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BACKGROUND: Schistosomiasis is a parasitic infection that can cause pulmonary hypertension (PH). Th2 CD4 T cells are necessary for experimental Schistosoma-PH. However, if T cells migrate to the lung to initiate, the localized inflammation that drives vascular remodeling and PH is unknown. METHODS: Mice were sensitized to Schistosoma mansoni eggs intraperitoneally and then challenged using tail vein injection. FTY720 was administered, which blocks lymphocyte egress from lymph nodes. T cells were quantified using flow cytometry, PH severity via heart catheterization, and cytokine concentration through ELISA. RESULTS: FTY720 decreased T cells in the peripheral blood, and increased T cells in the mediastinal lymph nodes. However, FTY720 treatment resulted in no change in PH or type 2 inflammation severity in mice sensitized and challenged with S. mansoni eggs, and the number of memory and effector CD4 T cells in the lung parenchyma was also unchanged. Notably, intraperitoneal Schistosoma egg sensitization alone resulted in a significant increase in intravascular lymphocytes and T cells, including memory T cells, although there was no significant change in parenchymal cell density, IL-4 or IL-13 expression, or PH. CONCLUSION: Blocking T cell migration did not suppress PH following Schistosoma egg challenge. Memory CD4 T cells, located in the lung intravascular space following egg sensitization, appear sufficient to cause type 2 inflammation and PH.

Schistosomiasis is one of the worlds most devastating parasitic diseases, afflicting 251 million people globally. The Neotropical snail Biomphalaria glabrata is an important intermediate host of the human blood fluke Schistosoma mansoni and a predominant model for schistosomiasis research. To fully exploit this model snail for biomedical research, here we report a haplotype-like, chromosome-level assembled and annotated genome of the homozygous iM line of B. glabrata that we developed at the University of New Mexico. Using multiple sequencing platforms, including Illumina, PacBio, and Omni-C sequencing, 18 sequence contact matrices representing 18 haploid chromosomes (2n = 36) were generated (337x genome coverage), and 96.5% of the scaffold sequences were anchored to the 18 chromosomes. Protein-coding genes (n = 34,559), non-coding RNAs (n = 2,406), and repetitive elements (42.52% of the genome) were predicted for the whole genome, and detailed annotations for individual chromosomes were also provided. Using this genomic resource, we have investigated the genomic structure and organization of the Toll-like receptor (TLR) and fibrinogen-domain containing protein (FReD) genes, the two important immune-related gene families. Notably, TLR-like genes are scattered on 13 chromosomes. In contrast, almost all (39 of 40) fibrinogen-related genes (FREPs) (immunoglobulin superfamily (IgSF) + fibrinogen (FBG)) are clustered within a 5-million nucleotide region on chromosome 13, yielding insight into mechanisms involved in the diversification of FREPs. This is the first genome of schistosomiasis vector snails that has been assembled at the chromosome level, annotated, and analyzed. It serves as a valuable resource for a deeper understanding of the biology of vector snails, especially Biomphalaria snails.

In the present study, the hexane extract from branches of Drimys brasiliensis (Winteraceae) displayed potent activity against Schistosoma mansoni parasites (100% mortality of the worms at 200 μg/mL). Bioactivity-guided fractionation afforded, in addition to the previously reported bioactive sesquiterpene 3,6-epidioxy-bisabola-1,10-diene, two chemically related drimane sesquiterpenes—polygodial (1) and 9-deoxymuzigadial (2). The anti-S. mansoni effects for compounds 1 and 2 were determined in vitro, with compound 1 demonstrating significant potency (EC50 value of 10 μM for both male and female worms), while 2 was inactive. Cytotoxicity assays against Vero cells revealed no toxicity for either compound (CC50 > 200 μM). Additionally, an in silico analysis was conducted using the SwissADME platform for 1, revealing that this natural sesquiterpene exhibited adherence to several ADME parameters and no PAINS violations. Finally, in vivo studies with S. mansoni-infected mice treated with compound 1 demonstrated a 44.0% reduction in worm burden, accompanied by decreases in egg production of 71.8% in feces and 69.5% in intestines. These findings highlight the potential of polygodial (1) as a promising prototype for schistosomiasis treatment. [ABSTRACT FROM AUTHOR]

