National mapping of schistosomiasis, soil-transmitted helminthiasis and anaemia in Yemen

Abstract

Author summarySchistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are endemic in Yemen. However, the precise prevalence and distribution of these diseases had remained unclear as cases were mainly identified sporadically in health facilities when patients with chronic complications sought treatment. This study provided the first comprehensive mapping of SCH and STH infections and anaemia through implementing a countrywide cross-sectional school-based survey. Country-wide, both diseases were found to present a significant public health burden. SCH and STH prevalence were more than 60.0%, and more districts were affected by intestinal than urogenital SCH. Based on the WHO classification, the SCH levels of infection ranged from mild to moderate. One quarter of Yemeni districts had severe or moderate levels of A. lumbricoides infection. Trichuriasis is the second most common STH after Ascariasis, with a mild to moderate level of infection in most districts, except three districts where it was severe. Anaemia is a severe or moderate public health problem in 26.5% and 36.1% of districts respectively. To the best of our knowledge this study presents the first national picture of anaemia burden in school-aged children in Yemen. The study's findings and recommendations will be used to inform the design of the ongoing national control and elimination programmes of these neglected tropical diseases in Yemen.BackgroundSchistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are known to be endemic in Yemen. However, the distribution of both diseases had not previously been assessed by a well-structured national mapping study covering all governorates. The main aim of this study was, therefore, to map the prevalence of SCH and STH in Yemen in order to better inform implementation of effective national control and elimination interventions. The assessment of the distribution of anaemia was also included as a well-known consequence of infection with both SCH and STH. Secondarily, the study aimed to provide a broad indication of the impact of large-scale treatment on the distribution of infection. Methodology and principal findingsTo achive these aims, 80,432 children (10-14 years old) from 2,664 schools in 332 of Yemen's 333 districts were included, in 2014, into this national cross-sectional survey. Countrywide, 63.3% (210/332) and 75.6% (251/332) of districts were found to be endemic for SCH and STH respectively. More districts were affected by intestinal than urogenital SCH (54.2% and 31.6% respectively). SCH infection was mostly mild and moderate, with no districts reporting high infection. One quarter (24.4%) of Yemeni districts had high or moderate levels of Ascaris lumbricoides infection. Infection with Trichuris trichiura was the second most common STH (44.9% of districts infected) after A. lumbricoides (68.1%). Hookworm was the least prevalent STH (9.0%).Anaemia was prevalent in 96.4% of districts; it represented a severe public health problem (prevalence >= 40%) in 26.5% of districts, and a mild to moderate problem in two thirds of the districts (33.7% and 36.1% respectively). ConclusionThis study provided the first comprehensive mapping of SCH, STH, and anaemia across the country. This formed the basis for evaluating and continuing the national control and elimination programme for these neglected tropical diseases in Yemen.