clove and Helminthiasis

School-aged children (SAC) have a considerable burden of intestinal schistosomiasis in Madagascar yet its burden in pre-school aged children (PSAC) is currently overlooked. To assess the at-risk status of PSAC, we undertook a pilot epidemiological survey in June 2019 examining children (n = 89), aged 2-4-years of balanced gender, in six remote villages in Marolambo District, Madagascar. Diagnosis included use of urine-circulating cathodic antigen (CCA) dipsticks and coproscopy of stool with duplicate Kato-Katz (K-K) thick smears. Prevalence of intestinal schistosomiasis by urine-CCA was 67.4% (95% confidence interval [CI]: 56.5-77.2%) and 35.0% (95% CI: 24.7-46.5%) by K-K. The relationship between faecal eggs per gram (epg) and urine-CCA G-scores (G1 to G10) was assessed by linear regression modelling, finding for every increment in G-score, epg increased by 20.4 (6.50-34.4, P = 0.006). Observed proportions of faecal epg intensities were light (78.6%), moderate (17.9%) and heavy (3.6%). Soil-transmitted helminthiasis was noted, prevalence of ascariasis was 18.8% and trichuriasis was 33.8% (hookworm was not reported). Co-infection of intestinal schistosomiasis and soil-transmitted helminthiasis occurred in 36.3% of PSAC. These results provide solid evidence highlighting the overlooked burden of intestinal schistosomiasis in PSAC, and they also offer technical  guidance for better surveillance data for the Madagascan national control programme.

Topics: Animals; Child; Child, Preschool; Cross-Sectional Studies; Feces; Helminthiasis; Humans; Madagascar; Prevalence; Schistosoma mansoni; Schistosomiasis mansoni

Gastrointestinal helminth-microbiota associations are shaped by various ecological processes. The effect of the ecological context of the host on the bacterial microbiome and gastrointestinal helminth parasites has been tested in a number of ecosystems and experimentally. This study takes the important step to look at these two groups at the same time and to start to examine how these communities interact in a changing host environment. Fresh faecal samples (N = 335) from eight wild Eulemur populations were collected over 2 years across Madagascar. We used 16S ribosomal RNA gene sequencing to characterise the bacterial microbiota composition, and faecal flotation to isolate and morphologically identify nematode eggs. Infections with nematodes of the genera Callistoura and Lemuricola occurred in all lemur populations. Seasonality significantly contributed to the observed variation in microbiota composition, especially in the dry deciduous forest. Microbial richness and Lemuricola spp. infection prevalence were highest in a previously intensely logged site, whereas Callistoura spp. showed no such pattern. In addition, we observed significant correlations between gastrointestinal parasites and bacterial microbiota composition in these lemurs, with 0.4-0.7% of the variation in faecal bacterial microbiota composition being explained by helminth infections. With this study, we show effects of environmental conditions on gastrointestinal nematodes and bacterial interactions in wild lemurs and believe it is essential to consider the potential role of microbiome-parasite associations on the hosts' GI stability, health, and survival.

Topics: Animals; Ecosystem; Feces; Female; Forestry; Gastrointestinal Microbiome; Helminthiasis; Helminths; Lemur; Madagascar; Male; Seasons

Endemic areas for soil-transmitted helminthiases often lack the tools and trained personnel necessary for point-of-care diagnosis. This study pilots the use of smartphone microscopy and an artificial neural network-based (ANN) object detection application named Kankanet to address those two needs.. A smartphone was equipped with a USB Video Class (UVC) microscope attachment and Kankanet, which was trained to recognize eggs of Ascaris lumbricoides, Trichuris trichiura, and hookworm using a dataset of 2,078 images. It was evaluated for interpretive accuracy based on 185 new images. Fecal samples were processed using Kato-Katz (KK), spontaneous sedimentation technique in tube (SSTT), and Merthiolate-Iodine-Formaldehyde (MIF) techniques. UVC imaging and ANN interpretation of these slides was compared to parasitologist interpretation of standard microscopy.Relative to a gold standard defined as any positive result from parasitologist reading of KK, SSTT, and MIF preparations through standard microscopy, parasitologists reading UVC imaging of SSTT achieved a comparable sensitivity (82.9%) and specificity (97.1%) in A. lumbricoides to standard KK interpretation (97.0% sensitivity, 96.0% specificity). The UVC could not accurately image T. trichiura or hookworm. Though Kankanet interpretation was not quite as sensitive as parasitologist interpretation, it still achieved high sensitivity for A. lumbricoides and hookworm (69.6% and 71.4%, respectively). Kankanet showed high sensitivity for T. trichiura in microscope images (100.0%), but low in UVC images (50.0%).. The UVC achieved comparable sensitivity to standard microscopy with only A. lumbricoides. With further improvement of image resolution and magnification, UVC shows promise as a point-of-care imaging tool. In addition to smartphone microscopy, ANN-based object detection can be developed as a diagnostic aid. Though trained with a limited dataset, Kankanet accurately interprets both standard microscope and low-quality UVC images. Kankanet may achieve sensitivity comparable to parasitologists with continued expansion of the image database and improvement of machine learning technology.

