title: Morbidity due to Schistosoma mansoni: an epidemiological assessment of distended abdomen syndrome in Ugandan school children with observations before and 1-year after anthelminthic chemotherapy.
abstract: The objectives of this study were to determine the prevalence and distribution of distended abdomens among Ugandan school children across a range of eco-epidemiological settings and to investigate the relationship between distended abdomens and helminth infections, in particular Schistosoma mansoni, before and 1-year after anthelminthic treatment. A cross-sectional survey was conducted on 4354 school children across eight districts, with a longitudinal 1-year follow-up of 2644 children (60.7%). On both occasions, parasitological, biometrical and clinical data were collected for each child. Baseline prevalence of S. mansoni and hookworms was 44.3% and 51.8%, respectively. Distended abdomens, defined as an abdominal circumference ratio (ACR) >1.05, were observed in 2.5% of the sampled children, several of whom presented with particularly severe distensions necessitating hospital referral. ACR scores were highly overdispersed between districts and schools. Multivariate regression analysis revealed that S. mansoni infection accounted for only a small fraction of ACR variation, suggesting that either single point prevalence and intensity measures failed to reflect this more chronically evolved morbidity and/or that other interacting factors were involved, e.g. malnutrition and malaria. At 1-year follow-up, ACR scores showed an overall trend of regression towards the mean, potentially indicative of amelioration following chemotherapy, but geographic overdispersion still remained.
authors.affiliation: Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Balen
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.forename: Edridah M
authors.initials: EM
authors.lastname: Tukahebwa
authors.forename: Francis
authors.initials: F
authors.lastname: Kazibwe
authors.forename: Sarah
authors.initials: S
authors.lastname: Whawell
authors.forename: Joanne P
authors.initials: JP
authors.lastname: Webster
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
mesh_terms: D000005:Abdomen / Q000469:parasitology*; D000871:Anthelmintics / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010270:Parasite Egg Count; D010349:Patient Compliance; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000188:drug therapy* / Q000453:epidemiology; D013577:Syndrome; D014454:Uganda / Q000453:epidemiology
chemical_list: D000871:Anthelmintics; D004338:Drug Combinations