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This was a collaborative project between the University of St Andrews and the University of Rwanda, funded by the Scottish Funding Council (XFC069). Visual impairment and blindness affect an estimated 2.2 billion people worldwide. Accessible low-cost diagnostic tools and interprofessional education and collaborative practice are part of ongoing strategies to improve eye care services. This study evaluated the impact of an interprofessional Arclight workshop on undergraduate healthcare students’ clinical identification skills related to eye health, and self-reported confidence in ophthalmic skills. Undergraduate students from clinical medical officer, ophthalmic clinical officer, Bachelors and Diploma nursing, and medical programmes at the University of Rwanda participated in a pilot interprofessional eye health workshop. The Arclight device, a low-cost ophthalmoscope and simulation eyes were used to enable students to practise ophthalmic skills and thereafter equip them. Clinical identification skills related to common eye conditions, and self-reported confidence in ophthalmic skills were assessed pre and post workshop. Overall, students’ ability to identify common eye conditions, and self-reported confidence in relation to all skills statistically improved post workshop, with some differences between professional groups in relation to eye health skills. This IPE experience used the Arclight package as a vehicle for IPE, enabling healthcare students to share and acquire new skills and confidence in relation to recognizing common eye conditions and assessing eye health. Publisher PDF

This article consists of a review article reporting the results of previous evaluations of the control of water, sanitation, and hygiene (WASH) related disease through the Community Hygiene Club (CHC) intervention from 2010 to 2020. CHC constitutes the main intervention for the control of WASH-related disease in Rwanda and is implemented countrywide. The study objective was to evaluate if the CHC intervention significantly reduced the prevalence of WASH-related disease after 10 years of its implementation in Rwanda. The study utilized online existing policy documents, research reports, and experiences on the CHC intervention in Rwanda published between 2010 and 2020. We selected and reviewed 12 published documents, and the evaluation followed the steps proposed by ACHI (2020) Health Impact Assessment (HIA) and related frameworks of effective implementation of community health interventions. The primary outcome measure used was the reduction of WASH-related disease while the secondary outcome measure used was the increase of household WASH practices at less than a 5% level of statistical significance. We also described the structure and the implementation process of the CHC intervention. From the case studies where frameworks of effective implementation of community health interventions were applied, the study results showed the intervention significantly (a) increased households’ WASH practices and (b) reduced WASH-related disease. Due to limited publications in the research area and the lack of association of the WASH-related diseases and practices to the CHC intervention’s evaluation for most of published research reports, we recommend additional field data for an extended conclusion and its generalization in Rwanda. The study highlights the need to use appropriate frameworks in the evaluation of community health interventions to (a) attribute the outcome to the intervention and (b) easily identify the shortcomings in case of failure to get expected outcomes.

The emergence of the SARS-CoV-2 Delta variant of concern (lineage B.1.617.2) in late 2020 resulted in a new wave of infections in many countries across the world, where it often became the dominant lineage in a relatively short amount of time. We here report on a novel genomic surveillance effort in Rwanda in the time period from June to September 2021, leading to 201 SARS-CoV-2 genomes being generated, the majority of which were identified as the Delta variant of concern. We show that in Rwanda, the Delta variant almost completely replaced the previously dominant A.23.1 and B.1.351 (Beta) lineages in a matter of weeks, and led to a tripling of the total number of COVID-19 infections and COVID-19-related fatalities over the course of only three months. We estimate that Delta in Rwanda had an average growth rate advantage of 0.034 (95% CI 0.025-0.045) per day over A.23.1, and of 0.022 (95% CI 0.012-0.032) over B.1.351. Phylogenetic analysis reveals the presence of at least seven local Delta transmission clusters, with two of these clusters occurring close to the border with the Democratic Republic of the Congo, and another cluster close to the border with Tanzania. A smaller Delta cluster of infections also appeared close to the border with Uganda, illustrating the importance of monitoring cross-border traffic to limit the spread between Rwanda and its neighboring countries. We discuss our findings against a background of increased vaccination efforts in Rwanda, and also discuss a number of breakthrough infections identified during our study. Concluding, our study has added an important collection of data to the available genomes for the Eastern Africa region, with the number of Delta infections close to the border with neighboring countries highlighting the need to further strengthen genomic surveillance in the region to obtain a better understanding of the impact of border crossings on lowering the epidemic curve in Rwanda.

