Duguay Claudia, Mosha Jacklin F, Lukole Eliud, Mangalu Doris, Thickstun Charles, Mallya Elizabeth, Aziz Tatu, Feng Cindy, Protopopoff Natacha, Mosha Franklin, Manjurano Alphaxard, Krentel Alison, Kulkarni Manisha A
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
National Institute of Medical Research Tanzania, Mwanza Research Centre, Mwanza, Tanzania.
PLOS Glob Public Health. 2023 Nov 22;3(11):e0002468. doi: 10.1371/journal.pgph.0002468. eCollection 2023.
Malaria and schistosomiasis are two major parasitic vector-borne diseases that are a particular threat to young children in Sub-Saharan Africa. In the present study, we investigated factors that are associated with malaria, schistosomiasis, and co-infection among school-aged children, using an explanatory sequential mixed-methods approach. A cross-sectional study was conducted in January 2022 in Misungwi, Tanzania, that sampled 1,122 children aged 5 to 14 years old for malaria and schistosomiasis infection. Mixed-effect logistic regression models were used to assess the association between infection prevalence or seroprevalence, and environmental determinants that create favorable conditions for vectors and parasites and social determinants that relate to disease exposure. Community mapping combined with direct field observations were conducted in August 2022 in three selected villages from the cross-sectional study to understand specific water use behaviors and to identify potential malaria mosquito larval breeding sites and freshwater snail habitat. The prevalence of malaria, seroprevalence of schistosomiasis, and co-infection in this study were 40.4%, 94.3%, and 38.1%, respectively. Individual-level factors emerged as the primary determinants driving the association with infection, with age (every one-year increase in age) and sex (boys vs girls) being statistically and positively associated with malaria, schistosomiasis, and co-infection (P<0.05 for all). Community maps identified many unimproved water sources in all three villages that were used by humans, cattle, or both. We found that children primarily fetched water, and that unprotected wells were dedicated for drinking water whereas ponds were dedicated for other domestic uses and cattle. Although not identified in the community maps, we found hand pumps in all three villages were not in use because of unpleasant taste and high cost. This study improves our understanding of individual, social and environmental factors that are associated with malaria, schistosomiasis, and co-infection, which can inform potential entry points for integrated disease prevention and control.
疟疾和血吸虫病是两种主要的寄生虫媒介传播疾病，对撒哈拉以南非洲的幼儿构成特别威胁。在本研究中，我们采用解释性序列混合方法，调查了学龄儿童中与疟疾、血吸虫病及合并感染相关的因素。2022年1月在坦桑尼亚的米松圭进行了一项横断面研究，对1122名5至14岁的儿童进行疟疾和血吸虫病感染抽样。使用混合效应逻辑回归模型评估感染率或血清阳性率与为病媒和寄生虫创造有利条件的环境决定因素以及与疾病暴露相关的社会决定因素之间的关联。2022年8月，在横断面研究中选取的三个村庄进行了社区绘图并结合直接实地观察，以了解具体的用水行为，并确定潜在的疟疾蚊虫幼虫滋生地和淡水蜗牛栖息地。本研究中疟疾的患病率、血吸虫病的血清阳性率和合并感染率分别为40.4%、94.3%和38.1%。个体层面的因素成为驱动感染关联的主要决定因素，年龄（每增加一岁）和性别（男孩与女孩）与疟疾、血吸虫病及合并感染在统计学上呈正相关（所有P<0.05）。社区地图显示，所有三个村庄都有许多未经改善的水源，供人类、牲畜或两者使用。我们发现儿童主要负责取水，未加保护的水井专门用于饮用水，而池塘则专门用于其他家庭用途和牲畜用水。尽管在社区地图中未发现，但我们发现所有三个村庄的手动泵都因味道不佳和成本高昂而未使用。这项研究增进了我们对与疟疾、血吸虫病及合并感染相关的个体、社会和环境因素的理解，可为综合疾病预防和控制的潜在切入点提供信息。