As 2030 approaches, the World Health Organization's due date for ending intestinal schistosomiasis as a public health problem in all endemic areas, understanding the current trends in the burden of schistosomiasis among schoolchildren in endemic areas is critical for monitoring the progress, identifying areas for improvement, and developing strategies to plan for instant response to mitigate the burden of schistosomiasis. From February to April of 2023, 328 students from three primary schools in Southwest Ethiopia participated in an institution-based cross-sectional study in the detection of Schistosoma mansoni. Intestinal schistosomiasis was identified among 242 school children, with a rate of infection of 73.8% (95% CI: (64.8–83.4%)). The rate of infection was higher among study participants aged between 10 and 13 years [AOR = 1.93, 95% CI: (1.1, 3.44). About 75% of the male participants were infected with Schistosoma mansoni [AOR = 0.83, 95% CI (0.49, 1.41). Nearly half (48.1%) of the S. mansoni infections among study participants were identified as heavy infections. More than half of the male study participants (50.3%) infected with Schistosoma mansoni had heavy infection intensity. Of the total female schoolchildren infected with Schistosoma mansoni, about 44.4% had a heavy infection. The prevalence and intensity of infection of Schistosoma mansoni in the study area are significantly noticeable, raising doubts on the effectiveness of the interventional programs or pin-points possible re-infection. Strategies to end the disease as a public health threat, mainly in remote and endemic areas, should consider novel integrated strategies targeting the life cycle of schistosomes besides the large-scale mass drug administration. [ABSTRACT FROM AUTHOR]

Simple Summary: This study highlights the genetic diversity of Bulinus globosus in Kenya, demonstrating that the AkInt3 intron is a valuable marker for detecting detailed intra-specific genetic variation, surpassing COI sequences. The presence of DNA recombination between AkInt3 haplogroups suggests that cross-fertilization is a common reproductive strategy, which may reduce inbreeding effects. Additionally, evidence of potential polyploidy points to further genetic complexity, warranting more studies. The findings indicate that AkInt3 primers could aid genetic studies in other Bulinus species, with distinct haplogroups suggesting significant genetic diversity. Future research across Africa will be essential for understanding B. globosus evolution and its role in disease transmission. Urinary schistosomiasis is caused by the blood fluke Schistosoma haematobium, which is predominantly found in Africa. The freshwater snail Bulinus globosus is its main intermediate host. The species that make up the B. globosus group are genetically complex, and their taxonomic status remains controversial. Genetic variation, heterozygosity, and DNA recombination in B. globosus were examined using the mitochondrial cytochrome c oxidase subunit 1 (COI) and the intron 3 region of the arginine kinase gene (AkInt3). A total of 81 B. globosus snails were collected from three different localities in Kwale County, Kenya. Genomic diversity, heterozygosity, DNA recombination, and haplotype network were calculated using AkInt3 sequences. Low polymorphism in the COI sequence divided B. globosus into six haplotypes (C1–C6). However, AkInt3 sequencing studies showed high polymorphisms, classifying 81 B. globosus snails into 44 haplotypes (H1–H44). These haplotypes were separated into three haplogroups (I–III). AkInt3 sequence heterozygosity was also found. DNA recombination haplotypes between haplogroups were commonly found in heterozygous samples. AkInt3 sequence studies showed high levels of genetic polymorphism and heterozygosity, supporting its use as a genetic marker for elucidating the population genetics of B. globosus. Furthermore, our study showed that B. globosus populations in Kenya form a "species complex". [ABSTRACT FROM AUTHOR]

Schistosomes are human-infective blood flukes characterised by their unique sex biology with genetically determined male and female individuals. The worms must physically couple heterosexually to enable the full maturation of their gonads, particularly of the female, and must remain paired to sustain maturation and egg production. Recent studies have highlighted that soluble molecules could provide a previously overlooked means of inter-sex communication, including over distance, which promotes development/maturation. We argue that developing a deeper understanding of the tentative remote molecular interactions between sexes is essential given: (i) the remarkable sexual biology of schistosomes, and (ii) the requirement to develop novel control strategies for human schistosomiasis. Persistent physical interaction between male and female schistosome adult worms has long been shown to be crucial for their development and sexual maturation, particularly for the female. Although not fully understood, worm pairing promotes local molecular communication between sexes, driving gonad and vitellaria differentiation. In this opinion article we (i) summarise evidence concerning molecular interactions underlying the physical pairing, and (ii) propose a new paradigm whereby remote male–female molecular communication may play an overlooked role in parasite sexual maturation. In this context we discuss recent research that supports both physical and remote male–female interactions driving differentiation of the gonads/vitellaria. This remote communication between sexes may be mediated by excretory–secretory products (ESPs). Integrated hypotheses are presented to stimulate research in this important and emerging field. