Treatment and Control of Schistosomiasis

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Treatment and Control of Schistosomiasis

• Village of São Pedro

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General Objectives

• To assess potential problems with treatment of
  schistosomiasis
• Population of 262 treated patients in São Pedro,
  Brazil
• To examine treatment administration through data
  from patient interviews
• To determine recommendations for and the
  influence on local health policy

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Background

• Treatment of Schistosomiasis infection
• Two drugs available- Praziquantel and Oxamnique
• Praziquantel is cheaper and safer and therefore,
  more widely used
• Praziquantel (WHO Dosage 40mg/kg)
• Cheap produced by Brazil Ministry of Health
  (MOH), costs approximately 0.65 (R1,1) per
  treatment
• Safe WHO approved for pregnant women and young
  children
• Easily administered in pill form
• Acts within 1 hour of ingestion by killing mature
  worms
• No reported resistance, but remains a concern
• Organizational problems of PCE result in
  irregular use of praziquantel in endemic areas in
  Brazil

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Background

• Side effects of Praziquantel according to medical
  literature
• Mild Nausea, vomiting, malaise, abdominal pain,
  dizziness, cutaneous rash
• In heavy infections Acute colic and bloody
  diarrhea
• WHO Recommended administration
• Single dose of 40 mg/kg
• Follow-up after 4-6 weeks
• 70-100 of patients cease to excrete eggs after
  first single dose

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Treatment in São Pedro

• Administered at São Pedro basic health unit
• Only individuals screening positive for eggs
  receive treatment
• Prevalence (44,7) below 50 threshold for mass
  treatment
• Screening test has moderate sensitivity (70-85)
• Pregnant and breastfeeding women not treated
• Forbidden by Brazilian MOH, although WHO approves
  it

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Treatment in São Pedro

• Single dose of Praziquantel (50mg/kg)
• Follow-up dose if patient screens positive again
  in 40-50 days
• Patients received treatment this week
• Last treatment was administered in 2002 by Funasa

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Analysis of Treatment Methods in São Pedro

• Utilized patient information databases made by
  Dr. Gazzinelli and team
• Developed questionnaire regarding
• Basic patient knowledge of schistosomiasis
• Treatment history
• Side Effects
• Improvement of symptoms
• Interviewed 94 residents of São Pedro out of 262
  that were treated for schistosomiasis

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Results and Observations

• Age distribution of study population

n 94
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Results and Observations

• High proportion of residents reporting side
  effects
• 73.3 of study population

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Results and Observations

• No patients reported severe side effects, such as
  acute colic or bloody diarrhea
• Older patients reported more side effects
• Mean age with side effects was 26.9 years versus
  17.8 years without side effects
• Majority of residents (83.7) would take
  treatment again
• No association between patients with side effects
  and willingness to take treatment

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Results and Observations

• Symptoms improved in 58.1 of patients
• 28.7 of patients expressed fear prior to
  treatment
• 84 of these patients experienced side effects,
  compared to 73.3 of the total study population

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Results and Observations

• Lack of knowledge on how to contract
  schistosomiasis
• 51 suggested they could be infected from stream
  water
• However, there were many common misconceptions
  including
• Walking around with bare feet
• Eating unwashed produce
• Contact with pig feces
• Contact with standing water

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Study Limitations

• Recall Bias
• Possible exaggeration of side effects
• Only 22.3 of patients regularly use other
  medication
• Primarily for lowering blood pressure
• Population inexperienced with medication use
• Desire to please health care officials
• Underpowered study
• Selection Bias
• Not a random sample
• Interviews often selected based on availability

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Future Research

• Compare our study population to data for general
  population
• Do São Pedro patients have significantly more
  side effects
• Determine more efficient treatment methods for
  São Pedro
• For example, annual treatment administered in
  school or church
• Analysis of patients who stated they would not
  take treatment again

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Influence on Health Policy

• Treatment requires supervision to be effective
• Current treatment model ensures patients take
  recommended dosage
• Data indicates that patients will continue to
  accept treatment from health unit despite side
  effects
• Lack of disease awareness hinders advances in
  treatment of schistosomiasis
• Residents unlikely to seek treatment on their own
• Unlikely to take pills without supervision

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Recommendations

• Seek other control methods
• Treatment very unlikely to control
  schistosomiasis problem
• Requires successful mass treatment of all
  residents
• Necessitates treatment of pregnant women
• Health education is key to controlling
  schistosomiasis
• Enhance awareness programs in local schools
• Explain infection and complications to patients

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Recommendations

• Increase awareness of possible symptoms of
  schistosomiasis
• Treatment is imperative for severe disease cases
• Can cause paralysis, bleeding, physical
  disability, malnourishment, poor performance,
  anemia, and even death
• May encourage residents to seek treatment on
  their own in the future

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Acknowledgements

• Thank you to all the residents of São Pedro the
  employees of the basic health unit the Secretary
  of Health, Mayor, and residents of Jequitinhonha
  Andrea Gazzinelli and Rodrigo Correa Oliveira and
  their team and our group leaders and colleagues.

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