Intestinal schistosomiasis in Uganda: Taking advanced diagnostics to the lakeshore

By Hajri Al-Shehri

Neglected Tropical Diseases (NTDs) are often a symptom of poverty and challenging living conditions. Those who are most affected are the poorest people living in remote rural areas, urban slums or in conflict zones. Schistosomiasis, for example, is often found in populations with very limited access to safe water and in environments poorly served by primary health outposts as typified by out-of-stock drugs and inadequate diagnostic testing. The lack of reliable statistics reporting on treatment and disease has kept the true burden of schistosomiasis in the shadows and failed to identify the inefficiencies of control programmes that are committed to reach those most in need of treatment.

I have just returned from a three-week epidemiological study on the shores of Lake Albert, Uganda. Working with Vector Control Division (VCD), Ministry of Health, Uganda we visited five rural primary schools in Hoima and Buliisa Districts, examining just over 50 children per school with a combination of diagnostic methods.

Performance of diagnostic tools in a high prevalence settings

urine antogen testsOur basic analysis revealed that in three schools on the immediate lakeshore, prevalence of active intestinal schistosomiasis was just over 85%. With such high levels detected, it is taken for granted that these children are in regular contact with contaminated water, remaining a daily way of life and mitigates the impact of the national control programme (NCP). The Uganda NCP started in 2003 and has been providing annual treatment of school children with praziquantel (PZQ) for over several years. But despite best intentions, it is clear that annual treatment is failing on the lakeshore and needs to be strengthened. Our clinical assessments showed substantial amounts of morbidity in these unfortunate children with swollen livers, numerous schistosome eggs and blood in stool as well as enlarged tummies.

My thoughts on successful fieldwork

Fieldwork is not just an important, stimulating and often challenging part of the research process I undertake; it also offers a wonderful way of seeing the world, and a chance for personal development. The key points are to understand theory, develop skills, integrate and build tacit knowledge, develop alternative solutions for the problems in certain places, and work cooperatively with a team. Despite our best efforts in preparations, fieldwork constantly offers surprises and ad hoc solutions that may fail miserably for many reasons: a sudden rainstorm reduces time at the study site, your way back to camp is blocked by a flood and you endure water-logged muddy roads that drain your energy, as does our intermittent camp electrical supply as our portable generator fails then you are hounded by irritating lake flies that dance around your head torch while you concentrate at the microscope. Conditions in the field are often unpredictable and can affect your aims in different ways sometimes being left frustrated but when you overcome these obstacles you have good reason to be proud and satisfied.

car in UgandaSo what are the ingredients for successful fieldwork? I now realise that fieldwork should have clear vision of what you want to accomplish but be flexible within a set of integrated goals and contingency plans that can be brought rapidly into action when needed. For example, assessing each day everyone’s workload, checking in-field logistics and sampling techniques is essential to adapt to local conditions, as well as having enough in reserve to put in extra effort when required. Before leaving to Uganda, my supervisor and I had many discussions during the planning process who explained the theory but I have now the practice. The key ingredient is that there is a small window of opportunity to get the survey right where all the necessary equipment, reagents and team’s skills are brought together at the right place and at the right time, ensuring that these remote communities can be well-attended. Only by doing so can the true burden of NTDs be brought out of the shadows and highlight today’s treatment needs. I am proud to have made an important contribution to the Uganda NCP with our colleagues from VCD.  

About the author

I was born in Asser, Saudi Arabia, and have worked there for several years as a specialist in molecular diagnosis of infectious diseases in Asser Central Hospital. Being based in this busy clinical laboratory, I have developed interests in Neglected Tropical Diseases, especially schistosomiasis, and completed an MSc degree in the UK in Biomolecular and Biomedical Sciences, Faculty of Life Sciences & Medicine, at Glasgow Caledonian University. To further extend my qualifications and broaden my experience, I started my PhD in June 2014 at the Liverpool School of Tropical Medicine with Professor Russell Stothard and decided to focus on the epidemiology and control of intestinal parasites. My project hopes to compare the performance of state-of-the-art diagnostic tools in high prevalence versus low prevalence settings and understand how these tools can be applied in my own country where schistosomiasis and soil-transmitted helminthiasis are nearing elimination. Writing a science blog helps me stay motivated and by sharing my recent fieldwork in Uganda, and highlights what I have learned.

 

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