Nanomedicine Translation Group, Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland.
CLINAM-European Foundation for Clinical Nanomedicine, Basel, Switzerland.
PLoS Negl Trop Dis. 2021 Dec 2;15(12):e0009486. doi: 10.1371/journal.pntd.0009486. eCollection 2021 Dec.
Schistosomiasis, caused by Schistosoma mansoni, is of great significance to public health in sub-Saharan Africa. In the Democratic Republic of Congo (DRC), information on the burden of S. mansoni infection is scarce, which hinders the implementation of adequate control measures. We assessed the geographical distribution of S. mansoni infection across Ituri province in north-eastern DRC and determined the prevailing risk factors.
METHODS/PRINCIPAL FINDINGS: Two province-wide, community-based studies were conducted. In 2016, a geographical distribution study was carried out in 46 randomly selected villages across Ituri. In 2017, an in-depth study was conducted in 12 purposively-selected villages, across the province. Households were randomly selected, and members were enrolled. In 2016, one stool sample was collected per participant, while in 2017, several samples were collected per participant. S. mansoni eggs were detected using the Kato-Katz technique. In 2017, a point-of-care circulating cathodic S. mansoni antigen (POC-CCA) urine test was the second used diagnostic approach. Household and individual questionnaires were used to collect data on demographic, socioeconomic, environmental, behavioural and knowledge risk factors. Of the 2,131 participants in 2016, 40.0% were positive of S. mansoni infection. Infection prevalence in the villages ranged from 0 to 90.2%. Of the 707 participants in 2017, 73.1% were tested positive for S. mansoni. Prevalence ranged from 52.8 to 95.0% across the health districts visited. Infection prevalence increased from north to south and from west to east. Exposure to the waters of Lake Albert and the villages' altitude above sea level were associated with the distribution. Infection prevalence and intensity peaked in the age groups between 10 and 29 years. Preschool children were highly infected (62.3%). Key risk factors were poor housing structure (odds ratio [OR] 2.1, 95% 95% confidence interval [CI] 1.02-4.35), close proximity to water bodies (OR 1.72, 95% CI 1.1-2.49), long-term residence in a community (OR 1.41, 95% CI 1.11-1.79), lack of latrine in the household (OR 2.00, 95% CI 1.11-3.60), and swimming (OR 2.53, 95% CI 1.20-5.32) and washing (OR 1.75, 95% CI 1.10-2.78) in local water bodies.
CONCLUSIONS/SIGNIFICANCE: Our results show that S. mansoni is highly endemic and a major health concern in Ituri province, DRC. Infection prevalence and intensity, and the prevailing socioeconomic, environmental, and behavioural risk factors in Ituri reflect intense exposure and alarming transmission rates. A robust plan of action is urgently needed in the province.
由曼氏血吸虫引起的血吸虫病对撒哈拉以南非洲的公共卫生具有重要意义。在刚果民主共和国（DRC），曼氏血吸虫感染的负担信息稀缺，这阻碍了充分控制措施的实施。我们评估了东北部伊图里省曼氏血吸虫感染的地理分布，并确定了主要的流行风险因素。
方法/主要发现：进行了两项全省范围的社区为基础的研究。2016 年，在伊图里省 46 个随机选择的村庄进行了地理分布研究。2017 年，在全省 12 个有针对性选择的村庄进行了深入研究。随机选择家庭，招募家庭成员。2016 年，每个参与者采集一份粪便样本，2017 年，每个参与者采集多份粪便样本。使用加藤氏厚涂片法检测曼氏血吸虫卵。2017 年，采用即时循环阴性质控抗原（POC-CCA）尿液检测作为第二种诊断方法。家庭和个人问卷用于收集人口统计学、社会经济、环境、行为和知识风险因素的数据。在 2016 年的 2131 名参与者中，40.0%的人感染了曼氏血吸虫。村庄的感染率从 0 到 90.2%不等。在 2017 年的 707 名参与者中，73.1%的人检测出曼氏血吸虫阳性。感染率在访问的卫生区从 52.8%到 95.0%不等。感染率从北到南，从西到东增加。暴露于阿尔伯特湖的水域和村庄的海拔高度与分布有关。感染率和强度在 10 至 29 岁年龄组中达到峰值。学龄前儿童感染率很高（62.3%）。主要风险因素包括住房结构差（比值比 [OR] 2.1，95%置信区间 [CI] 1.02-4.35）、靠近水体（OR 1.72，95%CI 1.1-2.49）、长期居住在社区（OR 1.41，95%CI 1.11-1.79）、家庭无厕所（OR 2.00，95%CI 1.11-3.60）、游泳（OR 2.53，95%CI 1.20-5.32）和在当地水体中洗涤（OR 1.75，95%CI 1.10-2.78）。
结论/意义：我们的结果表明，曼氏血吸虫在刚果民主共和国伊图里省高度流行，是一个主要的健康问题。伊图里省的感染率和强度以及流行的社会经济、环境和行为风险因素反映了强烈的暴露和令人震惊的传播率。该省迫切需要制定一项强有力的行动计划。
