Global Health Institute, Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Département des Sciences de la Santé Publique, Direction de la Formation, Institut National de Santé Publique, Bujumbura, Burundi.
Parasit Vectors. 2020 Apr 21;13(1):206. doi: 10.1186/s13071-020-04076-4.
Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration with praziquantel has been rolled out in 11 endemic districts. The national programme relies on school-based surveys with kato-katz to monitor the impact of mass drug administration. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears at health centre level could be used.
From the Burundian National Health Information System, we collected routine incidence data on intestinal schistosomiasis as determined by direct smear examination in all 45 sanitary districts during 2011-2015. A temporal trends analysis was performed using a mixed negative binomial regression. Sanitary districts with mass drug administration campaigns with praziquantel (n = 11) were compared with those without (n = 34). In addition, prevalence data on intestinal schistosomiasis based on kato-katz results from a school-based national mapping in 2014 were compared with the incidence data in health centres based on direct smear results, in the same 45 sanitary districts.
In the 11 sanitary districts applying mass drug administration with praziquantel, the incidence rate decreased significantly for the years 2014 (β = - 0.826, P = 0.010) and 2015 (β = - 1.294, P < 0.001) and for the five-year period (β = - 0.286, P < 0.001), whereas in the 34 districts where mass drug administration was not delivered, there was no significant decrease over time (β = - 0.087, P = 0.219). In most of the 45 sanitary districts, the low prevalence based on kato-katz in school children was confirmed by low incidence rates based on direct smears in the health centres.
National Health Information System surveillance data, based on routinely collected direct smear results at health centre level, may be able to monitor the impact of mass drug administration with praziquantel on intestinal schistosomiasis in Burundi. Control and elimination of intestinal schistosomiasis call for integration of adequate diagnosis and treatment into routine activities of primary health care facilities, as recommended by the World Health Organization since more than 20 years. When moving towards elimination, more sensitive tests, such as the point-of-care circulating cathodic antigen assay are desirable.
肠血吸虫病在布隆迪仍是一个公共卫生问题。自 2008 年以来，该国在 11 个流行地区每年都开展以吡喹酮为基础的大规模药物治疗。国家方案依靠以学校为基础的加藤氏滤纸法粪便检查来监测大规模药物治疗的效果。我们探讨了是否可以使用在基层医疗中心通过直接粪便涂片确定的常规肠道血吸虫病数据。
我们从布隆迪国家卫生信息系统收集了 2011 年至 2015 年期间所有 45 个卫生区通过直接涂片检查确定的肠道血吸虫病的常规发病率数据。使用混合负二项回归进行时间趋势分析。比较了有（n=11）和没有（n=34）大规模药物治疗活动的卫生区。此外，还将 2014 年以学校为基础的全国绘图基于加藤氏滤纸法的肠道血吸虫病患病率数据与同一 45 个卫生区基层医疗中心基于直接涂片结果的发病率数据进行了比较。
在应用吡喹酮进行大规模药物治疗的 11 个卫生区，2014 年（β=-0.826，P=0.010）和 2015 年（β=-1.294，P<0.001）以及五年期间（β=-0.286，P<0.001）发病率显著下降，而在未开展大规模药物治疗的 34 个区，发病率并未随时间推移而显著下降（β=-0.087，P=0.219）。在大多数 45 个卫生区，以学校儿童为基础的加藤氏滤纸法的低患病率与基层医疗中心直接涂片的低发病率相符。
国家卫生信息系统监测数据，基于基层医疗中心常规收集的直接涂片结果，可能能够监测布隆迪吡喹酮大规模药物治疗对肠道血吸虫病的影响。正如世界卫生组织 20 多年来所建议的，控制和消除肠道血吸虫病需要将适当的诊断和治疗纳入初级卫生保健机构的常规活动。在向消除迈进时，更敏感的检测方法，如即时循环抗原检测，是可取的。