The progression of the SARS-CoV-2 pandemic in Africa has so far been heterogeneous and the full impact is not yet well understood. Here, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations, predominantly from Europe, which diminished following the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1 and C.1.1. Although distorted by low sampling numbers and blind-spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a breeding ground for new variants.

Background: Globally, over 325 and 170 million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV), respectively. If untreated, these infections can progress to cirrhosis or hepatocellular carcinoma. The primary aim of this study was to determine the prevalence, genetic diversity, and factors associated with HBV and HCV among couples attending antenatal care in rural Rwanda. Methods: This was a cross-sectional survey of HBV and HCV seroprevalence. Study participants were administered a brief structured questionnaire to obtain information on sociodemographic and behavioural risk factors for HBV and HCV. Participant blood samples were screened for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV) using rapid diagnostic kits; confirmatory testing was done by enzyme immunoassay and nucleic acid tests. HBV genotypes were determined using nested polymerase chain reaction; HCV genotypes were determined by reverse transcriptase PCR followed by hybridisation with sequence-specific oligonucleotides. Statistical associations between risk factors and infection status were determined using Chi-square tests and bivariate logistic regression. Results: In total, 220 individuals participated in the study. This includes 110 pregnant women and 110 male partners who were attending antenatal care at Gitare and Cyanika health centres. Two participants (0.9%) had serological evidence of HBV infection, and 4 participants (1.8%) were infected with HCV. HBV genotype A accounted for all HBV infections; HCV genotype 4 accounted for all HCV infections. None of the assessed factors were associated with HBV infection while occupation type and scarification were significantly associated with HCV infection (P values were .03 and

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for coronavirus disease 19 (COVID-19), is a single-stranded positive-sense ribonucleic acid (RNA) virus that typically undergoes one to two single nucleotide mutations per month. COVID-19 continues to spread globally, with case fatality and test positivity rates often linked to locally circulating strains of SARS-CoV-2. Furthermore, mutations in this virus, in particular those occurring in the spike protein (involved in the virus binding to the host epithelial cells) have potential implications in current vaccination efforts. In Rwanda, more than twenty thousand cases have been confirmed as of March 14th 2021, with a case fatality rate of 1.4% and test positivity rate of 2.3% while the recovery rate is at 91.9%. Rwanda started its genomic surveillance efforts, taking advantage of pre-existing research projects and partnerships, to ensure early detection of SARS-CoV-2 variants and to potentially contain the spread of variants of concern (VOC). As a result of this initiative, we here present 203 SARS-CoV-2 whole genome sequences analyzed from strains circulating in the country from May 2020 to February 2021. In particular, we report a shift in variant distribution towards the newly emerging sub-lineage A.23.1 that is currently dominating. Furthermore, we report the detection of the first Rwandan cases of the VOCs, B.1.1.7 and B.1.351, among incoming travelers tested at Kigali International Airport. We also discuss the potential impact of COVID-19 control measures established in the country to control the spread of the virus. To assess the importance of viral introductions from neighboring countries and local transmission, we exploit available individual travel history metadata to inform spatio-temporal phylogeographic inference, enabling us to take into account infections from unsampled locations during the time frame of interest. We uncover an important role of neighboring countries in seeding introductions into Rwanda, including those from which no genomic sequences are currently available or that no longer report positive cases. Our results point to the importance of systematically screening all incoming travelers, regardless of the origin of their travels, as well as regional collaborations for durable response to COVID-19.

