Wami Welcome M, Nausch Norman, Midzi Nicholas, Gwisai Reggis, Mduluza Takafira, Woolhouse Mark, Mutapi Francisca
Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
National Institute of Health Research, Causeway, Harare, Zimbabwe.
PLoS Negl Trop Dis. 2015 Mar 20;9(3):e0003649. doi: 10.1371/journal.pntd.0003649. eCollection 2015 Mar.
Several studies have been conducted quantifying the impact of schistosome infections on health and development in school-aged children. In contrast, relatively little is known about morbidity levels in preschool-aged children (≤ 5 years) who have been neglected in terms of schistosome research and control. The aim of this study was to compare the utility of available point-of-care (POC) morbidity diagnostic tools in preschool versus primary school-aged children (6-10 years) and determine markers which can be used in the field to identify and quantify Schistosoma haematobium-related morbidity.
METHODS/PRINCIPAL FINDINGS: A comparative cross-sectional study was conducted to evaluate the performance of currently available POC morbidity diagnostic tools on Zimbabwean children aged 1-5 years (n=104) and 6-10 years (n=194). Morbidity was determined using the POC diagnostics questionnaire-based reporting of haematuria and dysuria, clinical examination, urinalysis by dipsticks, and urine albumin-to-creatinine ratio (UACR). Attributable fractions were used to quantify the proportion of morbidity attributable to S. haematobium infection. Based on results of attributable fractions, UACR was identified as the most reliable tool for detecting schistosome-related morbidity, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination. The results of urine dipstick attributes showed that proteinuria and microhaematuria accounted for most differences between schistosome egg-positive and negative children (T=-50.1; p<0.001). These observations were consistent in preschool vs. primary school-aged children.
CONCLUSIONS/SIGNIFICANCE: Preschool-aged children in endemic areas can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. UACR for detecting albuminuria is recommended as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in children in the field. The use of dipstick microhaematuria and proteinuria as additional indicators of schistosome-related morbidity would improve the estimation of disease burden in young children.
已经开展了多项研究来量化血吸虫感染对学龄儿童健康和发育的影响。相比之下，对于在血吸虫病研究和防控方面被忽视的学龄前儿童（≤5岁）的发病水平了解相对较少。本研究的目的是比较现有即时检测（POC）发病诊断工具在学龄前儿童与小学适龄儿童（6 - 10岁）中的效用，并确定可在现场用于识别和量化埃及血吸虫相关发病情况的标志物。
方法/主要发现：开展了一项比较性横断面研究，以评估现有POC发病诊断工具对1 - 5岁（n = 104）和6 - 10岁（n = 194）津巴布韦儿童的性能。使用基于POC诊断问卷的血尿和排尿困难报告、临床检查、试纸条尿液分析以及尿白蛋白与肌酐比值（UACR）来确定发病情况。归因分数用于量化埃及血吸虫感染所致发病情况的比例。基于归因分数的结果，UACR被确定为检测血吸虫相关发病情况最可靠的工具，其次是试纸条、肉眼尿液检查、问卷，最后是临床检查。试纸条检测结果显示，蛋白尿和微量血尿占血吸虫卵阳性和阴性儿童之间的大多数差异（T = -50.1；p < 0.001）。这些观察结果在学龄前儿童与小学适龄儿童中是一致的。
结论/意义：使用适用于大龄儿童的现有相同诊断工具，可以有效地筛查流行地区学龄前儿童的血吸虫相关发病情况。建议将用于检测蛋白尿的UACR作为现场快速评估埃及血吸虫感染所致儿童发病情况的最佳选择。将试纸条微量血尿和蛋白尿用作血吸虫相关发病情况的额外指标将改善对幼儿疾病负担的估计。
