Improving the monitoring and evaluation of schistosomiasis by determining appropriate targets and utilizing new technologies

The World Health Organization’s framework for the assessment of schistosomiasis morbidity control utilizes the prevalence of heavy-intensity infections in a homogenous ecological zone. The foundational research for the use of heavy-intensity infections is at least 30 years old. Research since then has illuminated the relationship between Schistosoma infection and all morbidity. In addition, severe, chronic, schistosomiasis morbidity is less common due to increasing dissemination of preventive chemotherapy. There are calls for improvements to the monitoring and evaluation framework, especially relating to the measurement of schistosomiasis morbidity.
The focus of this thesis was to improve the schistosomiasis monitoring and evaluation framework by evaluating whether those current infection measures are linked to morbidity indicators. For those measures linked to indicators, an attempt was made to calculate programmatic targets linked to morbidity using robust methods.
Targets based on microhaematuria prevalence were calculated based on community-level S. haematobium prevalence. For S. mansoni, associations between infection and morbidity were much weaker and it appears unlikely that a reliable target can be found. S. mansoni morbidity control may require changes to accurately measure the S. mansoni morbidity burden in a geographic area. Incorporating new technologies, such as portable, tablet-based ultrasound systems, may allow researchers and control programs to collect schistosomiasis morbidity indicators.