Ekpo Uwem F, Olamiju Francisca O, Mogaji Hammed O, Ovia Samuel N, Oladipupo Olanike O, Kehinde Alice Y, Oyediran Fatai O, Aderogba Moses, Makau-Barasa Louise K
Federal University of Agriculture, Abeokuta, Nigeria.
Akwa Ibom State University, Ikot Akpaden, Nigeria.
Am J Trop Med Hyg. 2025 Feb 18;112(5):987-999. doi: 10.4269/ajtmh.24-0352. Print 2025 May 7.
Efforts to eliminate schistosomiasis in Africa have advanced, with most countries evaluating the impact of preventive chemotherapy (PC) on disease burden. WHO has recommended eight distinct methodologies for such assessment. We, therefore, investigated the sensitivity of three prominent methodologies-sentinel, cluster, and practical, each varying in site selection, sampling approach, and data interpretation. We conducted a cross-sectional study among 2,093 children across 45 schools in Ese-Odo, Ile-Oluiji, and Irele local government areas (LGAs) of Ondo, Nigeria. Fresh stool and urine samples were processed using Kato-Katz and urine filtration techniques to estimate prevalence, which was compared with 2014 baseline estimates. Findings showed significant prevalence reductions in Ese-Odo from 1.3% (95% CI: 0.5-3.3) at baseline to 0.1% (95% CI: 0.01-0.95) at impact (d = -92.3%, P = 0.03) and in Ile-Oluiji from 58.0% (95% CI: 53.9-62.1) to 1.8% (95% CI: 0.9-3.3; d = -97%, P = 0.00). However, it increased from 3.0% (95% CI: 1.6-5.6) to 5.3% (95% CI: 3.8-7.3) in Irele (d = 66%, P = 0.13). Higher prevalence estimates were observed with the practical method compared with cluster and sentinel across the three LGAs: 0.3% versus 0.1% versus 0.0% in Ese-Odo, 5.8% versus 5.3% versus 5.4% in Irele, and 2.2% versus 1.8% versus 1.5% in Ile-Oluiji (all P >0.05). Sentinel and cluster methodologies suggest stopping PC, whereas the practical method suggests continued PC in Irele. Our findings demonstrate that practical assessment is a sensitive method for refining PC decisions.
非洲消除血吸虫病的工作取得了进展，大多数国家正在评估预防性化疗（PC）对疾病负担的影响。世界卫生组织推荐了八种不同的评估方法。因此，我们研究了三种主要方法——哨点法、整群法和实用法的敏感性，这三种方法在地点选择、抽样方法和数据解读方面各有不同。我们在尼日利亚翁多州埃塞 - 奥多、伊莱 - 奥卢伊吉和伊雷勒地方政府辖区（LGA）的45所学校的2093名儿童中开展了一项横断面研究。使用加藤厚涂片法和尿液过滤技术对新鲜粪便和尿液样本进行处理，以估算流行率，并与2014年的基线估算值进行比较。结果显示，埃塞 - 奥多的流行率从基线时的1.3%（95%置信区间：0.5 - 3.3）显著降至影响期的0.1%（95%置信区间：0.01 - 0.95）（d = -92.3%，P = 0.03），伊莱 - 奥卢伊吉从58.0%（95%置信区间：53.9 - 62.1）降至1.8%（95%置信区间：0.9 - 3.3；d = -97%，P = 0.00）。然而，伊雷勒的流行率从3.0%（95%置信区间：1.6 - 5.6）升至5.3%（95%置信区间：3.8 - 7.3）（d = 66%，P = 0.13）。在这三个地方政府辖区中，与整群法和哨点法相比，实用法得出的流行率估算值更高：埃塞 - 奥多分别为0.3%、0.1%和0.0%，伊雷勒分别为5.8%、5.3%和5.4%，伊莱 - 奥卢伊吉分别为2.2%、1.8%和1.5%（所有P>0.05）。哨点法和整群法表明应停止预防性化疗，而实用法表明伊雷勒应继续进行预防性化疗。我们的研究结果表明，实用评估是优化预防性化疗决策的一种敏感方法。
