Epidemiology of gut and liver multimorbidities in the context of chronic intestinal schistosomiasis

肠道血吸虫病以肠道和肝脏进行性损伤为特征，由寄生血吸虫(曼氏血吸虫)长期感染引起。大多数感染者生活在撒哈拉以南非洲。相关情况包括肠道炎症、肝脾肿大、门脉周围纤维化、门脉高压、上消化道出血、腹水、贫血和营养不良。作为一组病因复杂的慢性疾病，我们建议将肠道血吸虫病作为一组多病原体来研究，而不是传统的作为单一疾病的观点。多发病是指一个人体内同时存在2种以上的慢性疾病，而不考虑病因。它正在全球范围内上升，并使诊断和病例管理复杂化。在乌干达，我们最近发现，尽管反复出现丙二醛，但肠道和肝脏疾病的负担很高。为了建立多病并存的流行病学，我们提出了以下假设。在丙二醛的背景下，即使在短期内(几年)，曼氏血吸虫相关慢性疾病在个人体内的积累和聚集在很大程度上是由这些共存疾病和个人内部疾病之间共同的社会-生态风险因素相互作用所解释的。在乌干达东部和西部，我们将建立一个以社区为基础的纵向队列，由3280人组成，为期四年，有六个研究期。通过主要的实地考察、临床和社会流行病学以及尖端的机器学习，我们的目标是1)确定肠道和肝脏疾病的共同集群和相互作用；2)开发计算工具来预测社会生态模式和疾病轨迹；以及3)使用患者报告的症状和优先顺序以及当地卫生工作者的知识来评估多病。

Intestinal schistosomiasis is characterised by progressive injury to the gut and liver and caused by an infection of long duration with parasitic blood flukes (Schistosoma mansoni). Most infected individuals live in sub-Saharan Africa. Associated conditions include gut inflammation, hepatosplenomegaly, periportal fibrosis, portal hypertension, upper gastrointestinal bleeding, ascites, anaemia, and undernutrition. Mass drug administration (MDA) of praziquantel is used to treat the blood flukes instead of the conditions, relying on reaching individuals before morbidity develops.As a group of chronic conditions with complex aetiologies, we propose studying intestinal schistosomiasis as a set of multimorbidities as opposed to the conventional view as a single disease. Multimorbidity is the coexistence of 2+ chronic conditions within an individual irrespective of cause. It is rising worldwide and complicating diagnosis and case management. In Uganda, we recently discovered a high burden of gut and liver conditions despite repeated MDA. To establish the epidemiology of multimorbidities, we propose the following hypothesis. In the context of MDA, the accumulation and clustering of chronic S. mansoni-associated conditions within an individual, even in the short term (few years), is largely explained by interactions of those coexisting conditions and shared social-ecological risk factors between conditions within individuals. In Eastern and Western Uganda, we will establish a longitudinal, community-based cohort of 3,280 individuals for four years with six study periods. With major fieldwork, clinical and social epidemiology, and cutting-edge machine learning, our objectives are to 1) identify common clusters and interactions of gut and liver conditions; 2) develop computational tools to predict social-ecological patterning and condition trajectories; and 3) assess multimorbidities using patient-reported symptoms and priorities, and local health worker knowledge.