Standley Claire J, Adriko Moses, Alinaitwe Moses, Kazibwe Francis, Kabatereine Narcis B, Stothard J Russell
Department of Zoology, Natural History Museum, London SW7 5BD, UK.
Geospat Health. 2009 Nov;4(1):39-53. doi: 10.4081/gh.2009.209.
Even with a national control programme in place, intestinal schistosomiasis continues to be a major public health problem in school-aged children and other community members in Uganda. This is especially the case in the environments around the Great Lakes, where disease transmission is high, such as Lake Victoria. Moreover, in the most remote areas, some schools might periodically miss large-scale drug administrations owing to inaccessibility. To provide contemporary monitoring and surveillance data, 27 schools along the lakeshore were surveyed with a rapid assessment protocol to determine both prevalence and intensity of Schistosoma mansoni and soil-transmitted helminth infections. In total, 25 (92.6%) of schools were positive for S. mansoni, with an average prevalence across the surveyed children of 42% and average infection intensity of 634 eggs per gram of faeces. Mean prevalence of Trichuris trichiura, Ascaris lumbricoides and hookworm was 12.9%, 9.3% and 2.4%, respectively. Results from questionnaire data revealed a high level of itinerancy among the children, and a total of 38.2% reported to have never received treatment for schistosomiasis, despite 96% living in districts targeted by the national control programme. A birthplace outside of Uganda was a significant predictor for increased risk of schistosomiasis infection (odds ratio (OR) = 9.6), and being resident at a school for less than a year was significantly associated with absence of praziquantel treatment (OR = 0.3). Univariate regression analysis showed a trend of increasing schistosomiasis towards the eastern region of Uganda, while semivariograms of infection prevalence demonstrated a range of spatial autocorrelation of ~78 km. Soil-transmitted helminth infections were more common in the Western region. Our results emphasise how social and demographic variables such as migration may affect epidemiological trends and confound the impact of existing treatment regimes.
即便乌干达已实施全国性防控计划，但肠道血吸虫病仍是学龄儿童及其他社区成员面临的重大公共卫生问题。在大湖周边地区，情况尤为如此，比如维多利亚湖周边疾病传播率很高。此外，在一些最偏远地区，部分学校因交通不便可能会定期错过大规模药物驱虫活动。为提供当代监测和 surveillance 数据，采用快速评估方案对湖岸沿线的27所学校进行了调查，以确定曼氏血吸虫和土壤传播蠕虫感染的流行率及感染强度。总计有25所（92.6%）学校曼氏血吸虫呈阳性，被调查儿童的平均流行率为42%，平均感染强度为每克粪便634个虫卵。鞭虫、蛔虫和钩虫的平均流行率分别为12.9%、9.3%和2.4%。问卷调查数据结果显示，儿童中有很高的流动性，尽管96%的儿童生活在国家防控计划所针对的地区，但总计有38.2%的儿童报告从未接受过血吸虫病治疗。出生在乌干达境外是血吸虫病感染风险增加的一个重要预测因素（优势比（OR）=9.6），而在学校居住不到一年与未接受吡喹酮治疗显著相关（OR = 0.3）。单变量回归分析显示，乌干达东部地区血吸虫病有增加趋势，而感染流行率的半变异函数显示空间自相关范围约为78公里。土壤传播蠕虫感染在西部地区更为常见。我们的研究结果强调了诸如移民等社会和人口统计学变量可能如何影响流行病学趋势并混淆现有治疗方案的效果。
