Gaps in health capacities for the case management of schistosomiasis and soil-transmitted helminths infections in Burundi

P. Bizimana, J.-P. Van Geertruyden, K. Polman and G. Ortu

Tropical Medicine and International Health, volume 20 suppl 1 pp 171–441 september 2015

Introduction

Since 2007, mass drug administrations (MDA) of praziquantel and albendazole for schistosomiasis (SCH) and soil-transmitted helminth infections (STHs) has been established in Burundi in endemic areas. Alongside MDAs, STH case management is performed in health facilities (HFs) but SCH case management is still a challenge. Routine surveillance is needed to allow the detection of new SCH foci of infection. We assessed the HFs capacity to treat STHs cases and to integrate SCH control in the routine activities.

Material and Methods

In 65 HFs, located in SCH and STHs endemic areas, data were collected made via semiquantitative questionnaires targeting HF managers, staff responsible for patient triage and referrals, staff in charge of disease surveillance, laboratory technicians and pharmacists.

Results

Abdominal pain (69.2%) and diarrhea (60.0%) werementioned by the care providers as the main signs of STHs infection. For SCH, bloody diarrhea and bloody stools were instead mentioned by only 13.9% and 7.7%. Compared to A3 diploma holder, superior diploma holder knew better diarrhea (P = 0.008) and hematuria (P = 0.04) as symptoms of SCH mansoni and haematobium infection respectively. Being trained on SCH improved the knowledge of blood in stools as a symptom of SCH mansoni (P = 0.01). The availability of guidelines for diagnosis of SCH improved the knowledge of hematuria as a symptom of SCH haematobium infection (P = 0.01). Guidelines for management of SCH and STHs were available in 33.9% of HFs, and laboratory procedures to confirm SCH and STHs were available in 29.3% and 63.1% of HFs, respectively.The direct smear microscopy is the unique test used for the diagnostic of SCH and STHs. The status of HFs (hospital, health centre, confessional, public, private) influences the costs of the consultation (P < 0.001) and the direct smear (P < 0.001) for SCH and STH. Albendazole and mebendazole were available in HFs but praziquantel was not. Finally, health staff considered their SCH case management very poor due to lack of disease knowledge, insufficient laboratory equipment and unavailability of praziquantel outside national MDAs.

Conclusion

The current health capacities for SCH case management and mainly for SCH and STHs detection are not adequate to establish a routine surveillance system for these diseases. Improvement of knowledge, detection and resources are strongly warranted for SCH and STHs control integration into HFs routine activities.

Disclosure

Nothing to disclose.