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness and cost‐effectiveness of integrating seasonal malaria chemoprevention (SMC) with mass drug administration for helminth control among school‐aged children living in communities where the burden of malaria and helminths is high in Ghana, West Africa. Methods: This cluster randomised controlled trial will enrol 1200 children aged 5–10 years. Eligible children randomised to intervention clusters will receive SMC drugs (sulphadoxine‐pyrimethamine plus amodiaquine) and anthelminthic drugs for soil‐transmitted helminths—(albendazole), and for schistosomiasis (praziquantel), while children randomised to control clusters will receive SMC drugs alone. Pre‐ and post‐intervention blood, urine and stool samples will be collected from children in both clusters. The effectiveness of the concomitant delivery will be determined by checking whether the combination of SMC and anthelminthic drugs prevents anaemia in the children randomised to the intervention clusters compared to the children in the control clusters. Cost analysis and cost‐effectiveness of this integrated delivery approach will be determined by estimating the incremental costs and effects of co‐administration of SMC drugs with mass drug administration of anthelminthic drugs compared to SMC alone, including cost savings due to cases of moderate and severe anaemia averted. Expected findings: The findings of this study will provide evidence to inform public health recommendations for an integrated control of malaria and helminths among children living in the poorest countries of the world. [ABSTRACT FROM AUTHOR]

Background: Environmental enteric dysfunction (EED) is an acquired subclinical condition of the small intestine with lasting health implications for nutritional status, linear growth and development among children. EED is characterised by structural and functional changes to the gut barrier. There are no standardised diagnostic criteria, however, a number of biomarkers have been evaluated to capture EED domains. While the causes of EED are not fully understood, risk factors include poor water, sanitation and hygiene conditions and exposure to enteric pathogens. Very few studies have evaluated the impact of schistosomiasis on EED despite repeated intestinal damage from parasite eggs passing across the gut barrier. Methods: In a cohort of 354 preschool‐aged children aged 12–47 months with Schistosoma mansoni infection recruited from the Lake Albert region of Uganda, we assessed exposure to water, sanitation and hygiene conditions and measured markers from each EED domain: intestinal inflammation (faecal calprotectin), epithelial damage (serum intestinal fatty‐acid binding‐protein), increased permeability (urine lactulose to mannitol ratio and faecal alpha‐1 antitrypsin) and microbial translocation (serum endotoxin core antibody). Results: In multivariable linear regression models, we found that children whose drinking water was sourced from Lake Albert had higher concentrations of intestinal fatty‐acid binding‐protein (β = 0.48, 95% CI 0.20–0.76, p < 0.001), and lack of toilet/latrine access was associated with higher concentrations of calprotectin (β = 0.48, 95% CI 0.18–0.78, p < 0.01). Higher schistosomiasis intensity (eggs per gram of stool) was associated with higher calprotectin (β = 0.10, 95% CI 0.02–0.17, p = 0.01), but not with other EED markers. Conclusions: Few studies have investigated schistosomiasis‐related morbidities in very young children infected with schistosomiasis. Our findings from Uganda show that poor water, sanitation and hygiene conditions and heavier schistosomiasis burden are associated with intestinal inflammation and damage, contributing to EED. Improved treatment coverage for preschool‐aged children infected with schistosomiasis may reduce the burden from EED and associated long‐term morbidities. [ABSTRACT FROM AUTHOR]

Fascioliasis and schistosomiasis are parasitic trematodiases of public health and economic concern in humans and livestock. However, data on the distribution and risk factors for fascioliasis remain limited, while epidemiological gaps hinder schistosomiasis control in Tanzania. This One Health, cross-sectional study examined the prevalence and risk factors of schistomiasis and fascioliasis in northern Tanzania, involving 310 livestock and 317 human participants from Arusha, Kilimanjaro, and Manyara regions. Using standard parasitological methods, livestock fascioliasis prevalence was 21.3%, while schistosomiasis prevalence was 1.0%. Human fascioliasis prevalence was 1.9%, while schistosomiasis prevalence was 12.6%. Female animals, particularly cattle in Kilimanjaro and Manyara, had higher odds of fascioliasis. Human–animal contact through husbandry increased schistosomiasis risk (aOR = 4.21; 95% CI: 1.81–9.80), while the use of borehole-water was protective (aOR = 0.33; 95% CI: 0.11–0.97). Fascioliasis risk was higher among individuals aged 36–55 years (aOR = 7.66; 95% CI: 1.36–43.23), with cabbage consumption offering protection (aOR = 0.08; 95% CI: 0.01–0.89). The study revealed inverted prevalence patterns of fascioliasis and schistosomiasis in humans and livestock, driven by vector-dependent transmission dynamics. These findings emphasize the need for an integrated One Health approach to manage shared human and animal health risks in Tanzania. [ABSTRACT FROM AUTHOR]