Suppressing infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will probably require the rapid identification and isolation of individuals infected with the virus on an ongoing basis. Reverse-transcription polymerase chain reaction (RT-PCR) tests are accurate but costly, which makes the regular testing of every individual expensive. These costs are a challenge for all countries around the world, but particularly for low-to-middle-income countries. Cost reductions can be achieved by pooling (or combining) subsamples and testing them in groups1-7. A balance must be struck between increasing the group size and retaining test sensitivity, as sample dilution increases the likelihood of false-negative test results for individuals with a low viral load in the sampled region at the time of the test8. Similarly, minimizing the number of tests to reduce costs must be balanced against minimizing the time that testing takes, to reduce the spread of the infection. Here we propose an algorithm for pooling subsamples based on the geometry of a hypercube that, at low prevalence, accurately identifies individuals infected with SARS-CoV-2 in a small number of tests and few rounds of testing. We discuss the optimal group size and explain why, given the highly infectious nature of the disease, largely parallel searches are preferred. We report proof-of-concept experiments in which a positive subsample was detected even when diluted 100-fold with negative subsamples (compared with 30-48-fold dilutions described in previous studies9-11). We quantify the loss of sensitivity due to dilution and discuss how it may be mitigated by the frequent re-testing of groups, for example. With the use of these methods, the cost of mass testing could be reduced by a large factor. At low prevalence, the costs decrease in rough proportion to the prevalence. Field trials of our approach are under way in Rwanda and South Africa. The use of group testing on a massive scale to monitor infection rates closely and continually in a population, along with the rapid and effective isolation of people with SARS-CoV-2 infections, provides a promising pathway towards the long-term control of coronavirus disease 2019 (COVID-19)., info:eu-repo/semantics/published

Funding: Global Challenges Research Funding awarded by the Scottish Funding Council. Preventable and treatable visual impairment affects more than 1 billion people worldwide. Rwanda has an estimated visual impairment prevalence of 3.7% amongst the 12 million inhabitants. Around one third of this demand could be addressed through a more integrated and collaborative approach, particularly in primary eye care services. Healthcare students, therefore, need to be prepared for collaborative practice in eye health through interprofessional learning. Interprofessional workshops were piloted with ophthalmic clinical officer, medical clinical officer, nursing and medical students from the University of Rwanda. The aim was to promote collaborative practice by teaching students how to assess and recognize common eye conditions using the Arclight; a low cost, solar powered, portable ophthalmoscope designed for use in low resource settings. Students reported that the workshop content was relevant to all professional groups. They valued the opportunity to learn interprofessionally, share their knowledge and perspectives, and acquire new knowledge and skills together. This pilot helped to identify the most relevant skills and knowledge for future interprofessional eye health training. It enabled the facilitators to reflect on how best to maintain a balance between a quality interprofessional experience and the more specific eye health related learning objectives. Postprint

Suppressing SARS-CoV-2 will likely require the rapid identification and isolation of infected individuals, on an ongoing basis. RT-PCR (reverse transcription polymerase chain reaction) tests are accurate but costly, making regular testing of every individual expensive. The costs are a challenge for all countries and particularly for developing countries. Cost reductions can be achieved by combining samples and testing them in groups. We propose an algorithm for grouping subsamples, prior to testing, based on the geometry of a hypercube. At low prevalence, this testing procedure uniquely identifies infected individuals in a small number of tests. We discuss the optimal group size and explain why, given the highly infectious nature of the disease, parallel searches are preferred. We report proof of concept experiments in which a positive sample was detected even when diluted a hundred-fold with negative samples. Using these methods, the costs of mass testing could be reduced by a factor of ten to a hundred or more. If infected individuals are quickly and effectively quarantined, the prevalence will fall and so will the costs of regularly testing everyone. Such a strategy provides a possible pathway to the longterm elimination of SARS-CoV-2. Field trials of our approach are now under way in Rwanda and initial data from these are reported here., Comment: Substantially expanded version: 24 pages, 3 figures in the main text; 6 tables and figures in Appendices and Supplementary Materials

