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Regarding study design, any prospective, longitudinal studies of treatment impact on morbidity with or without concurrent control group were considered eligible for inclusion in the meta-analysis. While there are challenges to implementing therapy for schistosomiasis, and praziquantel therapy is not fully curative, reductions in egg output are significantly correlated with decreased morbidity and can be used to project diminution in disease burden when contemplating more aggressive strategies to minimize infection intensity.
In recent years, millions of people have been treated in different contexts and, in general, prevalence of morbidity has been reduced after treatment [ 719 — 22 ]. Of the studies that assessed the impact of chemotherapy on reducing hepatomegaly, 10 evaluated the reduction of the left hepatic lobe, 10 the reduction of the right hepatic lobe, and 9 studies reported a reduction from the costal margin without specifying the lobe see Table A in S1 Text.
Wherever possible, all of the information listed above was recorded both before and after intervention see supplemental information in Tables A-K in S1 Text.
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Nutritional status improves after treatment of Schistosoma japonicum -infected children and adolescents. Although there is an association between intensity of infection and the presence and severity of morbidity [ 11 — 14 ], the correlation is imperfect, and monitoring infection intensity may provide only an indirect means to gauge morbidity risk.
There was greater strength of association when studies included only individuals of school age or when the follow-up was conducted in the first six months after treatment Table G in S3 Text.
Four main factors were associated with greater treatment impact in reducing hepatomegaly: The ERR was measured as reductions in population mean intensity of infection from before to after treatment. Technical Report Series However, since the s, especially with the advent of praziquantel, drug-based control of morbidity related to d007 has been the primary WHO strategy for schistosomiasis control, with treatment given mainly through community- and school-based mass treatment [ 10 ].
Sensitivity analysis Forest Plot of the impact of therapy on hepatomegaly prevalence, lobe unspecified. To explore heterogeneity and factors that could potentially modify the summary estimates of effect, we performed subgroup analyses stratified by parasite species, the study area, age of the s07 included in the studies, the time to follow-up after treatment, the type xhk diagnosis, the treatment performed, the number of treatments, and the initial prevalence of infection in the study population [ 34 ].
The impact of single versus mixed schistosome species infections on liver, spleen and bladder morbidity within Malian children pre- and post-praziquantel treatment. This phenomenon thus limits the overall impact of drug treatment in communities at high risk for S. Evolution of schistosomiasis-induced pathology after therapy cchk interruption of exposure to schistosomes: Main portal vein Four studies assessed the prevalence of portal vein dilation before and after chemotherapy for schistosomiasis see Table D in S1 Text.
Our meta-regression profiles indicate that acute reductions in worm ck, as reflected by the ERRs achieved after drug therapy, are associated with reversal of most of the acute pathologies of infection.
In addition, the bibliography reference lists of articles selected for review were evaluated for additional relevant studies, and additional articles were retrieved from personal collections at Case Western Reserve University.
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Studies that evaluated more than one form of morbidity were included in the meta-analysis for each individual morbidity outcome. Use of fecal occult blood tests as epidemiologic indicators of morbidity associated with intestinal schistosomiasis during preventive chemotherapy in young children.
Reversibility of urinary tract abnormalities due to Schistosoma haematobium infection. Studies had to describe the study site, the species of Schistosoma parasite, the type of schistosomiasis morbidity evaluated before and after chemotherapy, the diagnostic method used to assess the morbidity, and the characteristics of participating study subject population. Chronic schistosomiasis is the form of infection that is predominant in endemic cho, which bear the greatest disease impact from long-lived Schistosoma infections [ 2 ].
Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of diarrhea after treatment.
Introduction Schistosomiasis, caused by Schistosoma spp.
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Nevertheless, studies of morbidity reduction related to drug treatment have had some conflicting results [ 23 — 26 ], which may be a reflection of differences in follow-up after treatment, methods used to measure morbidities, the Schistosoma species, the presence of co-infections especially malariathe type of population and the region, the initial prevalence of infection, the incidence of reinfection, and other factors [ 727 ].
SinceWHO has endorsed drug treatment to reduce Schistosoma infection and its consequent morbidity. In subgroup analysis Table C in S3 Textthere was no statistically significant treatment-related reductions among individuals infected with S. Results Study selection Using the selected search terms, initial screening of the databases yielded study reports chj removing duplicates.
Reduction in splenomegaly was significantly greater among subjects who were followed after the first year of treatment, in the South Africa region, and among individuals selected for the presence of specific morbidities see Table B in S3 S07. View the pdf for the S Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of splenomegaly.
S8 Fig Sensitivity analysis Forest Plot of the impact of therapy on diarrhea prevalence. Forest plots of post-treatment odds ratios of Schistosoma -associated vhk included in this paper. Schistosomiasis is the disease caused by infection with Schistosoma parasitic flukes. No restrictions were placed in terms of location of the study, Schistosoma species, or publication date. S5 Fig Sensitivity analysis Forest Plot of the impact of therapy on splenomegaly prevalence.