Adult Schistosoma produces a large number of eggs that play essential roles in host pathology and disease dissemination. Consequently, understanding the mechanisms of sexual maturation and egg production may open a new avenue for controlling schistosomiasis. Here, we describe that Bantam miRNA and miR-1989 regulate Wnt signaling pathway by targeting Frizzled-5/7/9, which is involved in ovarian development and oviposition. Additionally, Frizzled-7 could cooperate with SjRho to maintain normal ovarian development and egg productions and SjRho may interact with Hsp60 to potentially support Frizzled-7 trafficking and signaling. Further in vivo inhibition of SjRho in mice model infected with Schistosoma results in a remarkable decrease in worm burden and egg productions. Our findings not only broaden the functions of Bantam miRNA and miR-1989 as well as Wnt signaling pathway, but also imply that interruption of Bantam/miR-1989-Frizzled-5/7/9-SjRho axis may serve as effective targets against schistosomiasis. Schistosoma sex-biased Bantam and miR-1989 microRNAs shed light on the roles of ovarian development and egg production in females by targeting Wnt signaling pathway. [ABSTRACT FROM AUTHOR]

Introduction: To address problems of over- and under-treatment with preventive chemotherapy resulting in ongoing transmission of schistosomiasis, the World Health Organization (WHO) recommends targeted mass drug administration (MDA) interventions at a sub-district level. In Tanzania, the lack of sub-district (ward) prevalence data has inhibited a transition to targeted treatment. Model-based prevalence estimation combined with routine surveillance data can be used to overcome this gap. We created a geostatistical model to estimate parasitological prevalence in the wards of the Lake Zone regions of Tanzania to investigate opportunities for enabling targeted MDA for schistosomiasis. With no precedent on how outputs from a geostatistical model could be used to inform decision-making in Tanzania, this qualitative study explores perceptions on what may challenge and motivate program staff in Tanzania's national schistosomiasis control program to integrate the models into routine planning to guide disease control interventions. Methods: Seven semi-structured, key informant interviews were conducted in 2022 examining perceived programmatic challenges and motivations of integrating the geostatistical model into current programming through various thematic areas: information systems, financing, services and operational capacity, policy and planning, and coordination. Key informants included decision-making staff in the Ministry of Health's neglected tropical diseases (NTD) control program, WHO NTD staff, schistosomiasis MDA implementing partners, academic experts studying the control of schistosomiasis, and central-level NTD coordinators. Results: Informants unanimously acknowledged that the geostatistical model could be useful in guiding targeted interventions, and found several factors that may motivate programmatic uptake including providing a financially feasible method to comprehensive prevalence estimates, facilitation of essential implementation tasks like site selection for MDA and screening, as well as annual calculation of treatments required for requesting medicine. Key challenges to integration were seen in limitation of existing modeling expertise, sensitization, and most importantly in the lack of WHO recommendations surrounding model use, as national disease control strategies and policies are built around WHO guidelines. Conclusions: Geostatistical models like the one presented can feasibly be integrated in decision-making for targeted interventions based on domestic capacity, financial availability and readiness. However, the lack of WHO guidance on the use of these tools calls for action to translate the potential of such models into recommendations that encourage routine integration from national programs. Overcoming this key inhibiting factor will be a crucial first step toward the integration of such models. Author summary: Schistosomiasis remains an extremely prevalent disease and a major public health problem in Tanzania despite years of disease control interventions like mass drug administration (MDA). While these interventions have expanded in scale and geographic coverage over the past 15 years, they still fail to reach millions of people who are estimated to need treatment with preventive chemotherapy (PC) drugs, resulting in severe morbidities and death secondary to schistosomiasis infection, and continued disease transmission. In its treatment guidelines, the World Health Organization (WHO) has advocated for national programs to move to a more targeted method of treatment to enable more effective and efficient use of limited resources. Problematically, decision makers in Tanzania don't have disease prevalence data for much of the country that would allow them to plan for such targeted distribution of PC in Tanzania. In 2024, KIT Royal Tropical Institute published a study on how disease prevalence estimates from geostatistical models can be used to fill these inhibitive data gaps and allow country programs to move to targeted treatment as advocated for in the WHO guidelines. With no clear precedent on how use of such