Urogenital schistosomiasis infection prevalence targets to determine elimination as a public health problem based on microhematuria prevalence in school-age children

Background Recent research suggests that schistosomiasis targets for morbidity control and elimination as a public health problem could benefit from a reanalysis. These analyses would define evidence-based targets that control programs could use to confidently assert that they had controlled or eliminated schistosomiasis as a public health problem. We estimated how low Schistosoma haematobium infection levels diagnosed by urine filtration in school-age children should be decreased so that microhematuria prevalence was at, or below, a "background" level of morbidity. Methodology Data obtained from school-age children in Burkina Faso, Mali, Niger, Tanzania, and Zambia who participated in schistosomiasis monitoring and evaluation cohorts were reanalyzed before and after initiation of preventive chemotherapy. Bayesian models estimated the infection level prevalence probabilities associated with microhematuria thresholds <= 10%, 13%, or 15%. Principal findings An infection prevalence of 5% could be a sensible target for urogenital schistosomiasis morbidity control in children as microhematuria prevalence was highly likely to be below 10% in all surveys. Targets of 8% and 11% infection prevalence were highly likely to result in microhematuria levels less than 13% and 15%, respectively. By contrast, measuring heavy-intensity infections only achieves these thresholds at impractically low prevalence levels. Conclusions/Significance A target of 5%, 8%, or 11% urogenital schistosomiasis infection prevalence in school-age children could be used to determine whether a geographic area has controlled or eliminated schistosomiasis as a public health problem depending on the local background threshold of microhematuria. Author summary For urogenital schistosomiasis, targets for morbidity control and elimination as a public health problem are based on the percentage of school-age children with a heavy intensity infection in a set of sentinel schools. These targets are not tied to specific morbidity indicators and should be reevaluated due to the recognition that all infections have an impact on people's health. Multiple studies have shown a strong association between urogenital schistosomiasis infection and microhematuria. In these analyses, data from children aged 6-15 years in monitoring and evaluation cohorts from five African countries were used to determine whether infection and heavy intensity infection targets could be developed, based on a prevalence of microhematuria in a school without schistosomiasis infections before and after initiation of a deworming program. Results indicate that targets of 5%, 8%, or 11% urogenital schistosomiasis infection prevalence in school-age children can be used to reliably conclude that a school is below a microhematuria prevalence of 10%, 13%, or 15%, respectively. These targets could be used by control program managers as guide to determine whether morbidity has been controlled or eliminated as a public health problem.