Background. In the Philippines, the current national control strategy for schistosomiasis is annual mass drug administration (MDA) with 40 mg/kg of praziquantel in all schistosomiasis-endemic ...villages with a prevalence ≥ 10%. Methods. A cross-sectional survey of schistosomiasis was conducted in 2012 on 18 221 individuals residing in 22 schistosomiasis-endemic villages in the province of Northern Samar. The prevalence of schistosomiasis, intensity of Schistosoma infection, and morbidity of disease were assessed. Results. Despite an active schistosomiasis-control program in Northern Samar for > 30 years, which included a MDA campaign in the last 5 years, the mean prevalence of schistosomiasis among 10 435 evaluated subjects was 27.1% (95% confidence interval CI, 26.3%-28.0%), and the geometric mean intensity of infection among 2832 evaluated subjects was 17.2 eggs per gram of feces (95% CI, 16.4-18.1). Ultrasonography revealed high levels of schistosomiasis-induced morbidity in the schistosomiasis-endemic communities. Left lobe liver enlargement (≥ 70 mm) was evident in 89.3% of subjects. Twenty-five percent of the study population had grade II/III liver parenchyma fibrosis, and 13.3% had splenomegaly (≥ 100 mm). Conclusions. MDA on its own was insufficient to control the prevalence of schistosomiasis, intensity of Schistosoma infection, or morbidity of the disease. Alternative control measures will be needed to complement the existing national MDA program.
•Schistosomiasis is a neglected tropical parasitic disease caused by the blood fluke Schistosoma.•Praziquantel is the mainstay of treatment and community-based control, but it is failing in some ...regions.•Schistosomiasis control in Asia is complicated by the zoonotic nature of the disease.•Vaccination of bovines has been proposed as a tool to assist in long-term control.•We report the results of a cluster randomized control trial using a SjCTPI-Hsp70 bovine vaccine.
Schistosomiasis is a neglected tropical parasitic disease caused by blood flukes of the genus Schistosoma. Schistosoma japonicum is zoonotic in China, the Philippines, and Indonesia, with bovines acting as major reservoirs of human infection. The primary objective of the trial was to examine the impact of a combination of human mass chemotherapy, snail control through mollusciciding, and SjCTPI bovine vaccination on the rate of human infection.
A 5-year phase IIIa cluster randomized control trial was conducted among 18 schistosomiasis-endemic villages comprising 18,221 residents in Northern Samar, The Philippines.
Overall, bovine vaccination resulted in a statistically significant decrease in human infection (relative risk RR = 0.75; 95% confidence interval CI = 0.69 to 0.82) across all trial follow-ups. The best outcome of the trial was when bovine vaccination was combined with snail mollusciciding. This combination resulted in a 31% reduction (RR = 0.69; 95% CI = 0.61 to 0.78) in human infection.
This is the first trial to demonstrate the effectiveness of a bovine vaccine for schistosomiasis in reducing human schistosome infection. The trial is registered with Australian New Zealand Clinical Trials Registry (ACTRN12619001048178).
Schistosomiasis is a neglected tropical disease with a very long endemic history in Asia. Great strides have been made to control the disease in China and the Philippines but the road to elimination ...is far from over, given the zoonotic nature of the schistosome parasites in both countries.
Summary Background A cross-sectional survey was performed in 2012 among 18 rural barangays in Northern Samar, the Philippines in order to determine the prevalence of single and multiple species ...helminth infections and the underlying risk factors of acquiring one or more parasites. Methods A total of 6976 participants who completed a medical questionnaire and provided a stool sample for examination were included in the final analysis. Results The overall prevalence rates of Schistosoma japonicum , Ascaris lumbricoides , Trichuris trichiura , and hookworm were found to be moderate to high at 28.9%, 36.5%, 61.8%, and 28.4%, respectively. However, the prevalence of harbouring any of the helminths was found to be higher at 75.6%. Significant variation was evident among the predicted barangay-specific random effects for infection with S. japonicum (barangay variance of 0.66, 95% confidence interval 0.31–1.40) and for any helminth infection (barangay variance of 0.63, 95% confidence interval 0.30–1.29). The predictive models showed, with greater than 80% sensitivity and specificity, that low socio-economic status, low levels of education, poor sanitation, proximity to water sources, occupation (i.e., farming and fishing), and male sex were all reliable indicators of infection status. Conclusions This study will aid in the targeting of limited resources for national treatment and WASH (water, sanitation, and hygiene) efforts in low- and middle-income countries.
