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For our analysis, it was assumed that the included studies represented the best available information for the population and morbidity of interest at the time it was undertaken.
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Sensitivity analysis Forest Plot of the impact of therapy on hematuria prevalence. In subgroup analysis Table C in S3 Textthere was no statistically significant treatment-related reductions among individuals infected with S. S8 Fig Sensitivity analysis Forest Plot of the impact of therapy on diarrhea prevalence. Despite the potential benefits of treatment, many affected persons have not yet been reached by treatment programs [ 28 ]. Hemoglobin Fifteen studies evaluated circulating blood hemoglobin cgk before and after specific chemotherapy for schistosomiasis see Table K in S1 Text.
However, the exclusion of one study with S. The presence of fhk in urine was measured in 12 studies see Table H in S1 Text and the reduction of its prevalence was highly significant OR 0. These new estimates may prove useful in cost-effectiveness estimations for program planning, and can provide direction for future operational research on treatment implementation strategies. Reassessment of the cost of chronic helmintic infection: Meta-analysis summary estimates indicated a significant reduction after chemotherapy s00 to pretreatment levels OR 0.
In our subgroup analyses, some study features were clearly linked to either better or more limited reductions in morbidity prevalence after treatment. Quantifying heterogeneity in a meta-analysis. Chk pdf Get the latest investor presentations from Chesapeake Energy. cchk
Random effects meta-analysis was used to derive summary estimates: Department of Health and Human Services guidelines https: The data used in this project were aggregated, anonymized data from previously published studies; as such, this study does not constitute human subjects research according to U.
This suggests that repeated or more effective anti-parasite drug treatment will be a valuable tool for greater reduction of Schistosoma -related patient morbidities in affected areas.
The impact of chemotherapy on morbidity due to schistosomiasis. S11 Fig Sensitivity analysis Forest Plot of the impact of therapy on proteinuria prevalence. Author summary Schistosomiasis is the disease caused by infection with Schistosoma parasitic flukes.
Studies that combined treatment for schistosomiasis with another 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 in S3 Text. Of importance to public health, it appears that monitoring of schistosomiasis-associated anemia impact should be planned for a period at one year or more after treatment.
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We appreciate the helpful comments of the SCORE Project leaders and participants, and their encouragement for completion of this project. While there are challenges to implementing therapy for dhk, and praziquantel therapy is not fully curative, reductions in egg output are significantly correlated with decreased morbidity and can be used to project diminution in disease burden when contemplating more aggressive strategies to minimize infection intensity.
The relative intensity of infection is an important correlate of morbidity, because the formation of the disease is related to the daily deposition of parasite eggs into host tissues [ 1748 — 50 ]. Overall, our results suggest that drug treatment significantly reduces but does not eliminate these common pathologic consequences of Schistosoma infection, and that the odds of improvement are linked to the magnitude of treatment-related reductions in adult worm burden of parasitic infection.
To explore heterogeneity and factors that could dhk 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 chm of diagnosis, the treatment performed, the number of treatments, and the initial prevalence of infection in the study population [ 34 ].
Four main factors were associated with greater treatment impact in reducing hepatomegaly: Nevertheless, studies of morbidity reduction related to drug treatment have had some conflicting results [ 23 — 26 ], which may be a reflection of differences in follow-up after treatment, methods used to measure morbidities, the Schistosoma species, the presence of co-infections especially malariathe type of population and the region, the initial prevalence of infection, the incidence of reinfection, and other factors [ 727 ].
Th2 responses in schistosomiasis.
Significant heterogeneity was observed among the studies included Fig 2 which could be modified by subgroup stratification according to region, age, and time of follow-up. Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: Post-treatment odds of splenomegaly and periportal fibrosis were not significantly reduced for infection with S.
Data collection process The data abstracted from selected publications were curated in the Microsoft Access study database. In our summary estimates, only two morbidities showed no consistent or significant change between pre- and post-treatment surveys.