02873nas a2200253   4500000000100000008004100001100002400042700001400066700001500080700001600095700001300111700001400124700001200138700001600150700001300166700001100179700001600190245014900206856005800355300001300413490000600426520217300432022001402605       2015                            d1 aSousa-Figueiredo JC1 aStanton M1 aKatokele S1 aArinaitwe M1 aAdriko M1 aBalfour L1 aReiff M1 aLancaster W1 aNoden BH1 aBock R1 aStothard RJ00aMapping of schistosomiasis and soil-transmitted helminths in Namibia: The first large-scale protocol to formally include rapid diagnostic tests.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509651/   ae00038310 v93 a<p><strong>BACKGROUND: </strong>Namibia is now ready to begin mass drug administration of praziquantel and albendazole against schistosomiasis and soil-transmitted helminths, respectively. Although historical data identifies areas of transmission of these neglected tropical diseases (NTDs), there is a need to update epidemiological data. For this reason, <em>Namibia adopted a new protocol for mapping of schistosomiasis and geohelminths, formally integrating rapid diagnostic tests (RDTs) for infections and morbidity.</em> In this article, we explain the protocol in detail, and introduce the concept of 'mapping resolution', as well as present results and treatment recommendations for northern Namibia.</p>

<p><strong>METHODS/FINDINGS/INTERPRETATION: </strong>This new protocol allowed a large sample to be surveyed (N = 17,896 children from 299 schools) at relatively low cost (7 USD per person mapped) and very quickly (28 working days). All children were analysed by RDTs, but only a sub-sample was also diagnosed by light microscopy. Overall prevalence of schistosomiasis in the surveyed areas was 9.0%, highly associated with poorer access to potable water (OR = 1.5, P&lt;0.001) and defective (OR = 1.2, P&lt;0.001) or absent sanitation infrastructure (OR = 2.0, P&lt;0.001). Overall prevalence of geohelminths, more particularly hookworm infection, was 12.2%, highly associated with presence of faecal occult blood (OR = 1.9, P&lt;0.001). Prevalence maps were produced and hot spots identified to better guide the national programme in drug administration, as well as targeted improvements in water, sanitation and hygiene. The RDTs employed (circulating cathodic antigen and microhaematuria for Schistosoma mansoni and S. haematobium, respectively) performed well, with sensitivities above 80% and specificities above 95%.</p>

<p><strong>CONCLUSION/SIGNIFICANCE: </strong>This protocol is cost-effective and sensitive to budget limitations and the potential economic and logistical strains placed on the national Ministries of Health. Here we present a high resolution map of disease prevalence levels, and treatment regimens are recommended.</p>
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