Highlights • We conducted a cross-sectional survey on 10,434 individuals residing in 22 rural barangays in Northern Samar, the Philippines in order to determine the prevalence of single and multiple ...species helminth infections, their geospatial distribution and underlying risk factors. • 52.7% of people were infected with at least two parasites and 4.8% with all four parasites. • Males aged 10-19 years were the most vulnerable to coinfection infection. Student, fishermen, farmers and housewives were the most vulnerable occupations for co-infection of A. lumbricoides and T. trichiura. • Considerable heterogeneity in the spatial distribution was observed for the different parasite species. • A better understanding of the geospatial distribution of multi-parasitism will guide future integrated strategies leading to elimination.
Anorectal malformations consist of a wide spectrum of conditions which can affect both sexes and involve the distal anus and rectum as well as the urinary and genital tracts. Patients have the best ...chance of a good functional outcome if the condition is diagnosed early and efficient anatomic repair is promptly instituted. This report describes a rare case of imperforate anus associated with both rectovaginal and rectocutaneous fistulas in a 6-year-old Filipino girl. The case highlights shortcomings in the healthcare delivery system combined with socio-economic factors that contributed to the delay in both diagnosis and the institution of adequate treatment. Care and preventive measures that can be implemented in low-resource settings to reduce the impact of birth defects are also discussed.
Background. There is evidence to support that nutritional deficiency can reduce the body's immune function, thereby decreasing resistance to disease and increasing susceptibility to intestinal ...parasites. Methods. A cross-sectional survey was carried out on 693 school-aged children from 5 schistosomiasis-endemic villages in Northern Samar, the Philippines. Data on dietary intake, nutritional status, and intestinal parasitic infection were collected. Results. The prevalence of stunting, thinness, and wasting was 49.2%, 27.8%, and 59.7% of all children. The proportion of children infected with Schistosoma japonicum (15.6%, P = .03) and hookworm (22.0%, P = .05) were significantly lower among children who met the recommended energy and nutrient intake (RENI) for total calories. The percentage of children infected with Trichuris trichiura was highest among children who did not meet the RENI for energy (74.1%, P = .04), iron (73.4%, P = .01), thiamine (74.0%, P = .00), and riboflavin (73.3%, P = .01). Susceptibility to having 1 or more parasitic infections was significantly associated with poor intake of energy (P = .04), thiamine (P = .02), and riboflavin (P = .01). The proportion of stunted children was significantly higher among children who did not meet the RENI for energy (68.9%, P = .002), protein (54.0%, P = .004), or niacin (30.8%, P = .02) and for those infected with hookworm (31.8%, P = .0002). After adjusting for potential confounders, protein intake less than the RENI (odds ratio OR, 1.48; 95% confidence interval CI, 1.03–2.14), and hookworm infection (OR, 1.77; 95% CI, 1.22–2.55) were the major predictors of stunting. Conclusions. The results support the hypothesis that poor nutrient intake may increase susceptibility to parasitic diseases and together they negatively affect childhood nutritional status.
Here we discuss the follow-up case of a 27-year-old male patient from rural Philippines, who was neglected by local health services after losing all four of his limbs as a result of a high-voltage ...electrical accident. The case follows the patient’s road to accessing prostheses, rehabilitation health services and physiotherapy. Significant disparities were found between the government health services and the private sector with respect to quality, accessibility and affordability. Access to affordable healthcare is a basic human right that must be a priority for low-income and middle-income countries.
We discuss the case of a 26-year-old male patient from Northern Samar, the Philippines who was left without essential health services after the amputation of all four limbs following a high voltage ...(20 000 volts) injury in Metro Manila in 2011. Local health services in the developing world are faced with enormous challenges in providing first-line care for burn patients. The cost of maintaining a burn unit, finding suitable qualified staff, and appropriate referral mechanisms are only some of the challenges faced. Once a patient is discharged from hospital they face more obstacles in obtaining artificial limbs, physiotherapy and access to mental health services. Disability pensions are non-existent thus patients place a considerable lifelong burden on their families.
Childhood cataracts are a major cause of treatable blindness. Early recognition, surgical intervention and appropriate follow-up after surgery can result in good visual outcomes. However, several ...factors may impact on the availability of such services, including lack of an available, affordable and accessible comprehensive eye care centre, financial limitations affecting coverage by the national healthcare provider, and household socioeconomic status. We report a case of congenital cataracts in a 12-year-old male adolescent from Northern Samar, the Philippines, who was left blind since birth. This case highlights the disparities in essential health services in the developing world and the challenges patients face in getting the care they need.
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