title: Mapping of Schistosomiasis and Soil-Transmitted Helminths in Namibia: The First Large-Scale Protocol to Formally Include Rapid Diagnostic Tests.
abstract: BACKGROUND
  Namibia is now ready to begin mass drug administration of praziquantel and albendazole against schistosomiasis and soil-transmitted helminths, respectively. Although historical data identifies areas of transmission of these neglected tropical diseases (NTDs), there is a need to update epidemiological data. For this reason, Namibia adopted a new protocol for mapping of schistosomiasis and geohelminths, formally integrating rapid diagnostic tests (RDTs) for infections and morbidity. In this article, we explain the protocol in detail, and introduce the concept of 'mapping resolution', as well as present results and treatment recommendations for northern Namibia.
  This new protocol allowed a large sample to be surveyed (N = 17,896 children from 299 schools) at relatively low cost (7 USD per person mapped) and very quickly (28 working days). All children were analysed by RDTs, but only a sub-sample was also diagnosed by light microscopy. Overall prevalence of schistosomiasis in the surveyed areas was 9.0%, highly associated with poorer access to potable water (OR = 1.5, P<0.001) and defective (OR = 1.2, P<0.001) or absent sanitation infrastructure (OR = 2.0, P<0.001). Overall prevalence of geohelminths, more particularly hookworm infection, was 12.2%, highly associated with presence of faecal occult blood (OR = 1.9, P<0.001). Prevalence maps were produced and hot spots identified to better guide the national programme in drug administration, as well as targeted improvements in water, sanitation and hygiene. The RDTs employed (circulating cathodic antigen and microhaematuria for Schistosoma mansoni and S. haematobium, respectively) performed well, with sensitivities above 80% and specificities above 95%.
  
  
  CONCLUSIONS
  This protocol is cost-effective and sensitive to budget limitations and the potential economic and logistical strains placed on the national Ministries of Health. Here we present a high resolution map of disease prevalence levels, and treatment regimens are recommended.
authors.affiliation: Centro de Investigação em Saúde de Angola (Health Research Center in Angola), Rua direita do Caxito, Hospital Provincial, Bengo, Angola; Department of Life Sciences, Natural History Museum, Wolfson Wellcome Biomedical Laboratories, London, United Kingdom.
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Sousa-Figueiredo
authors.affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Stanton
authors.affiliation: Namibia Ministry of Health and Social Services, Windhoek, Namibia.
authors.forename: Stark
authors.initials: S
authors.lastname: Katokele
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Arinaitwe
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Adriko
authors.affiliation: The END Fund, New York, New York, United States of America.
authors.forename: Lexi
authors.initials: L
authors.lastname: Balfour
authors.affiliation: The END Fund, New York, New York, United States of America.
authors.forename: Mark
authors.initials: M
authors.lastname: Reiff
authors.affiliation: The END Fund, New York, New York, United States of America.
authors.forename: Warren
authors.initials: W
authors.lastname: Lancaster
authors.affiliation: Department of Entomology & Plant Pathology, Oklahoma State University, Stillwater, Oklahoma, United States of America.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Noden
authors.affiliation: Department of Biological Sciences, University of Namibia, Windhoek, Namibia.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Bock
authors.affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D008297:Male; D009276:Namibia / Q000453:epidemiology; D012547:Schistosoma / Q000302:isolation & purification* / Q000502:physiology; D012552:Schistosomiasis / Q000175:diagnosis* / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D012987:Soil / Q000469:parasitology*; D055815:Young Adult
chemical_list: D012987:Soil