models would be integrated into existing schistosomiasis control programs, this study sought to examine perceptions of challenges and incentives to programs associated with integrating these models into the planning process in Tanzania. Through interviews with key informants involved in the planning of schistosomiasis control in Tanzania, the study finds clear actionable barriers to integrating such models in existing systems, despite their perceived utility to support the planning of targeted interventions. In this study, we explore challenges and motivating factors of using this model to better understand blockers inhibiting routine use of such models across highly endemic countries like Tanzania that are stagnating on elimination targets and unable to move to targeted interventions. By examining motivating factors, we further seek to understand what encourages programmatic uptake of models to facilitate their eventual integration into health systems in endemic areas. We believe that results from this study should help to motivate the WHO to standardize recommendations around using geostatistical models, like the one presented in this study, which may serve as powerful tools to better plan interventions and reduce transmission of schistosomiasis. Such recommendations may, as this study found, have a large influence on country uptake of novel tools at country level, helping them to combat a devastating disease that affects so many millions of people across Sub-Saharan Africa and other parts of the world. [ABSTRACT FROM AUTHOR]

Background: Schistosomiasis, a neglected tropical disease, affects approximately 40 million women of reproductive age contributing to preventable anaemia during pregnancy, intrauterine growth retardation and low birth weight. In spite of the high prevalence rate of this disease among school aged children in Abakaliki, no study in Abakaliki has looked at the burden of Schistosomal infection in pregnancy with a view to determining maternal and neonatal outcomes. Objective: To determine the association between schistosomal infection and maternal anemia, low birth weight, and other neonatal outcomes in Abakaliki. Materials and methods: This was a prospective cohort study involving 94 randomly selected pregnant women with schistosomal infection and 94 matched controls without schistosomal infection. Pregnant women included were at 34 to 36 weeks of gestation. The Kato–Katz technique was used for identification and quantification of the S. mansoni, and S. japonicum, parasites in the stool, while the Ziel–Neilson stain was used for detection of the S. haematobium parasites in the urine. The patients were followed up until delivery to determine maternal and neonatal outcomes. The data were analysed using IBM SPSS version 20. The level of significance is at P – value < 0.05. Results: The prevalence of schistosomiasis in the study area was (94/968) 9.71%. The predominant species identified was Schistosoma haematobium (61/94; 64.9%). Nulliparous women were more likely to have heavy schistosomiasis infections than multiparous women (OR 6.09, 95% CI 2.3 – 15.68; P =0.0001). Neonates of women infected with schistosomiasis had low birth weight compared with the control group (2.91 ±0.70kg vs. 3.20±0.60kg, P = 0.002). Placental mass was lower in cohort of women with the disease compared with the control (0.49±0.08kg vs. 0.52±0.09kg, P = 0.02). All the cohort of women with schistosomiasis were anaemic (28±1.9 vs. 30 ±2.1, P = < 0.0001). Burden of maternal anaemia was very high among cohort with heavy infection compared with those that had light infection (OR = 2.4 95%CI1.02-5.9, P = 0.04). Schistosoama haematobium infection was more likely to cause lower maternal haematocrit levels than Schistosoama mansoni infection was (OR 4.72 95% CI 1.87–11.95, P < 0.001). Conclusion: Schistosomiasis in pregnancy is associated with adverse maternal and neonatal outcomes. S. haematobium was more likely to cause maternal anaemia than S. mansoni. We recommend routine antenatal screening of Schistosomiasis infection in the study area and the need to consider routine administration of praziquantel to antenatal attendee in the study area. [ABSTRACT FROM AUTHOR]

Infectious disease can reduce labor productivity and incomes, trapping subpopulations in a vicious cycle of ill health and poverty. Efforts to boost African farmers' agricultural production through fertilizer use can inadvertently promote the growth of aquatic vegetation that hosts disease vectors. Recent trials established that removing aquatic vegetation habitat for snail intermediate hosts reduces schistosomiasis infection rates in children, while converting the harvested vegetation into compost boosts agricultural productivity and incomes. We develop a bioeconomic model that interacts an analytical microeconomic model of agricultural households' behavior, health status, and incomes over time with a dynamic model of schistosomiasis disease ecology. We calibrate the model with field data from northern Senegal. We show analytically and via simulation that local conversion of invasive aquatic vegetation to compost changes the feedback among interlinked disease, aquatic, and agricultural systems, reducing schistosomiasis infection and increasing incomes relative to the current status quo, in which villagers rarely remove aquatic vegetation. Aquatic vegetation removal disrupts the poverty-disease trap by reducing habitat for snails that vector the infectious helminth and by promoting the production of compost that returns to agricultural soils nutrients that currently leach into surface water from on-farm fertilizer applications. The result is healthier people, more productive labor, cleaner water, more productive agriculture, and higher incomes. Our model illustrates how this ecological intervention changes the feedback between the human and natural systems, potentially freeing rural households from poverty-disease traps. [ABSTRACT FROM AUTHOR]

