Intestinal schistosomiasis is still a public health problem in Burundi. Since 2008, annual mass drug administration (MDA) with praziquantel have been rolled out in 11 endemic districts. The national programme relies on school based surveys with Kato-Katz (KK) to monitor the impact of MDA. We explored whether routine data on intestinal schistosomiasis as determined by direct fecal smears (DS) at health centre (HC) level could be used.
We collected routine incidence data on intestinal schistosomiasis from the Burundian National Health Information System. These data concerned the number of intestinal schistosomiasis cases as detected by DS examination in the HC of all 45 sanitary districts (SD) between 2011 and 2015. A temporal trends analysis was performed using mixed Negative Binomial regression. Sanitary districts with MDA campaigns with praziquantel (n=11) were compared with those without (n=34). In addition, KK-based prevalence data from a school-based national mapping in 2014 were compared with the DS-based incidence data in the 45 SD.
In the 11 SD applying MDA with praziquantel, the incidence rate decreased significantly for the years 2014 (β2014=-0.826, p=0.010) and 2015 (β2015=-1.294, p<0.001) and for the five-year period (β=-0.286, p<0.001), whereas in the 34 districts without MDA, there was no significant trend (β=-0.087, p=0.219). In most of the 45 SD, the low prevalences based on KK in school children were confirmed by low incidence rates based on DS in the HC.
The results of this preliminary study suggest that routine surveillance data at HC level, may be able to monitor the impact of MDA with praziquantel on intestinal schistosomiasis in Burundi. However, more sensitive POC diagnostic tests, such as the POC-CCA assay are desirable when moving from control to elimination of schistosomiasis. Elimination of intestinal schistosomiasis calls for integration of adequate diagnosis and treatment into routine activities of primary health care facilities.