title: Identifying and evaluating field indicators of urogenital schistosomiasis-related morbidity in preschool-aged children.
abstract: BACKGROUND
  Several studies have been conducted quantifying the impact of schistosome infections on health and development in school-aged children. In contrast, relatively little is known about morbidity levels in preschool-aged children (≤ 5 years) who have been neglected in terms of schistosome research and control. The aim of this study was to compare the utility of available point-of-care (POC) morbidity diagnostic tools in preschool versus primary school-aged children (6-10 years) and determine markers which can be used in the field to identify and quantify Schistosoma haematobium-related morbidity.
  
  
  RESULTS
  A comparative cross-sectional study was conducted to evaluate the performance of currently available POC morbidity diagnostic tools on Zimbabwean children aged 1-5 years (n=104) and 6-10 years (n=194). Morbidity was determined using the POC diagnostics questionnaire-based reporting of haematuria and dysuria, clinical examination, urinalysis by dipsticks, and urine albumin-to-creatinine ratio (UACR). Attributable fractions were used to quantify the proportion of morbidity attributable to S. haematobium infection. Based on results of attributable fractions, UACR was identified as the most reliable tool for detecting schistosome-related morbidity, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination. The results of urine dipstick attributes showed that proteinuria and microhaematuria accounted for most differences between schistosome egg-positive and negative children (T=-50.1; p<0.001). These observations were consistent in preschool vs. primary school-aged children.
  
  
  CONCLUSIONS
  Preschool-aged children in endemic areas can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. UACR for detecting albuminuria is recommended as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in children in the field. The use of dipstick microhaematuria and proteinuria as additional indicators of schistosome-related morbidity would improve the estimation of disease burden in young children.
authors: Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Welcome M
authors: WM
authors: Wami
authors: Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Norman
authors: N
authors: Nausch
authors: National Institute of Health Research, Causeway, Harare, Zimbabwe.
authors: Nicholas
authors: N
authors: Midzi
authors: Ministry of Health and Child Care, Murewa District Hospital, Murewa, Zimbabwe.
authors: Reggis
authors: R
authors: Gwisai
authors: Department of Biochemistry, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe.
authors: Takafira
authors: T
authors: Mduluza
authors: Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Mark
authors: M
authors: Woolhouse
authors: Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom; Centre for Immunity, Infection and Evolution, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors: Francisca
authors: F
authors: Mutapi
mesh_terms: D000418:Albumins / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D006417:Hematuria / Q000473:pathology; D006801:Humans; D007223:Infant; D009017:Morbidity; D019095:Point-of-Care Systems; D011507:Proteinuria / Q000473:pathology; D011934:Reagent Strips; D012553:Schistosomiasis haematobia / Q000453:epidemiology* / Q000473:pathology*; D011795:Surveys and Questionnaires; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D000418:Albumins; D011934:Reagent Strips; D003404:Creatinine