Identifying and Evaluating Field Indicators of Urogenital Schistosomiasis-Related Morbidity in Preschool-Aged Children.

Background: Several studies have been conducted quantifying the impact of schistosome infections on health and development in school-aged children. In contrast, relatively little is known about morbidity levels in preschool-aged children (≤5 years) who have been neglected in terms of schistosome research and control. The aim of this study was to compare the utility of available point-of-care (POC) morbidity diagnostic tools in preschool versus primary school-aged children (6–10 years) and determine markers which can be used in the field to identify and quantify Schistosoma haematobium-related morbidity. Methods/Principal Findings: A comparative cross-sectional study was conducted to evaluate the performance of currently available POC morbidity diagnostic tools on Zimbabwean children aged 1–5 years (n=104) and 6–10 years (n=194). Morbidity was determined using the POC diagnostics questionnaire-based reporting of haematuria and dysuria, clinical examination, urinalysis by dipsticks, and urine albumin-to-creatinine ratio (UACR). Attributable fractions were used to quantify the proportion of morbidity attributable to S. haematobium infection. Based on results of attributable fractions, UACR was identified as the most reliable tool for detecting schistosome-related morbidity, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination. The results of urine dipstick attributes showed that proteinuria and microhaematuria accounted for most differences between schistosome egg-positive and negative children (T=-50.1; p<0.001). These observations were consistent in preschool vs. primary school-aged children. Conclusions/Significance: Preschool-aged children in endemic areas can be effectively screened for schistosome-related morbidity using the same currently available diagnostic tools applicable to older children. UACR for detecting albuminuria is recommended as the best choice for rapid assessment of morbidity attributed to S. haematobium infection in children in the field. The use of dipstick microhaematuria and proteinuria as additional indicators of schistosome-related morbidity would improve the estimation of disease burden in young children. Author Summary: Schistosomiasis is a major parasitic disease affecting children in Africa, with impacts on health, growth and cognitive development. Recently, the World Health Organization has recommended inclusion of preschool-aged children (≤5 years) in schistosome control programmes. However, so far the performance of available morbidity diagnostic tools has not been thoroughly evaluated in this age group. To address this knowledge gap, we conducted a study in preschool children comparing the utility of currently available point-of-care tools for diagnosing Schistosoma haematobium-related morbidity, namely: questionnaire-reported haematuria and dysuria, clinical examination, dipstick urinalysis, and measurement of urine albumin-to-creatinine ratio (UACR). We also investigated the performance of these tools in older children (6–10 years). Our study identified UACR as the most reliable tool for detecting schistosome-related morbidity in terms of the morbidity attributable to schistosome infection, followed by dipsticks, visual urine inspection, questionnaires, and lastly clinical examination The study further showed that the tools currently used in school-aged children for diagnosing schistosome-related morbidity can be extended to preschool children, allowing easier integration of this age group into treatment and monitoring programmes. [ABSTRACT FROM AUTHOR]