Objective To explore whether HIV self-testing (HIVST) would have the capacity to improve uptake of HIV testing services among male youths in Rwanda. We conducted a qualitative study of 22 male youths attending tertiary institutions and the Kimisagara Youth Centre in Kigali, Rwanda. Data collection was conducted through open interviews. Data analysis was conducted through thematic content analysis. Results Our findings revealed that most male youths had poor knowledge of HIV self-testing (HIVST), but the majority were willing to adopt it. Four main themes emerged during data analysis. Theme one indicated that male youths experienced a lack of sufficient information on HIVST. From theme two, it was uncovered that some male youths were indifferent to HIVST. From theme three, it emerged that most men perceived the cost as the main barrier to HIVST; however, if it was offered free of charge, they were willing to adopt it. Finally, theme four revealed that most male youths willing to adopt HIVST were concerned about the potential social harm and possible adverse events associated with HIVST.

Suppressing infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) will probably require the rapid identification and isolation of individuals infected with the virus on an ongoing basis. Reverse-transcription polymerase chain reaction (RT-PCR) tests are accurate but costly, which makes the regular testing of every individual expensive. These costs are a challenge for all countries around the world, but particularly for low-to-middle-income countries. Cost reductions can be achieved by pooling (or combining) subsamples and testing them in groups

Background: In response to the need for interventions that facilitate the accessibility of medical services in poor communities, an outreach activity was organized in semi-rural areas of Maraba and Simbi sectors located in Huye district, Southern province of Rwanda. The outreach was undertaken by health sciences students and involved the screening of hypertension, risk of diabetes, hepatitis, anemia, eye disease, and HIV.Methods: Clinical assessments and rapid laboratory diagnostic assays were used to screen invited residents from the two selected communities. An observation research was conducted from May 21 to 25 May, 2018, at Maraba and Simbi sector located in Huye district, Southern province, Rwanda. We employed a purposively sampling technique for participants' recruitment in the outreach. The outreach was conducted as part teaching program and community engagement, and was endorsed by college of medicine and health sciences and all the subjects voluntarily participated in this exercise; the ethical approval was not applicable for this outreach activity. Results: The total beneficiaries from those sectors were 1427 citizens of whom females predominated at 72%. During the screening, hypertension was found to be high at 47.8% among adults. Anemia which mostly presumes iron deficiency was observed at 32.5% among under 15 years old children and at 15% in pregnant women. The vision impairment and cataract were observed at 5.66 and 19.59%, respectively. The assessed viral infection indicated a rate of 0.56% for HIV, 1.03% for HBV, and 7.17% for HCV. High blood glucose was found in 10.4% of the screened population.Conclusions: The findings highlight a high burden of non-communicable diseases (NCDs) in rural communities and call for further investigations and interventions to align with the sustainable development goals (SDGs), particularly access to affordable health services. Furthermore, the success of this outreach highlights the potential contribution of health care trainees in achieving these goals and calls for integration of such interventions in the health education curriculum.

BACKGROUND & OBJECTIVE: Rwanda has generally experienced low uptake of HIV testing services among men. However, the reasons behind this have not been researched. The main aim of this study was to explore whether HIV self-testing (HIVST) would have the capacity to improve uptake of HIV testing services among men in Rwanda. METHODS: We conducted a qualitative study of 22 men attending tertiary institutions and the Kimisagara Youth Centre in Kigali, Rwanda. Data collection was conducted through open interviews. Data analysis was conducted through thematic content analysis. RESULTS: Our findings revealed that most men had poor knowledge of HIVST, but the majority were willing to adopt it. Four main themes emerged during data analysis. Theme one indicated that men experienced a lack of sufficient information on HIVST. From theme two, it was uncovered that some men were indifferent to HIVST. From theme three, it emerged that most men perceived the cost as the main barrier to HIVST; however, if it was offered free of charge, they were willing to adopt it. Finally, theme four revealed that most men willing to adopt HIVST were concerned about the potential social harm and possible adverse events associated with HIVST.