Background: Our primary focus was Schistosoma mansoni infection and schoolchildren. Within communities the social environment may promote individual risk of infection for the school-aged children. There will also be demographic groups who are not targeted or reached by preventive chemotherapy campaigns. The behaviours of these other groups will interact with those of school-aged children, resulting in further infection risk through exposure-related behaviours. Furthermore, perception of the disease may significantly influence the schoolchildren's lived experience of the infection and associated disease. It is therefore crucial to document the daily experiences of schoolchildren living in schistosomiasis high transmission areas along Lake Albert, Hoima District. Methods: An ethnographic study explored schoolchildren's perspectives and daily life organisations that shape their risk of schistosomiaisis and their perceptions of the disease. The study was conducted between November 2022 and August 2023. It involved in-depth interviews with schoolchildren and their parents, key informant interviews, focus group discussions with schoolchildren, and participant observations. Data was analysed using a reflexive thematic analysis. Code reports were generated inductively using ATLAS.ti (Version 7). Results: The study revealed a significant level of knowledge and awareness about schistosomiasis among schoolchildren. They had understanding of the risk factors, continued exposure, and experiences of illness, though they had little autonomy to address these through their own behaviour as they were influenced by the behaviour of others and macro-factors such as WASH provision and economic need. Study participants experienced individual-level effects of schistosomiasis such as educational impacts and isolation as a significant form of stigma. Conclusions: There is a need for continued community sensitisation and awareness campaigns to address social stigma, educational impact, and contamination and exposure-related behaviours. National and regional policies and programmes on WASH, livelihood and poverty eradication programmes need to be revisited in schistosomiasis high transmission areas to help provide alternatives and improve schoolchildren's lived experiences. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral schistosomiasis is a rare but severe manifestation of Schistosoma japonicum infection, often leading to significant neurological impairment. This case report details the clinical presentation, diagnostic challenges, and treatment of a 3-year-old girl with cerebral schistosomiasis in Sichuan, China. Case description: A 3-year-old girl from a rural area in Sichuan, China, presented with a 3-month history of unstable walking, left facial paralysis, drowsiness, and intermittent fever. Brain MRI revealed giant polycystic lesions in the right temporal, parietal, and occipital lobes, suggestive of an abscess with ependymitis. Despite no history of travel to endemic areas or known freshwater exposure, the patient was diagnosed with cerebral schistosomiasis due to Schistosoma japonicum based on histological examination and metagenomic next-generation sequencing (mNGS) of brain tissue obtained through surgery. The patient underwent surgical resection of the lesions and received two courses of praziquantel combined with corticosteroids and anticonvulsants. Despite residual left-sided hemiplegia, her cognitive function remained comparable to that of her peers, and no recurrence of the disease was observed over three years of follow-up. Conclusion: This case underscores the diagnostic challenges of cerebral schistosomiasis, particularly in non-endemic areas or in the absence of a clear history of freshwater exposure. Early surgical intervention combined with praziquantel treatment can lead to favorable outcomes, even in severe cases with extensive brain involvement. [ABSTRACT FROM AUTHOR]

