular Schistosoma mansoni, before and 1-year after anthelminthic treatment. A cross-sectional survey was conducted on 4354 school children across eight districts, with a longitudinal 1-year follow-up of 2644 children (60.7%). On both occasions, parasitological, biometrical and clinical data were collected for each child. Baseline prevalence of S. mansoni and hookworms was 44.3% and 51.8%, respectively. Distended abdomens, defined as an abdominal circumference ratio (ACR) >1.05, were observed in 2.5% of the sampled children, several of whom presented with particularly severe distensions necessitating hospital referral. ACR scores were highly overdispersed between districts and schools. Multivariate regression analysis revealed that S. mansoni infection accounted for only a small fraction of ACR variation, suggesting that either single point prevalence and intensity measures failed to reflect this more chronically evolved morbidity and/or that other interacting factors were involved, e.g. malnutrition and malaria. At 1-year follow-up, ACR scores showed an overall trend of regression towards the mean, potentially indicative of amelioration following chemotherapy, but geographic overdispersion still remained