Schistosomiasis in African infants and preschool children: let them now be treated! - PubMed (original) (raw)

Review

Schistosomiasis in African infants and preschool children: let them now be treated!

J Russell Stothard et al. Trends Parasitol. 2013 Apr.

Abstract

The occurrence of schistosomiasis within African infants and preschool children has been much better documented in recent years, revealing an important burden of disease previously overlooked. Despite mounting evidence showing that treatment with praziquantel is safe, beneficial, and could be delivered within ongoing public health interventions, young children still do not have satisfactory access to this drug, and a significant treatment gap exists. Progress towards resolution of this unfortunate health inequity is highlighted, including the development of an appropriate paediatric praziquantel formulation, and present blocks are identified on securing this issue within the international health agenda.

Copyright © 2013 Elsevier Ltd. All rights reserved.

PubMed Disclaimer

Figures

Figure 1

Figure 1

Advanced intestinal schistosomiasis in an 8-year-old child. This young child was encountered during general disease surveillance activities on the Sesse Islands, Lake Victoria in November 2010. Clinical presentations such as this are still common throughout endemic areas of Uganda and warrant better formal recording if the burden of morbidity in young children is to be quantified. Sadly, although this child may have received his first praziquantel (PZQ) treatment within primary school, his individual morbidity is already at an advanced stage and may not be fully reversible. Had this child had treatment at a preschool age this might have been averted, which is perhaps a strong indictment that further inaction is unethical.

Figure I

Figure I

The current WHO height pole with a lower height threshold of 94 cm cannot be used for dosing children smaller than the one depicted and a downwardly extended dosing pole was needed for administration of PZQ for infants and preschool-aged children without recourse to weighing scales. (a) Original WHO (left) and extended (right) height pole with new 0.75 (¾) and 0.5 (½) tablet divisions. (b) Theoretical cross-country validation of the extended height pole with 99 cm, 84 cm, and 60 cm thresholds with best targeted dose of 40 mg/kg denoted by a red arrow, with acceptable dosing (30–60 mg/kg) indicated within the grey box.

Figure I

Figure I

At an early age, first water contact typically occurs by passive mechanisms (i.e., being bathed) before a later gradual transition towards active mechanisms as the child is able to enter water alone. (a) The time, place, and duration of high-risk activities along the shoreline can be estimated by GPS data logging devices, which may be worn on the upper arm or wrist by study participants thus enabling a digital track-log of putative active water contact on the water margins. (b) GPS data logging approaches may, however, be confounded by specific behaviours, for example, (left) although the child may be in a high spatial risk zone, (s)he is not at immediate risk due to being carried; however, being bathed with jerry can collected water is a high-risk activity (right), although it is difficult to define spatially within the lake shoreline context.

References

    1. Stothard J.R., Gabrielli A-F. Schistosomiasis in African infants and preschool children: to treat or not to treat? Trends Parasitol. 2007;23:83–86. - PubMed
    1. Johansen M.V. Leave children untreated and sustain inequity! Trends Parasitol. 2007;23:568–569. - PubMed
    1. Stothard J.R., Gabrielli A-F. Response to Johansen et al.: Leave children untreated and sustain inequity! Trends Parasitol. 2007;23:569–570. - PubMed
    1. World Health Organization (2010) Report of a Meeting to Review the Results of Studies on the Treatment of Schistosomiasis in Preschool-aged Children, pp. 1–23, World Health Organization
    1. Ekpo U.F. Schistosomiasis in infants and pre-school-aged children in sub-Saharan Africa: implication for control. Parasitology. 2012;139:835–841. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources