{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T23:05:38Z","timestamp":1789513538932,"version":"build-2803163510"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100011722","name":"Higher Education Funding Council for England","doi-asserted-by":"publisher","award":["Core"],"award-info":[{"award-number":["Core"]}],"id":[{"id":"10.13039\/100011722","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Intestinal schistosomiasis was not considered endemic in Lake Malawi until November 2017 when populations of\n                      <jats:italic>Biomphalaria pfeifferi<\/jats:italic>\n                      were first reported; in May 2018, emergence of intestinal schistosomiasis was confirmed. This emergence was in spite of ongoing control of urogenital schistosomiasis by preventive chemotherapy. Our current study sought to ascertain whether intestinal schistosomiasis is transitioning from emergence to outbreak, to judge if stepped-up control interventions are needed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      During late-May 2019, three cross-sectional surveys of primary school children for schistosomiasis were conducted using a combination of rapid diagnostic tests, parasitological examinations and applied morbidity-markers; 1) schistosomiasis dynamics were assessed at Samama (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200980) and Mchoka (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200980) schools, where\n                      <jats:italic>Schistosoma mansoni<\/jats:italic>\n                      was first reported, 2) occurrence of\n                      <jats:italic>S. mansoni<\/jats:italic>\n                      was investigated at two non-sampled schools, Mangochi Orphan Education and Training (MOET) (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200960) and Koche (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u200960) schools, where\n                      <jats:italic>B. pfeifferi<\/jats:italic>\n                      was nearby, and 3) rapid mapping of schistosomiasis, and\n                      <jats:italic>B. pfeifferi<\/jats:italic>\n                      , conducted across a further 8 shoreline schools (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u2009240). After data collection, univariate analyses and Chi-square testing were performed, followed by binary logistic regression using generalized linear models, to investigate epidemiological associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 520 children from 12 lakeshore primary schools were examined, mean prevalence of\n                      <jats:italic>S. mansoni<\/jats:italic>\n                      by \u2018positive\u2019 urine circulating cathodic antigen (CCA)-dipsticks was 31.5% (95% confidence interval [\n                      <jats:italic>CI<\/jats:italic>\n                      ]: 27.5\u201335.5). Upon comparisons of infection prevalence in May 2018, significant increases at Samama (relative risk [RR]\u2009=\u20091.7, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.4\u20132.2) and Mchoka (RR\u2009=\u20092.7, 95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 1.7\u20134.3) schools were observed. Intestinal schistosomiasis was confirmed at MOET (18.3%) and Koche (35.0%) schools, and in all rapid mapping schools, ranging from 10.0 to 56.7%. Several populations of\n                      <jats:italic>B. pfeifferi<\/jats:italic>\n                      were confirmed, with two new eastern shoreline locations noted. Mean prevalence of urogenital schistosomiasis was 24.0% (95%\n                      <jats:italic>CI<\/jats:italic>\n                      : 20.3\u201327.7).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We notify that intestinal schistosomiasis, once considered non-endemic in Lake Malawi, is now transitioning from emergence to outbreak. Once control interventions can resume after coronavirus disease 2019 (COVID-19) suspensions, we recommend stepped-up preventive chemotherapy, with increased community-access to treatments, alongside renewed efforts in appropriate environmental control.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-020-00736-w","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T05:03:02Z","timestamp":1598850182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["An outbreak of intestinal schistosomiasis, alongside increasing urogenital schistosomiasis prevalence, in primary school children on the shoreline of Lake Malawi, Mangochi District, Malawi"],"prefix":"10.1186","volume":"9","author":[{"given":"Sekeleghe A.","family":"Kayuni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus M.","family":"O\u2019Ferrall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamish","family":"Baxter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josie","family":"Hesketh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bright","family":"Mainga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"David","family":"Lally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad H.","family":"Al-Harbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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Written informed guardian consent was obtained for each school child before participation in surveys.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have provided consent for publication of the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"121"}}