Background: Mozambique is one of the countries with the highest prevalence of schistosomiasis, although there is little data on the prevalence of disease and associated morbidity in the adult population. This study aimed to describe and characterize the morbidity associated with schistosomiasis in the adult population of Chókwè district and to explore the use of anamnestic questionnaires and urine dipsticks, as well as point-of-care ultrasound for urinary related findings, to better characterize disease prevalence and morbidity. Methodology: Between April and October 2018, we conducted a cross-sectional study embedded within the Chókwè Health Research and Training Centre. Data were collected on sociodemographic variables, signs and symptoms for schistosomiasis and water related activities. Infection status was determined by urine filtration, Kato-Katz thick smear and DNA detection. Point-of care urinary tract ultrasonography was performed to assess structural morbidity associated with Schistosoma haematobium infection. Multivariate logistic regression was used to search for associations between risk factors, signs and symptoms, infection status and ultrasound abnormalities. Principal findings: Our study included 1033 participants with a mean age of 32 years old. The prevalence of Schistosoma haematobium, Schistosoma mansoni and ultrasound detected urinary tract abnormalities were 11.3% (95% CI 9.5%-13.4%), 5.7% (95% CI 4.3%-7.5%) and 37.9% (95% CI 34.8%-41.2%), respectively. Of the 37.9% with urinary tract abnormalities, 14.5% were positive for Schistosoma haematobium. Reported hematuria in the last month (p = 0.004, aOR 4.385) and blood in the urine dipstick (p = 0.004, aOR 3.958) were markers of Schistosoma haematobium infection. Reporting lower abdominal pain (p = 0.017, aOR 1.599) was associated with ultrasound abnormalities. Conclusion: Using microscopy and DNA analysis for both Schistosoma haematobium and Schistosoma mansoni in conjunction with urinary ultrasound abnormalities gives us several insights into correlations between disease prevalence (microscopic and anatomical) and demographic details in a high-risk population. Author summary: Schistosomiasis is one of the most common parasitic diseases in the world, mainly affecting people living in sub-Saharan Africa. Mozambique is one of the countries with the highest prevalence of the disease. Chronic urinary schistosomiasis in the adult population can lead to hematuria, anemia, urinary tract lesions and eventually death from renal failure and bladder cancer. The characteristics of the chronic form of disease in the adult population of Mozambique is unknown. A cross-sectional, community-based study was conducted to assess current morbidity and the risk factors for schistosomiasis among the adult population of Chókwè district, Mozambique. The prevalence of urinary schistosomiasis was 11.3%, intestinal schistosomiasis was 5.7% and urinary tract ultrasound abnormalities were 37.9%. Of the 37.9% with ultrasound abnormalities, 14.5% were positive for Schistosoma haematobium. In this study, reporting hematuria in the last month and blood in the urine were found to be diagnostic markers of urinary schistosomiasis, and reporting lower abdominal pain was associated with ultrasound abnormalities. The high prevalence of anatomical urinary tract ultrasound abnormalities suggests that the disease has an important impact on the long-term health of the adult population. [ABSTRACT FROM AUTHOR]

Background: The WHO Neglected Tropical Disease Roadmap for 2021–2030 includes the goal of eliminating schistosomiasis as a public health problem in all endemic countries. Despite heightened efforts since 2012, critical action is still required in addressing barriers to Mass Drug Administration, the primary control method. This includes improvement in adherence by the populations in persistent schistosomiasis hotspots. One such hotspot is the shoreline of Lake Albert, Uganda, where schistosomiasis control is provided to school-aged children and adults. An overemphasis on regular treatment, without comprehensively addressing factors that result in low uptake of treatment in these high-risk populations is likely to impact the elimination of schistosomiasis as a public health problem. Methods: An ethnographic study using in-depth interviews, key informant interviews, focus group discussions and participant observation was conducted at two study sites along Lake Albert. Thematic content analysis was used during data analysis. Results: The study revealed that the size, taste and smell of the drug, along with its side-effects; poor community integration and occupational behaviour resulting in non-mobilisation; and unfounded rumours and beliefs remain reasons for persistent low uptake of praziquantel by some. Conversely, lived experience of improved health through participation and knowledge of the dangers of the disease if not treated, facilitated treatment uptake. Positive attitudes to localised sensitisation by community drug distributors show social influence facilitates crucial knowledge attainment. Treatment uptake is further facilitated by the delivery of the drug at no cost at home. Crucially, for the majority of participants the facilitating factors were found to outweigh the inhibitory factors related to the drug's side effects. Conclusion: We recommend a good community engagement strategy that provides continuous education and sensitisation, with improved recruitment and training provision for Community Drug Distributors to facilitate programme reach to groups with current poor engagement. Author summary: Over the last two decades, in the Lake Albert region, Uganda, there have been a number of interventions targeted at schistosomiasis by grass root structures, and district and national level actors; but despite this the Lake Albertine districts remain