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All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings.

Krauth SJ, Greter H, Stete K, Coulibaly JT, Traoré SI, Ngandolo BN, Achi LY, Zinsstag J, N'Goran EK, Utzinger J - Parasit Vectors (2015)

Bottom Line: Kappa agreement and regression models were employed to compare data for different S. haematobium prevalence categories.We found a "background" prevalence of microhaematuria (13 %, on average) which does not seem to be associated with schistosomiasis in most settings, irrespective of the prevalence of S. haematobium.Our findings underscore the need for highly accurate diagnostic tools for settings targeted for elimination of urogenital schistosomiasis.

View Article: PubMed Central - PubMed

Affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. stefanie.krauth@unibas.ch.

ABSTRACT

Background: Reagent strip testing for microhaematuria has long been used for community diagnosis of Schistosoma haematobium. Sensitivities and specificities are reasonable, and hence, microhaematuria can serve as a proxy for S. haematobium infection. However, assessment of test performance in the context of the underlying S. haematobium prevalence is rare and test parameters other than sensitivity and specificity have been neglected.

Methods: Data about the association between microhaematuria and urine filtration results from three studies were compared and put into context with findings from a recent Cochrane review. Data were stratified by S. haematobium prevalence to identify prevalence-related differences in test performance. Kappa agreement and regression models were employed to compare data for different S. haematobium prevalence categories.

Results: We found a "background" prevalence of microhaematuria (13 %, on average) which does not seem to be associated with schistosomiasis in most settings, irrespective of the prevalence of S. haematobium. This background level of microhaematuria might be due to cases missed with urine filtration, or alternative causes apart from S. haematobium. Especially in very-low prevalence settings, positive results for microhaematuria likely give an inaccurate picture of the extent of S. haematobium, whereas negative results are a sound indicator for the absence of infection.

Conclusions: Reagent strip testing for microhaematuria remains a good proxy for urogenital schistosomiasis, but implications of test results and scope of application differ depending on the setting in which reagent strips are employed. In very-low prevalence settings, microhaematuria is an unstable proxy for urogenital schistosomiasis and treatment decision should not be based on reagent strip test results alone. Our findings underscore the need for highly accurate diagnostic tools for settings targeted for elimination of urogenital schistosomiasis.

No MeSH data available.


Related in: MedlinePlus

Seemingly unrelated microhaematuria, S. haematobium prevalence with and without associated microhaematuria and overall prevalence of microhaematuria by sex and age-group in northern Côte d’Ivoire and in the baseline survey in Chad
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Fig7: Seemingly unrelated microhaematuria, S. haematobium prevalence with and without associated microhaematuria and overall prevalence of microhaematuria by sex and age-group in northern Côte d’Ivoire and in the baseline survey in Chad

Mentions: Furthermore, our data indicate that this seemingly unrelated microhaematuria is mostly independent of gender. Although females consistently showed slightly higher levels of microhaematuria seemingly unrelated to S. haematobium than males in our studies from northern Côte d’Ivoire and Chad, this gender difference was only marginal over all age groups with the exception of females and males aged 45 years and above (Fig. 7).Fig. 7


All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings.

Krauth SJ, Greter H, Stete K, Coulibaly JT, Traoré SI, Ngandolo BN, Achi LY, Zinsstag J, N'Goran EK, Utzinger J - Parasit Vectors (2015)

Seemingly unrelated microhaematuria, S. haematobium prevalence with and without associated microhaematuria and overall prevalence of microhaematuria by sex and age-group in northern Côte d’Ivoire and in the baseline survey in Chad
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4641389&req=5

Fig7: Seemingly unrelated microhaematuria, S. haematobium prevalence with and without associated microhaematuria and overall prevalence of microhaematuria by sex and age-group in northern Côte d’Ivoire and in the baseline survey in Chad
Mentions: Furthermore, our data indicate that this seemingly unrelated microhaematuria is mostly independent of gender. Although females consistently showed slightly higher levels of microhaematuria seemingly unrelated to S. haematobium than males in our studies from northern Côte d’Ivoire and Chad, this gender difference was only marginal over all age groups with the exception of females and males aged 45 years and above (Fig. 7).Fig. 7

Bottom Line: Kappa agreement and regression models were employed to compare data for different S. haematobium prevalence categories.We found a "background" prevalence of microhaematuria (13 %, on average) which does not seem to be associated with schistosomiasis in most settings, irrespective of the prevalence of S. haematobium.Our findings underscore the need for highly accurate diagnostic tools for settings targeted for elimination of urogenital schistosomiasis.

View Article: PubMed Central - PubMed

Affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland. stefanie.krauth@unibas.ch.

ABSTRACT

Background: Reagent strip testing for microhaematuria has long been used for community diagnosis of Schistosoma haematobium. Sensitivities and specificities are reasonable, and hence, microhaematuria can serve as a proxy for S. haematobium infection. However, assessment of test performance in the context of the underlying S. haematobium prevalence is rare and test parameters other than sensitivity and specificity have been neglected.

Methods: Data about the association between microhaematuria and urine filtration results from three studies were compared and put into context with findings from a recent Cochrane review. Data were stratified by S. haematobium prevalence to identify prevalence-related differences in test performance. Kappa agreement and regression models were employed to compare data for different S. haematobium prevalence categories.

Results: We found a "background" prevalence of microhaematuria (13 %, on average) which does not seem to be associated with schistosomiasis in most settings, irrespective of the prevalence of S. haematobium. This background level of microhaematuria might be due to cases missed with urine filtration, or alternative causes apart from S. haematobium. Especially in very-low prevalence settings, positive results for microhaematuria likely give an inaccurate picture of the extent of S. haematobium, whereas negative results are a sound indicator for the absence of infection.

Conclusions: Reagent strip testing for microhaematuria remains a good proxy for urogenital schistosomiasis, but implications of test results and scope of application differ depending on the setting in which reagent strips are employed. In very-low prevalence settings, microhaematuria is an unstable proxy for urogenital schistosomiasis and treatment decision should not be based on reagent strip test results alone. Our findings underscore the need for highly accurate diagnostic tools for settings targeted for elimination of urogenital schistosomiasis.

No MeSH data available.


Related in: MedlinePlus