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The reduction of fibrosis prevalence was measured in 12 studies see Table C in S1 Text that found, overall, a significant reduction in the odds of fibrosis after chemotherapy compared to pretreatment levels OR 0.
The N by each line indicates the number of studies included in that meta-analysis. Eight studies evaluated the prevalence of blood in the stool see Table F in S1 Text and the meta-analysis summary estimate indicated a significant reduction after chemotherapy for schistosomiasis OR 0.
Prior analysis has indicated that the benefit in terms of gains in hemoglobin levels is greatest among those who have anemia at baseline, or those who have greater levels of microhematuria or infection intensity [ 1520 ].
Search strategy Published 0s07 were identified in the electronic databases using the PICO strategy Patient, Intervention, Comparator, and Outcome to develop the descriptors.
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Thirteen studies evaluated school age children and three evaluated adult males. Schistosomiasis and soil-transmitted helminthiases: We systematically reviewed 71 available reports of Schistosoma -related morbidity reduction and determined, based on a meta-analysis of the primary data, that the odds of persisting morbidity progressively decrease when greater post-treatment reductions in parasite burden are achieved, as reflected by reduced egg counts in standard diagnostic testing.
S12 Fig Sensitivity analysis Forest Plot of the impact of therapy on urinary bladder abnormalities prevalence. Assessment for potential publication bias was carried out by visual inspection of funnel plots, and statistically by calculating the Egger test [ 32 ].
ORs and their confidence intervals for individual studies are shown numerically in the statistics columns, and graphically by the corresponding black boxes and black lines. To explore heterogeneity and factors that could potentially modify the summary estimates of effect, we performed subgroup analyses stratified by parasite species, the study area, age of the subjects included in the studies, the time to follow-up after treatment, the type of diagnosis, the treatment performed, the number of treatments, and the initial prevalence of infection in the study population [ 34 ].
Table H in S3 Text. Rev Soc Bras Med Trop. Despite the potential benefits of treatment, many affected persons have not yet been reached by treatment programs [ 28 ]. Abstract Background SinceWHO has endorsed drug treatment to reduce Schistosoma infection and its consequent morbidity.
We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tools for pre-post design studies https: As outlined in Fig 1of these study reports were excluded after second stage screening, leaving a total s00 reports for inclusion in the systematic review. We excluded animal studies, case studies, reviews, and studies with individuals selected only from clinics s00 hospitals.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. When considering all of these studies, there was significant reduction in the odds of having diarrhea after the intervention OR 0.
To do this, we catalogued treatment impact on eleven key morbidities linked to infection by any of the three major Schistosoma parasites of humans, S. Reassessment of the cost of chronic helmintic infection: Most studies worked with endemic populations living in small clusters and so did not select an entire population or a randomly-selected subsample to follow.
No restrictions were placed in terms of location of the study, Schistosoma species, or publication date.
When considering only school-age subjects, the difference in the mean hemoglobin levels pre-intervention vs. Sensitivity analysis by exclusion of a single study at a time from the meta-analysis did not affect the results S14 Fig. Regarding measured impact on splenomegaly, it was not uncommon that the studies selected for meta-analysis involved subjects who were co-infected with other chronic pathogens, especially malaria, which could explain a lesser effect of anti-schistosomal therapy on splenomegaly after treatment [ 2236 ].
In subgroup analysis Table C in S3 Textthere was no statistically significant treatment-related reductions among individuals infected with S.
Studies that evaluated morbidity before and after treatment were identified by online searches and searches chl private archives. S3 Fig Sensitivity analysis Forest Plot of the impact of therapy on right lobe hepatomegaly prevalence.
The presence of blood in the urine is a well-accepted marker of S. Quantitative pooled analysis of treatment effects catalogued from the eligible studies was performed using Comprehensive Meta-Analysis software, v. Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis: Studies that combined treatment for s070 with 0s07 anthelmintic mebendazole or albendazole and studies using capillary blood for diagnosis found higher mean differences post-treatment, but these also did not reach statistical significance Table K chm S3 Text.
Meta-analysis of observational studies in epidemiology: Open in a separate window. S11 Fig Sensitivity analysis Forest Plot of the impact of therapy on proteinuria prevalence. Cross-sectional studies suggest chm correlation between infection intensity and risk for Schistosoma -related pathology. Blood in the stool Eight studies evaluated the prevalence of blood in the stool see Table F in S1 Text and the meta-analysis summary estimate indicated a significant reduction after chemotherapy for schistosomiasis OR 0.
More recent research has also put emphasis on systemic morbidities associated with Schistosoma infection such as anemia, growth stunting, impaired cognition, undernutrition, diarrhea, and decreased physical fitness; however, this additional burden of schistosomiasis was not well studied in many older works, and until the s, improvement in these outcomes was not generally appreciated as a potential benefit of morbidity control [ 8 ].
Splenomegaly Spleen size was evaluated before and after chemotherapy for schistosomiasis in 21 studies see Table B in S1 Text. Schistosoma haematobium infection and morbidity before and after large-scale administration of praziquantel in Burkina Faso. For the included urogenital morbidities associated with infection by S.
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Large -scale questionnaire surveys of blood in the stool, trialed as rapid assessment tools for identifying high-risk communities in sub-Saharan Africa, have shown that this symptom can be a valuable indicator for the diagnosis of S. Log odds ratio of hematuria, proteinuria, and bladder abnormalities according to post-treatment egg reduction rate.
S8 Fig Sensitivity analysis Forest Plot of the impact of therapy on diarrhea prevalence. Wherever possible, all of the information listed above was recorded both before and after intervention see supplemental information in Tables A-K in S1 Text. S3 Text Tables A-K indicating the results of subgroup analysis of pre- and post-treatment morbidity prevalence.