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Urine heme dipsticks are useful in monitoring the impact of praziquantel treatment on Schistosoma haematobium in sentinel communities of Delta StateNigeria. Author summary Schistosomiasis is the disease caused by infection with Schistosoma parasitic flukes.

Author information Article notes Copyright and Cuk information Disclaimer. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tools for pre-post design studies https: Sensitivity analysis by exclusion of one study at a time from the meta-analysis did not affect the results see S9 Fig.

There was significant heterogeneity among the studies in the three types of evaluation Fig 2that was not significantly reduced by subgroup analyses see Hck A in S3 Text. Overall, our results suggest that drug treatment significantly reduces but does not eliminate these common pathologic consequences of Schistosoma infection, and that the odds of improvement are linked to the magnitude of treatment-related reductions in adult worm burden of parasitic infection.

The usual parameters employed to assess the effectiveness of treatment have been its effects on the intensity and prevalence of infection.

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Panel A, Forest plot and meta-analysis for the difference in mean hemoglobin levels, pre-intervention vs. Assessment for potential publication bias was carried out by visual inspection of funnel plots, and statistically by calculating the Egger test [ 32 ]. 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 ]. Three main factors had the greatest association with reductions of periportal fibrosis: The data analyzed in this study may have been influenced by confounders such as uneven sex distributions, the presence of co-infections, and variation in local reinfection rates that could not be controlled for in the meta-analysis.

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It was only when we pooled three studies with follow-up greater than 12 months after intervention that the mean post-treatment hemoglobin level was found to be significantly higher compared with pretreatment. In clinical studies, portal vein diameter is an indicator that correlates with portal vein pressure and risk for hemorrhage [ 47 ].

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Trop Med Int Health. Thus, the decrease in prevalence after chemotherapy in this meta-analysis represent the complete reversal of morbidity. PDF Click here for additional data file. Duplicate publications and papers reporting reanalysis of previously published data were excluded at this stage. Corresponding Forest plots of included studies and their summary statistics are included in Supplemental Information file S1 Fig. S11 Fig Sensitivity analysis Forest Plot of the impact of therapy on proteinuria prevalence.

Log odds ratio of hematuria, proteinuria, and bladder abnormalities according to post-treatment egg reduction rate. Rev Soc Bras Med Trop. Across all studies, the aggregate odds of having the right hepatic lobe enlarged was reduced significantly OR 0. The impact of single versus mixed schistosome species infections on liver, spleen and bladder morbidity within Malian children pre- and post-praziquantel treatment. Large -scale questionnaire surveys of blood in the stool, trialed as rapid assessment tools for identifying high-risk communities in sub-Saharan Africa, have shown that this symptom can be a valuable indicator for the diagnosis of S.

Sensitivity analysis Forest Plot of the impact of therapy on blood in stool prevalence. Adult schistosome worms colonize the human body for years, excreting eggs every day. Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of hepatomegaly lobe not specified. Moreover, the evidence may be limited in terms of generalizability because of the limitations in the design of included studies, and because the diverse populations selected for analysis yielded a high degree of heterogeneity across studies.

Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of blood in stool. In our quantitative meta-analysis, which focused on morbidity prevalence before and after chemotherapy, only morbidities reported by more than one study from which the necessary data could be extracted were included.

Sensitivity analysis Forest Plot of the impact of therapy on blood hemoglobin levels. S6 Fig Sensitivity analysis Forest Plot of the impact of therapy on periportal fibrosis prevalence.

For those morbidities related to intestinal schistosomiasis, i.

The relative intensity of infection is an important correlate of morbidity, because the formation of the disease is related to the daily deposition of parasite eggs into host tissues [ 1748 — 50 ].

Blood in the stool Eight studies evaluated the prevalence of blood in the stool see Table F in S1 Text and the meta-analysis summary estimate indicated a significant reduction after chemotherapy for schistosomiasis OR 0. Impact of repeated community-based selective chemotherapy on morbidity due to schistosomiasis mansoni. 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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Besides that, when the study of Gryseels, et al. Meta-analysis summary estimates indicated a significant reduction after chemotherapy compared to pretreatment levels OR 0. Association of the therapeutic activity of praziquantel with the reversal of Symmers’ fibrosis induced by Schistosoma mansoni. Sensitivity analysis Forest Plot of the impact of therapy on proteinuria prevalence.

S3 Text Tables A-K indicating the results of subgroup analysis of pre- and post-treatment morbidity prevalence. Main portal vein Four studies assessed the prevalence of portal vein dilation before and after chemotherapy for schistosomiasis see Table D in S1 Text. Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren.

Eight studies evaluated the cessation of episodes of diarrhea after anti-schistosomal chemotherapy see Table E in S1 Text. Sensitivity analysis by exclusion of one single study at a time from the meta-analysis did not affect the results S5 Fig. In many cases, more significant treatment effects were observed when studies were performed on school age children or on subpopulations selected for existing pathology at baseline.

Partial reversal of morbidity, such as a shift from grade 3 to grade 2 as reported in some studies, was not considered. The reduction of fibrosis prevalence was measured in 12 studies see Table C in S1 Text that found, overall, a significant reduction in the odds of fibrosis after chemotherapy compared to pretreatment levels OR 0. Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of ultrasound abnormalities of the urinary bladder.

Study selection References obtained from each search were exported to reference manager software Mendeley version 1.

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The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Discussion Quantification of the net changes in Schistosoma infection-associated morbidity chl, from before to after treatment, is one way to critically value the impact of drug-based control of schistosomiasis, which is the strategy currently recommended by WHO and other agencies [ 10 ].

Although hematuria, proteinuria, and bladder abnormalities appear to respond quickly to anti-schistosomal ckh, in step with the ERRs achieved, the relatively smaller improvements in prevalence of hydronephrosis suggest that this form of morbidity is a more slowly resolving and sometimes irreversible form of urinary tract schistosomiasis.