a highly endemic region for schistosomiasis. In recognition of this persistent schistosomiasis, we examined the factors that inhibit or facilitate adherence to mass drug administration (MDA) using an ethnographic approach. Lived experience of improved health through participation and knowledge of the dangers of the disease if not treated, facilitated treatment uptake. Localised social influence was crucial in gaining knowledge that facilitated uptake. Key were positive attitudes to sensitisation conducted by community drug distributors; whilst uptake of treatment by children was reportedly heavily influenced by their mothers' positive attitudes to treatment. The drug itself, praziquantel, was described as "very strong" and "effective" because of the relief from symptoms. There are, however, a number of people, both children and adults, who fail to adhere to MDA. Therefore, we recommend continuous education and sensitisation, alongside increased number and training of Community drug distributors/village health team members; with continued motivation for them as they are vital in enabling treatment uptake. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminths (STH) and schistosomiasis comprise the most wide-spread NTDs globally. Preventative chemotherapy is a cost-effective approach to controlling morbidity of both diseases, but relies on large scale surveys to determine and revise treatment frequency. Availability of detailed information on survey costs is limited despite recent methodological surveying innovations. We micro-costed a survey of STH and schistosomiasis in Kenya, and linked results to precision estimates of competing survey methods to compare cost-efficiency. Methods: Costs from a 2017 Kenyan parasitological survey were retrospectively analyzed and extrapolated to explore marginal changes when altering survey size, defined by the number of schools sampled and the number of samples taken per school. Subsequent costs were applied to simulated precision estimates of model-based geostatistical (MBG) and traditional survey designs. Cost-precision was calculated for a range of survey sizes per method. Four traditional survey design scenarios, based around WHO guidelines, were selected to act as reference cases for calculating incremental cost-effectiveness ratios (ICERs) for MBG design. Findings: MBG designed surveys showed improved cost-precision, particularly if optimizing number of schools against samples per school. MBG was found to be more cost-effective under 87 of 92 comparisons to reference cases. This comprised 14 situations where MBG was both cheaper and more precise, 42 which had cost saving with precision trade off (ICERs; $8,915-$344,932 per percentage precision lost); and 31 more precise with increased cost (ICERs; $426-$147,748 per percentage precision gained). The remaining 5 comparisons represented extremes of MBG simulated site selection, unlikely to be applied in practice. Interpretation: Efficiency gains are possible for deworming surveys when considering cost alone, such as through minimizing sample or analysis costs. However further efficiency maximization is possible when designing surveys using MBG given its improved precision and ability to optimize the balance between number of schools and sample size per school. Author summary: Soil-transmitted helminths (STH) and schistosomiasis are widespread neglected tropical diseases (NTDs) which require preventative chemotherapy (PC) for morbidity control among school–aged children. A key component of PC for both diseases is the use of large-scale surveys to determine prevalence in order to guide treatment frequency. Given the need for a population estimate, surveys represent a substantial proportion of helminth control program budgets. There is a need to understand costing components of these surveys to make best use of available resources and tie costs to recent innovations in survey design methods, termed Model Based Geostatistics (MBG), which have been shown to deliver more precise results, given the same resources, than traditional design approaches. Detailed bottom up costing is provided for a representative survey of STH and schistosomiasis conducted in Kenya in 2017. Results are analyzed and extrapolated to demonstrate how costs differ depending on numbers of schools surveyed and individuals sampled per school. Extrapolations are coupled with a previous simulation study comparing the precision of traditional and MBG-based design and analysis of the same series of surveys conducted in Kenya. A range of cost-precision estimates are generated to show incremental cost-effectiveness ratios of both traditional and geospatial survey design under varying budget constraints, represented by survey size. The geostatistical design, under almost all reference case comparisons is cost saving, more precise, or both. Substantial increases in cost-efficiency are possible when geostatistical methods are used to design and analyse large representative surveys of helminths. This is critical for the future of school-based deworming programs as a greater emphasis is placed on maintaining cost-effectiveness in environments where prevalence and morbidity due to STH and schistosomiasis are reducing. [ABSTRACT FROM AUTHOR]