Topics: Ancylostomatoidea; Animals; Ascaris lumbricoides; Feces; Helminthiasis; Hookworm Infections; Humans; Image Processing, Computer-Assisted; Madagascar; Microscopy; Neural Networks, Computer; Parasite Egg Count; Point-of-Care Systems; Sensitivity and Specificity; Smartphone; Software; Soil; Trichuris

Neglected tropical diseases (NTDs) account for a large disease burden in sub-Saharan Africa. While the general cost-effectiveness of NTD interventions to improve health outcomes has been assessed, few studies have also accounted for the financial and education gains of investing in NTD control.. We built on extended cost-effectiveness analysis (ECEA) methods to assess the health gains (e.g. infections, disability-adjusted life years or DALYs averted), household financial gains (out-of-pocket expenditures averted), and education gains (cases of school absenteeism averted) for five NTD interventions that the government of Madagascar aims to roll out nationally. The five NTDs considered were schistosomiasis, lymphatic filariasis, and three soil-transmitted helminthiases (Ascaris lumbricoides, Trichuris trichiura, and hookworm infections).. The estimated incremental cost-effectiveness for the roll-out of preventive chemotherapy for all NTDs jointly was USD125 per DALY averted (95% uncertainty range: 65-231), and its benefit-cost ratio could vary between 5 and 31. Our analysis estimated that, per dollar spent, schistosomiasis preventive chemotherapy, in particular, could avert a large number of infections (176,000 infections averted per $100,000 spent), DALYs (2,000 averted per $100,000 spent), and cases of school absenteeism (27,000 school years gained per $100,000 spent).. This analysis incorporates financial and education gains into the economic evaluation of health interventions, and therefore provides information about the efficiency of attainment of three Sustainable Development Goals (SDGs). Our findings reveal how the national scale-up of NTD control in Madagascar can help address health (SDG3), economic (SDG1), and education (SDG4) goals. This study further highlights the potentially large societal benefits of investing in NTD control in low-resource settings.

Topics: Adolescent; Anthelmintics; Child; Child, Preschool; Cost-Benefit Analysis; Elephantiasis, Filarial; Female; Health Education; Helminthiasis; Humans; Madagascar; Male; Schistosomiasis; Soil; Tropical Medicine

In a study in three neighbouring villages of southern Madagascar, where Schistosoma mansoni is hyperendemic, ultrasound examination using the Niamey protocol showed marked differences in the burden of disease from one village to another. Hepatosplenic schistosomiasis was more frequent in the village with the highest geometric mean egg counts and the earliest onset of infections, demonstrating that the morbidity induced by S. mansoni may vary greatly within a given area. True representativeness of study populations, a keystone of epidemiological studies, is mandatory to obtain a clear picture of a wide area. Ultrasound examinations in a small number of villages, or even a single one, may be a questionable approach. Using logistic regression analysis, the explanatory variables found to be significantly associated with a risk of severe hepatosplenic disease in our study were sex, age, village of residence and S. mansoni egg counts. On the other hand, a concurrent infection with an intestinal helminth seems to reduce the risk of severe hepatosplenic disease. Further studies should assess the role and possible impact of intestinal helminths on S. mansoni associated-morbidity.

Topics: Adolescent; Adult; Age Distribution; Analysis of Variance; Child; Child, Preschool; Female; Helminthiasis; Humans; Hypertension, Portal; Infant; Infant, Newborn; Likelihood Functions; Liver Diseases, Parasitic; Logistic Models; Madagascar; Male; Parasite Egg Count; Prevalence; Residence Characteristics; Risk Factors; Schistosomiasis mansoni; Splenic Diseases

Topics: Adolescent; Child; Child, Preschool; Feces; Helminthiasis; Humans; Madagascar; Parasite Egg Count; Population Surveillance; Rural Population; Schistosomiasis mansoni

This study of schistosomiasis and intestinal parasites was carried out on 496 children in the Firaisana (District) of Ankilivalo in Western Madagascar. The prevalence of these parasites was determined and data collected on nutrition, agriculture and the use of water in order to gain an understanding of the transmission and effects of these parasites. Recommendations for their control are suggested. In two schools within the area of a major irrigation scheme the prevalence of urinary schistosomiasis was 69%, and 50% suffer from at least one intestinal worm. In a school outside the main irrigation area, the prevalence of schistosomiasis was much lower (7%). Ultimately the control of schistosomiasis will depend on improvements to the irrigation and drainage infrastructure, and in standards of sanitation. However, chemotherapy is the only method of bringing the disease under control in the short term.

Topics: Adolescent; Animals; Bulinus; Child; Child Nutritional Physiological Phenomena; Female; Fresh Water; Helminthiasis; Humans; Madagascar; Male; Schistosomiasis haematobia; Swimming; Water; Water Supply

The course of an investigation trip through Madagascar is sketched. It allowed to analyze the parasitological situation. It is explained with the sociological and economical facts and the unusual fauna of this island. The two biggest problems are Malaria tropica and schistosomatosis (bilharziasis). Further, Ancylostoma, Ascaris, taeniids, and Wuchereria occur. Plague is rare. Fasciola gigantica has been introduced since short time only. Introduction of other parasites must be feared. Sleeping illness and nagana are lacking, as well as rabies, yellow fever, Fasciola hepatica, Echinococcus granulosus, Hymenolepis nana, Trichinella spiralis and Dracunculus medinensis. Effective control measures may not be reasonable at present because of the socio-economic structure as a result of the former colonial status.

Topics: Alcoholism; Environment; Expeditions; Helminthiasis; Humans; Madagascar; Malaria; Parasitic Diseases; Public Health; Schistosomiasis; Socioeconomic Factors; Tropical Climate