title: The unacknowledged impact of chronic schistosomiasis.
abstract: OBJECTIVE
  To summarize new knowledge on the range of disease due to chronic schistosomiasis and examine the debilitating burden of both light and heavy infection; to outline goals of disease prevention, including current age-targeted strategies and more extended programmes aimed at preventing transmission.
  
  
  METHODS
  A systematic search of 2004-2007 papers via PUBMED and related databases using 'schistosom' and disability- or treatment-related subject headings. Reports were independently reviewed for inclusion.
  
  
  RESULTS
  Sixty-eight papers met review objectives. These suggest new evidence for a causative link between schistosome infection, antiparasite inflammation, and risk for anaemia, growth stunting and undernutrition in affected populations, as well as exacerbation of co-infections and impairment of cognitive development and work capacity. Formal quality-of-life assessment defines a significant 9.5-24% disability with the most aggressive schistosome species, Schistosoma japonicum.
  
  
  CONCLUSIONS
  Schistosomiasis represents a serious but under-recognized disease burden for many developing countries. Infection (and not intensity of infection) should be considered the defining feature of morbidity formation. Links between infection and long-term disabilities reduce the chances of combating rural poverty. Changes in our appreciation of schistosomiasis-related disease burden means it is no longer appropriate to leave infected persons untreated, and newer approaches to control should focus on preventing transmission.
authors.affiliation: Center for Global Health and Diseases, Case Western Reserve University School of Medicine 10900 Euclid Avenue, Cleveland, Ohio 44106-7286, USA. chk@cwru.edu
authors.forename: Charles H
authors.initials: CH
authors.lastname: King
authors.forename: Madeline
authors.initials: M
authors.lastname: Dangerfield-Cha
mesh_terms: D000740:Anemia / Q000469:parasitology; D000818:Animals; D002908:Chronic Disease; D015897:Comorbidity; D003906:Developing Countries; D006801:Humans; D011788:Quality of Life; D012547:Schistosoma / Q000276:immunology / Q000472:pathogenicity*; D012552:Schistosomiasis / Q000150:complications / Q000469:parasitology / Q000517:prevention & control