title: Morbidity of schistosomiasis mansoni in the highlands of Madagascar and comparison of current sonographical classification systems.
abstract: To study the morbidity of schistosomiasis mansoni in the highlands of Madagascar, a cross-sectional study examined the extent to which liver fibrosis occurred in a rural community. The Managil and the Cairo classification systems were used. A second purpose was to investigate the effect of the measurements of 2 different branches of the portal vein (either segmental or sub-segmental branches) on the resulting staging of morbidity using the Cairo classification system. In a rice farmer village, 656 inhabitants (95% of the total population) were parasitologically examined; 561 patients underwent sonographic work-up based on the Managil scoring system, and in 307 randomized patients the outer to outer diameters of both the segmental and the sub-segmental branches of the portal vein were measured and scored by the Cairo classification system. Overall prevalence of schistosomiasis mansoni in the study area in 1994 was 68.3%. Upon sonographic examination and scoring by the Managil system 23.4% of the population showed liver changes (Managil degree I/II/III, 20%/2.5%/0.9%). Measuring the sub-segmental branches only and scoring by the Cairo classification, 19% of the study population were found to have liver changes, none with severe fibrosis. By contrast, 82% were found to have liver changes (Cairo degree 1/2/3, 70%/11%/2%) when the segmental branches were measured. The diameters of the sub-segmental branches were about two-thirds of those of the segmental branches. Both the Cairo- and the Managil-examination protocols have pitfalls. Using the Cairo classification, a considerable systematic error in classifying morbidity is created by measuring different branches of the portal vein.
authors.affiliation: Max-von-Pettenkofer Institute of Microbiology, Ludwig-Maximilian University, Munich, Germany. harald.hoffmann@mpk.med.uni-muenchen.de
authors.forename: H
authors.initials: H
authors.lastname: Hoffmann
authors.forename: P
authors.initials: P
authors.lastname: Esterre
authors.forename: V A
authors.initials: VA
authors.lastname: Ravaoalimalala
authors.forename: J H
authors.initials: JH
authors.lastname: Ehrich
authors.forename: E
authors.initials: E
authors.lastname: Doehring
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000531:Altitude; D001827:Body Height; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000145:classification / Q000453:epidemiology / Q000473:pathology; D008109:Liver Diseases, Parasitic / Q000145:classification / Q000453:epidemiology* / Q000473:pathology; D008270:Madagascar / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010270:Parasite Egg Count; D011169:Portal Vein / Q000473:pathology; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012555:Schistosomiasis mansoni / Q000145:classification / Q000453:epidemiology* / Q000473:pathology