The burden of schistosomiasis morbidity in African children: validating novel, low-cost and scalable detection tools and optimizing praziquantel treatment

Schistosomiasis is a parasitic disease that affects over 100 million children in the world living mostly in sub-Saharan Africa. This thesis explored several aspects of the disease affecting the health of children from two African endemic countries: Kenya and Uganda. Epidemiological work revealed a worrisome association between schistosomiasis and malnutrition (both acute and chronic) as well as anaemia. A novel paediatric quality of life assessment was performed in children with the disease with a significant decrease in their psychosocial functioning. Further work went into testing and validating novel morbidity detection tools to identify sub-clinical and overt disease; firstly in Kenya the 20-meter shuttle run test performed accurately in detecting anaemia associated with schistosomiasis, secondly in Uganda, point-of-care tests (faecal occult blood and calprotectin) correlated with severity of intestinal schistosomiasis. As a disease of poverty, schistosomiasis co-exists with other pandemic diseases such as HIV and the tandem HIV-schistosomiasis has not yet been explored in children. A review on the current knowledge on the subject to help delineate the very needed research agenda is presented. The final work in the thesis is the first pharmacokinetic/pharmacodynamics study of praziquantel in children, the only drug available for the treatment of schistosomiasis. The results of this study suggest that the current recommended dose for control programmes may be too low, particularly for preschool children. Overall, this work is an important contribution to paediatric schistosomiasis and opens up future research venues that need to be explored in order to fully understand this disabling disease. This can be done through better clinical staging, affordable morbidity detection tools and optimized treatment.