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

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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.