Background: Protective acquired immunity against helminths and allergic sensitisation are both characterised by high IgE antibody levels. Levels of IgE antibodies are naturally tightly regulated by several mechanisms including binding of the CD23 receptor. Following observations that helminth infections and allergic sensitisation may co-present, the current study aims to investigate the relationship between the soluble CD23 (sCD23) receptor, parasite-specific IgE responses and allergic sensitisation in people exposed to the helminth parasite Schistosoma haematobium. Methods: A cohort of 434 participants was recruited in two villages with different levels of S. haematobium infection in Zimbabwe. Serum levels of the 25-kDa fragment of sCD23 were related to levels of schistosome infection intensity, allergen (house dust mite, HDM) and schistosome-specific IgE, total IgE and skin sensitisation to HDM. Results: sCD23 levels rose significantly with schistosome infection intensity but declined significantly with schistosome-specific IgE levels. Furthermore, sCD23 levels were negatively associated with skin sensitisation and IgE reactivity against HDM, but showed no relationship with total IgE. Conclusion: The results are consistent with the suppression of parasite and allergen-specific IgE levels by sCD23. Further mechanistic studies will determine the relevance of this potential regulatory mechanism in the development of helminth-specific immune responses in atopic individuals.

Pneumonia is a public health problem in the tropics, and the 7-valent pneumococcal conjugative vaccine (PCV-7) has been introduced in an effort to prevent the disease and therefore reduce childhood mortality. In Rwanda, PCV-7 was introduced in 2009, and we aimed to determine its impact on the rate of child hospitalization/mortality due to pneumonia. A retrospective survey was conducted on hospitalization rates and pediatric deaths between two periods, that is, before the introduction of PCV-7 (2007–2009) and after the introduction of PCV-7 (2010–2013) in Kabutare District Hospital. There was a 53% reduction in hospitalization, with a significant decline in in-hospital deaths between the two periods. There was also a significant correlation between vaccination coverage and decline in hospitalization rates between 2009 and 2013. We conclude that PCV-7 vaccine is associated with significant reduction in the rate of child hospitalization and mortality but more mechanistic studies are warranted to determine the immunological impact, especially in the context of coinfections and malnutrition.

SUMMARY Field studies show an association between schistosome infection and atopy, but the effects of anti-helminthic treatment on this association have not yet been investigated in human populations with different schistosome endemicity levels. This study aimed to compare the effects of anti-helminthic treatment on responses directed against the house dust mite Dermatophagoides pteronyssinus (Derp1) and Schistosoma haematobium in Zimbabwean populations living in high and low schistosome infection areas. Derp1- and schistosomespecific IgE and IgG4 antibodies were quantified by ELISA before and 6 weeks after anti-helminthic treatment. Following treatment, there were changes in the immune responses, which varied with place of residence. After allowing for the effects of sex, age and baseline infection intensity, there was no significant treatment effect on the change in anti-schistosome IgE and IgG4 in the high infection area. However, the antischistosome IgE ⁄ IgG4 ratio increased significantly, while anti-Derp1 IgE responses decreased as a result of treatment. In the low infection area, treatment resulted in a significant increase in anti-worm IgE levels, but there was no significant treatment effect on anti-schistosome or anti-Derp1 IgE ⁄ IgG4 ratios. Thus, the study shows that the level of schistosome endemicity affects the host responses to schistosome and mite antigens following anti-helminthic treatment.

