Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa
Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa
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DOI：
10.1016/s0001-706x(03)00029-9
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发表时间：
2003-05-01
期刊：
影响因子：
2.7
通讯作者：
Engels, D
中科院分区：
文献类型：
--
作者：
van der Werf, MJ;de Vlas, SJ;Engels, D
发展中国家的卫生政策制定需要对（全球）疾病负担进行估算。目前，关于血吸虫病的大多数现有数据仅限于感染个体的数量。我们探究了血吸虫感染与临床发病情况之间的关系，以便估算撒哈拉以南非洲地区埃及血吸虫和曼氏血吸虫感染所致特定疾病发病个体的数量。我们在文献中搜索了来自现场研究的横断面数据，这些数据同时报告了血吸虫感染和发病情况。以此推导出发病情况与感染之间的函数关系。在对诊断方法进行标准化之后，对具有特定类型临床发病情况或病理的个体数量进行了预测。由于只有国家或地区的感染总患病率数据，我们对这些国家社区内感染水平的异质性进行了调整。据估算，在撒哈拉以南非洲地区的6.82亿人（2000年估算值）中，共有7000万人在过去两周内出现与埃及血吸虫感染相关的血尿，3200万人出现排尿困难。超声检测到的埃及血吸虫的严重后果，即严重膀胱壁病变和严重肾积水，预计分别为1800万和1000万例。据估算，曼氏血吸虫感染导致78万人腹泻，440万人便血，850万人肝肿大。由于曼氏血吸虫感染患病率与腹泻和便血患病率之间的关联不是很明确，所得估算结果可能偏低。利用现有的非常有限的数据，我们估算因肾功能衰竭（由埃及血吸虫引起）和呕血（由曼氏血吸虫引起）导致的死亡率分别为每年15万和13万。鉴于血吸虫病相关疾病的病例总数以及相关死亡人数总体较高，我们得出结论：血吸虫病在撒哈拉以南非洲仍然是一个重要的公共卫生问题。（C）2003爱思唯尔科学出版公司。版权所有。
Health policy making in developing countries requires estimates of the (global) burden of disease. At present, most of the available data on schistosomiasis is limited to numbers of individuals harbouring the infection. We explored the relationship between the presence of schistosome infection and clinical morbidity, in order to estimate numbers of individuals with disease-specific morbidity for Schistosoma haematobium and Schistosoma mansoni infection in sub-Saharan Africa. We searched the literature for cross-sectional data from field studies reporting both schistosome infection and morbidity. This was used to derive a functional relationship between morbidity and infection. After standardisation for diagnostic method, the number of individuals with specific types of clinical morbidity or pathology was predicted. As only aggregated prevalences of infection were available for countries or areas, we adjusted for heterogeneity in infection levels within communities in those countries. In total, 70 million individuals out of 682 million (2000 estimate) in sub-Saharan Africa were estimated to experience haematuria in the last 2 weeks associated with S. haematobium infection, and 32 million dysuria. Ultrasound detected serious consequences of S. haematobium, major bladder wall pathology and major hydronephrosis, were predicted at 18 and 10 million, respectively. Infection with S. mansoni was estimated to cause diarrhoea in 0.78 million individuals, blood in stool in 4.4 million and hepatomegaly in 8.5 million. As the associations between prevalence of S. mansoni infection and prevalence of diarrhoea and blood in stool were not very clear, the resulting estimates may be underestimations. Using the very limited data available, we estimated the mortality rates due to non-functioning kidney (from S. haematobium) and haematemesis (from S. mansoni) at 150 000 and 130 000 per year. Given the overall high number of cases with schistosomiasis-related disease and associated death, we conclude that schistosomiasis remains an important public health problem in sub-Saharan Africa. (C) 2003 Elsevier Science B.V. All rights reserved.