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Tables A-K indicating the results ch, subgroup analysis of pre- and post-treatment morbidity prevalence. Cross-sectional studies suggest pre-treatment correlation between infection intensity and risk for Schistosoma -related pathology. This was seen for the outcomes of hepatomegaly, diarrhea, periportal fibrosis, and abnormalities of the urinary bladder.
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Published online Feb Sensitivity analysis Forest Plot of the impact of therapy on periportal fibrosis prevalence. Forest plot of the effect of anti-schistosomal treatment on hemoglobin levels. Sensitivity analysis by exclusion of a single study at a time from the meta-analysis did not affect the results. Results Study selection Using the selected search terms, initial screening of the databases yielded study reports after removing duplicates.
Twenty-six studies reported geometric mean data outcomes, while 12 reported arithmetic means. Epidemiological assessment of Schistosoma haematobium -induced kidney and bladder pathology chm rural Zimbabwe.
Thus, the number of identified studies was higher than the number of publications, but each study was included in the quantitative analysis no more than once per morbidity. In many cases, more significant treatment effects were observed when studies were performed on school age children or on subpopulations selected for existing pathology at baseline. Odds ratios for morbidities related to schistosomiasis after treatment.
When considering all of these studies, there was significant reduction in the odds of having diarrhea after the intervention OR 0. Significant heterogeneity was observed among the studies included Fig 2 which could be reduced by subgroup stratification according to region, age, and follow-up time Table E in S3 Text.
Sensitivity analysis by subgroup showed that studies that used ultrasound for diagnosis, studies chhk only school age individuals, studies having follow-up less than 12 months after treatment, studies of individuals with S.
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For intestinal schistosomiasis caused by S. In the overall analysis, the odds of having the left hepatic lobe enlarged was reduced significantly OR 0.
Overall, there was a significant reduction in the odds of splenomegaly after treatment intervention OR 0. Reassessment of the cost of chronic helmintic infection: Panel A, Forest plot and meta-analysis for the difference in mean hemoglobin levels, pre-intervention vs.
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When considering only school-age subjects, the difference in the mean hemoglobin levels pre-intervention vs. The meta-analysis of the three studies that included only adult males Fig 3Panel B also found an increase in average hemoglobin from before to after the intervention, but this difference was not statistically significant, SMD 0.
In addition, many older studies did not detail their criteria for selection of the population. Significant heterogeneity was observed among the studies Fig 2 and the subgroup analysis was performed in order to identify the causes see Table G in S3 Text.
Of note, the reductions in morbidities associated with urogenital schistosomiasis, with the exception of injuries to the upper urinary tract, were more likely to be significant if evaluated in the first six months after treatment. Impact of treatment on selected morbidities Hepatomegaly Of the studies that assessed the impact of chemotherapy on reducing hepatomegaly, 10 evaluated the reduction of the left hepatic lobe, 10 the reduction of the right hepatic lobe, and 9 studies reported a reduction from the costal margin without specifying the lobe see Table A in S1 Text.
Several strategies, such as environmental control of the intermediary host, provision of safe water, and medical treatment have been used, singly and in combination [ 9 ].
Nutritional status improves after treatment of Schistosoma japonicum -infected children and adolescents. Our systematic review and meta-analysis sought to summarize many decades of research on disease-related benefits of treatment for schistosomiasis. In addition, like hydronephrosis in urogenital schistosomiasis, splenic enlargement in intestinal schistosomiasis is likely a marker of more severe and more prolonged chronic intestinal schistosomiasis, and it may be more difficult to achieve regression with late treatment [ 4647 ].
Eight studies evaluated the cessation of episodes of diarrhea after anti-schistosomal chemotherapy see Table E in S1 Text. Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis: In addition, the bibliography reference lists of articles selected for review were evaluated for additional relevant studies, and additional articles were retrieved from personal collections at Case Western Reserve University.
We found no evidence of publication bias using unweighted, non-randomized values in the Egger test. Reduction in splenomegaly was significantly greater among subjects who were followed after the first year of treatment, in the South Africa region, and among individuals selected for the presence of specific morbidities see Table B in S3 Text.
Significant heterogeneity was observed among the included studies Fig 2which chkk somewhat when grouped among the studies performed in South Africa and in the subgroup with individuals selected for some specific morbidity Table B in S3 Text. Sensitivity analysis Forest Plot of the impact of therapy on right lobe hepatomegaly prevalence.
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s007 Author information Article notes Copyright and License information Disclaimer. Forest plot showing sensitivity analysis, performed by removing one study at a time, for the effect of treatment on prevalence of left hepatic lobe hepatomegaly. Reduction of heterogeneity was observed, but heterogeneity remained high among studies that included the entire population, studies that included only infected individuals, studies with follow-up greater than 12 months, and studies performed in West Africa.
Log odds ratio for post-treatment chj, according to egg reduction rates achieved, by hepatic lobe. In order to strengthen the evidence base for Schistosoma morbidity control, there is a clear need to perform additional cohort trials that are both well-designed and well-reported.
Table H in S3 Text. For hematuria, we only included studies that evaluated the microhematuria detected by reagent strips, whereas studies of hematuria detected by ss007 inspection were excluded. For this step we designed a Microsoft Access database form, using the eligibility criteria as s070, in order to assist in the archiving of eligible studies for the systematic review.
Spleen size was evaluated s0007 and after chemotherapy for schistosomiasis in 21 studies see Table B in S1 Text. Sensitivity analysis Forest Plot of the impact of therapy on blood hemoglobin levels. Quantification of the net changes in Schistosoma infection-associated morbidity prevalence, from before to after treatment, is one way to critically value the impact of drug-based control of schistosomiasis, which is the strategy currently recommended by WHO and other agencies [ 10 ].