A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its Elimination
A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its Elimination
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DOI：
10.3390/tropicalmed4010021
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发表时间：
2019-03-01
影响因子：
2.9
通讯作者：
Lamberton, Poppy H. L.
中科院分区：
文献类型：
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作者：
Krauth, Stefanie J.;Balen, Julie;Lamberton, Poppy H. L.
自从世纪中期第一份已知的血吸虫病书面报告以来，研究人员一直致力于增加对寄生虫、其宿主以及导致感染和疾病的机制的了解。这种知识的产生对于制定改进的干预策略至关重要。然而，尽管对血吸虫病的直接风险因素有广泛的知识基础，但仍然缺乏与更复杂、相互关联且往往隐藏的传播驱动因素有关的信息，这些因素阻碍了干预措施的成功和可持续性。这种复杂的、多方向的、非线性的和协同的相互依赖性最好通过将集成系统视为一个整体来理解。需要一种能够解决这种复杂性的研究方法，并找到以前被忽视的传播因果机制，其中包括各种各样的影响因素。系统流行病学作为一种整体研究方法，可以将经典流行病学的知识与生物学、生态学、社会科学和其他学科的知识相结合，并将其与专家和受影响人群的非正式、隐性知识联系起来。它可以帮助揭示影响范围更广但难以确定的直接或间接影响暴露、感染、传播和疾病发展的过程，以及这些过程如何相互关联和相互影响。利用系统流行病学来解决持续存在的疾病热点、失败的干预方案以及在大规模药物管理方案和研究中被系统忽视的人口群体，可以帮助克服消除血吸虫病进展中的障碍。因此，对整个血吸虫病系统的全面认识应成为实现控制发病率和消除传播的战略目标的优先研究议程。
Ever since the first known written report of schistosomiasis in the mid-19th century, researchers have aimed to increase knowledge of the parasites, their hosts, and the mechanisms contributing to infection and disease. This knowledge generation has been paramount for the development of improved intervention strategies. Yet, despite a broad knowledge base of direct risk factors for schistosomiasis, there remains a paucity of information related to more complex, interconnected, and often hidden drivers of transmission that hamper intervention successes and sustainability. Such complex, multidirectional, non-linear, and synergistic interdependencies are best understood by looking at the integrated system as a whole. A research approach able to address this complexity and find previously neglected causal mechanisms for transmission, which include a wide variety of influencing factors, is needed. Systems epidemiology, as a holistic research approach, can integrate knowledge from classical epidemiology, with that of biology, ecology, social sciences, and other disciplines, and link this with informal, tacit knowledge from experts and affected populations. It can help to uncover wider-reaching but difficult-to-identify processes that directly or indirectly influence exposure, infection, transmission, and disease development, as well as how these interrelate and impact one another. Drawing on systems epidemiology to address persisting disease hotspots, failed intervention programmes, and systematically neglected population groups in mass drug administration programmes and research studies, can help overcome barriers in the progress towards schistosomiasis elimination. Generating a comprehensive view of the schistosomiasis system as a whole should thus be a priority research agenda towards the strategic goal of morbidity control and transmission elimination.