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From a weighing scale to a pole: a comparison of two different dosage strategies in mass treatment of Schistosomiasis haematobium
The Skaraborg Institute for Research and Development, Skövde, Sweden.ORCID iD: 0000-0002-3816-9229
Nigerian Field Epidemiology and Laboratory Training Program, Abuja, Nigeria.
Department of Community Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
The Skaraborg Institute for Research and Development, Skövde, Sweden.
2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, article id 25351Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Clinical schistosomiasis in endemic countries is treated with a single dose of praziquantel per 40 mg/kg body weight. Treating according to weight, in resource-poor settings when thousands of doses are to be administered in mass treatment campaigns, is considered problematic. A calibrated dose-pole based on height was developed and is now used in mass treatment campaigns for determining the doses for schoolchildren. The dose-pole will generate dose errors since every child population contains individuals that are either short or tall for weight. The aim of this study is to explore whether the WHO praziquantel pole is a satisfactory dose instrument for mass treatment of S. haematobium.

METHODS: In 1996 and 2002, 1,694 children were surveyed in the Kilimanjaro Region, Tanzania. We compared doses given by weight to doses given by height using descriptive statistics and regression.

CONCLUSIONS AND INTERPRETATION: The WHO dose-pole for praziquantel is based on height of the patient; however, children with the same height will differ in weight. Our study shows that children with the same weight could qualify for up to four different dose levels based on their height. The largest variation of doses based on the WHO dose-pole will be found in children below 20 kg of bodyweight. Using bodyweight and tablet halves as the smallest tablet division unit to determine the doses of praziquantel, one only has to identify every 6th kilogram of bodyweight; the doses will then vary a lot less than when using the WHO dose-pole.

Place, publisher, year, edition, pages
2014. Vol. 7, article id 25351
Keywords [en]
S. haematobium, dosage, dose-pole, mass treatment, overdosage, praziquantel, underdosage
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-154549DOI: 10.3402/gha.v7.25351ISI: 000345966800001PubMedID: 25476930OAI: oai:DiVA.org:umu-154549DiVA, id: diva2:1272589
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
In thesis
1. Control or elimination: terms for public health interventions against tungiasis and schistosomiasis haematobium
Open this publication in new window or tab >>Control or elimination: terms for public health interventions against tungiasis and schistosomiasis haematobium
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The thesis revolves around diagnosis and treatment of tungiasis (sand flea disease) and schistosomiasis haematobium. The causing parasites, Tunga penetrans and Schistosoma haematobium, both have the ability to penetrate intact skin.

Tungiasis is a neglected parasitic skin disease, prevalent in resource-poor communities in sub-Saharan Africa, South America and the Caribbean. Its global prevalence has never been properly assessed. The prevalence may be as high as 60 percent in resource-poor urban settings. Repeated infections result in disfigurement and mutilations foremost of the feet, eventually leading to impaired mobility. Schistosomiasis haematobium, or urogenital schistosomiasis, is prevalent above all in Africa with around 100 million infected individuals. It causes damage to internal organs and could lead to serious sequelae in the urogenital tract.

The aim is to examine aspects and prerequisites for control and elimination of the two diseases in an east African context. Even if both diseases are caused by a parasite and associated with poverty, they exhibit distinct differences for public health interventions, especially considering control and elimination.

The thesis contains a dialectic comparison of diagnoses and treatments problematising possibilities and hindrances for public health interventions in rural locations in Uganda, Kenya and Tanzania, from where the empirical data are collected in the four encompassing studies. Two deal with treatment of tungiasis, where the idea is to use silicon-based oils in order to suffocate the parasite. Rigorous clinical treatment trials on humans are so far lacking. The conclusion is that the tested substance works much better than current treatments. It is also shown that an efficient, yet parsimonious treatment procedure can be successful, even in resource-poor settings.

WHO promotes a dose-pole for determining the number of praziquantel tablets in mass treatment campaigns of schistosomiasis. An alternative dosage procedure is proposed to avoid side-effects and promote compliance. Since mass treatment campaigns currently target children and adults at risk in endemic areas, the choice of diagnostic method will have consequences. Prevailing parasitological methods for field surveys are not sensitive enough, especially where the prevalence is seemingly low. The suggested more sensitive diagnostic method, that detects the level of urogenital schistosomiasis in population groups, is a both affordable and manageable approach in resource-poor settings.

Is control or elimination possible for tungiasis and urogenital schistosomiasis? The conclusion is that elimination cannot be achieved without environmental interventions, use of repellants, vaccines and ultimately a fight against poverty. A multidisciplinary approach is needed to understand and sustainably resolve the problems. Important disciplines for this public health endeavour are epidemiology, sociology and ethics.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2018. p. 41
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1999
Keywords
tungiasis, urogenital schistosomiasis, control, elimination, public health, intervention, diagnosis, treatment, neglected tropical diseases, praziquantel, mass treatment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-154553 (URN)978-91-7601-989-4 (ISBN)
Public defence
2019-01-25, Triple Helix, Samverkanshuset, Umeå Universitet, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2018-12-21 Created: 2018-12-19 Last updated: 2018-12-20Bibliographically approved

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Nordin, PerKrantz, Ingela

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