Background: The hygiene hypothesis suggests that parasitic infections protect against allergic diseases by modulating the host’s immune responses. Experimental studies indicate that this protection depends on the intensity of parasitic infection, but this observation has not been tested in human populations. The aim of this study is to investigate whether the intensity of Schistosoma haematobium infection is related to atopic responses and whether this relationship differs between populations with distinct parasite transmission dynamics. Methods: The study was conducted in two villages with different Schistosoma haematobium transmission dynamics, i.e. high (n = 365) and low (n = 307) transmission. Allergic reactivity to the common house dust mite (Dermatophagoides pteronyssinus) was measured by skin prick tests and allergen-specific IgE and IgG4 quantified by enzyme-linked immunosorbent assay. Atopic responses were related to current infection intensity and schistosome transmission levels. Results: Schistosome infection intensity was negatively associated with the skin prick reactivity, mite-specific IgE and the ratio IgE/IgG4 in the high-transmission village. However, when only low levels of infection were analyzed in the 2 villages, there was no correlation between mite-specific responses and infection intensity. Conclusion: The relationship between schistosome infection and atopic responses is dependent on the intensity of current schistosome infection. Thus, consistent with results from animal models, with an increasing parasite burden, the immunoregulation of immune responses to allergens appears to become more pronounced.

SUMMARYDespite the overlapping distribution ofSchistosoma haematobiumandPlasmodium falciparuminfections, few studies have investigated early immune responses to both parasites in young children resident in areas co-endemic for the parasites. This study measures infection levels of both parasites and relates them to exposure and immune responses in young children. Levels of IgM, IgE, IgG4 directed against schistosome cercariae, egg and adult worm and IgM, IgG directed againstP. falciparumschizonts and the merozoite surface proteins 1 and 2 together with the cytokines IFN-γ, IL-4, IL-5, IL-10 and TNF-αwere measured by ELISA in 95 Zimbabwean children aged 1–5 years. Schistosome infection prevalence was 14·7% and that ofPlasmodiuminfection was 0% in the children. 43. 4% of the children showed immunological evidence of exposure to schistosome parasites and 13% showed immunological evidence of exposure toPlasmodiumparasites. Schistosome–specific responses, indicative of exposure to parasite antigens, were positively associated with cercariae-specific IgE responses, whilePlasmodium-specific responses, indicative of exposure to parasite antigens, were negatively associated with responses associated with protective immunity againstPlasmodium. There was no significant association between schistosome-specific andPlasmodium-specific responses. Systemic cytokine levels rose with age as well as with schistosome infection and exposure. Overall the results show that (1) significantly more children are exposed to schistosome andPlasmodiuminfection than those currently infected and; (2) the development of protective acquired immunity commences in early childhood, although its effects on infection levels and pathology may take many years to become apparent.

The global prevalence of gestational diabetes (GDM) in pregnant 20-49 year old women has increased to 16.9%, although data from Africa on GDM are scarce, and risk exposure to pregnant women is unknown. Among the 288 pregnant women screened in Rwanda, 8.3% of women with FPG >126 mg/dL (>6.9 mmol/L) had GDM. Age >41 years (45.8% vs. 18.9%; p

Characterisation of protective helminth acquired immunity in humans or experimental models has focused on effector responses with little work conducted on memory responses. Here we show for the first time, that human helminth infection is associated with altered proportions of the CD4+ memory T cells, with an associated alteration of T(H)1 responses. The reduced CD4+ memory T cell proportions are associated with a significantly lower ratio of schistosome-specific IgE/IgG4 (marker for resistance to infection/re-infection) in uninfected older people. Helminth infection does not affect the CD8+ memory T cell pool. Furthermore, we show for the first time in a helminth infection that the CD4+ memory T cell proportions decline following curative anti-helminthic treatment despite increased CD4+ memory cell replication. Reduced accumulation of the CD4+ memory T cells in schistosome-infected people has implications for the development of natural or vaccine induced schistosome-specific protective immunity as well as for unrelated pathogens.

