Point-of-care ultrasonography for S. haematobium associated urinary tract morbidity evaluation in the adult population of Mozambique

Abstract

Schistosomiasis is a parasitic and disabling waterborne neglected tropical disease caused by a trematode belonging to genus Schistosoma. The burden of urinary schistosomiasis morbidity is relatively high in Sub-Saharan Africa. Ultrasound has proved to be useful in the identification of not only bladder lesions, but also of the upper urinary tract. The point-of-care ultrasound helps to objectively assess organ lesions and clarify clinical manifestations presented by patients. Thus, to assess and characterize Schistosoma haematobium urinary tract morbidity in the adult population of Chókwè district, we have employed a point-of care ultrasound protocol based on previous WHO guidelines. Among the 912 ultrasounds performed in a representative study sample of adults, echogenic foci inside bladder lumen were found in only 0.3% of participants. Renal pelvis was the most frequent location for ultrasound abnormalities (23.1%), followed by the ureters (20.4%) and bladder wall (11.6%). The only risk factor found in our study to be associated with ultrasound abnormalities was being born in Chókwè district (p=0.026). For quality control purpose, 236 out of 912 ultrasounds were reviewed by an expert. The interobserver analysis showed a good correlation between the field investigator and expert classification. Findings corroborate not only for the need of urinary schistosomiasis morbidity assessment in highly endemic regions but also reinforce the need to develop simplified ultrasound protocols that can be used by local health personal.