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Member Research and Reports

Johns Hopkins: Open Defecation Biggest Risk Factor for Schistosomiasis in Uganda, New National Study Finds

A new study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the Makerere School of Public Health in Kampala, Uganda, found that the national prevalence of schistosomiasis in Uganda was higher than previously understood — 25.6 percent overall with a prevalence of 36.1 percent among children ages two to four.

Schistosomiasis is a leading parasitic infection in terms of morbidity and mortality worldwide, second only to malaria, and has remained intractable in Uganda despite efforts to eliminate it through mass drug administration. The water-based, vector-borne disease is transmitted by snails in surface water bodies contaminated by human feces, often through the practice of open defecation. The study found that the most significant risk-factor for the disease was an individual’s open defecation behaviors in surface waters such as lakes, rivers and ponds.

The study was published online August 14 in the journal PLOS Neglected Tropical Diseases.

To measure the national scale of schistosomiasis in Uganda, the researchers, collaborating with the Uganda Bureau of Statistics on the sampling, conducted a nationally representative survey with 9,183 study participants age two and older. The survey included a household and individual questionnaire, disease testing based on detection of worm antigens (circulating cathodic antigen–CCA), diagnosis and treatment.

“Schistosomiasis transmission is an important measure for whether or not a community is open defecation free,” says Dr. Natalie Exum, assistant scientist in the department of environmental health and engineering and the study’s co-principal investigator.

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