Urogenital schistosomiasis is a debilitating disease caused by the parasitic trematode Schistosoma haematobium, which currently infects >100 million people [1]. Humans are exposed to infective larvae (cercariae), which invade via percutaneous penetration; adult male and female worms, which mate in the urogenital tract; and eggs, which are transmitted to the environment in urine. Repeated passage of eggs across the bladder and urogenital tract leads to characteristic immune-mediated morbidities [2, 3]. The World Health Organization advocates schistosomiasis control via treatment with the antihelminthic drug praziquantel (PZQ) [4] due to its efficacy at clearing infection [5, 6] and reducing the prevalence of schistosome-associated morbidities [7]. Praziquantel treatment also alters schistosome-specific immune responses, and removal of infection and/or exposure to antigens released from parasites damaged by treatment may influence responses to subsequent infection [8–10]. Studies showing a decline in the proportion of circulating T regulatory (Treg) cells [11] and increased effector responses to parasite [12, 13] and nonparasite antigens [14, 15] post-treatment indicate that immunoregulatory mechanisms established during infection are alleviated when infection is removed. Furthermore, PZQ-induced changes in antibody levels, CD23+ B cells [16], and cellular proliferation [13] have been associated with reduced Schistosoma mansoni reinfection rates, suggesting that treatment may have longer-term benefits in addition to transient infection clearance. Taken together, these observations suggest that treatment alters not only the magnitude of the host immune response but also the phenotype of schistosome-specific responses. However, although previous human studies have inferred relative changes in the phenotype of the schistosome-specific cytokine response from changes in individual responses [12, 17], this hypothesis has not been directly assessed. Importantly, experimental models of helminth infection suggest that innate cells and CD4+ T helper (Th) cells (Th1, Th2, Treg, and Th17) cross-regulate one another during infection [18, 19], and the interaction between these responses rather than levels of individual cytokines alone may influence resistance to reinfection [20]. No studies to date have investigated schistosome-specific, Th17-associated cytokine responses in humans despite the role of Th17 in schistosome egg-mediated immunopathologies in mice [21–23] and detectable levels of Th17-type cytokines in plasma samples from S. haematobium–exposed humans [24]. This study addresses 4 key hypotheses relating to the effect of PZQ on schistosome-specific immune responses: (1) treatment influences levels of schistosome-specific, Th17-associated cytokines in addition to the previously assayed cytokines; (2) the cytokine environment (comprising markers associated with innate inflammatory, Th1, Th2, Th17, and regulatory responses) of treated individuals is fundamentally altered relative to pretreatment responses; (3) the effects of treatment on schistosome-specific cytokines differ between responses to cercariae, adult worms and eggs; and (4) cytokine responses elicited 6 weeks post-treatment influence reinfection rates. Our results yield insights into the immunological effects of antihelminthic treatment and how these relate to parasite life history and the development of protective immunity.

Even though Rwanda lies within a region that has a high prevalence of schistosomiasis and soil-transmitted helminth (STH) infections, epidemiological information regarding these infections in the country remains scarce. The present review attempts to compile the available data on schistosomiasis and STHs, from 1940 to 2014, to provide an insight on the epidemiological profile of these infections. This information will, in turn, support the design and implementation of sustainable control measures. The available records indicate that only Schistosoma mansoni and all the major species of STHs are endemic in Rwanda. In 2008, the national prevalence of S. mansoni was reported to be 2.7%, ranging from 0 to 69.5%, and that of STH infections was 65.8% (diagnosed using the Kato-Katz technique). The prevalence of these infections varies from one district to another, with schoolchildren remaining a highly affected group. The main control approach is mass drug administration using albendazole and praziquantel, mostly targeting school-aged children in school environments. In 2008, adult individuals living in areas with a prevalence of S. mansoni ≥30% were also included in the mass drug administration programme. However, despite Rwanda achieving an almost 100% coverage of this programme in 2008–2010, the transmission of S. mansoni and STHs continues to take place, as illustrated by the most recent surveys. If Rwanda is to achieve sustainable control and elimination of schistosomiasis and STHs, there is a need to revise the country’s control strategy and adopt an integrated control approach that involves a combination of measures. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0212-z) contains supplementary material, which is available to authorized users.