# Piloting the Schistosomiasis Practical and Precision Assessment approach in five health districts of the N’zérékoré region, Republic of Guinea

## TL;DR

A study in Guinea tested a new method to assess schistosomiasis infection levels and treatment needs in five health districts.

## Contribution

The study piloted the Schistosomiasis Practical and Precision Assessment (SPPA) approach for evaluating schistosomiasis at the sub-district level.

## Key findings

- Schistosoma mansoni prevalence was high (66.1%) across four of five health districts.
- Schistosoma haematobium prevalence was low (4.3%) in the region.
- The SPPA approach was feasible and provided actionable data for targeted treatment strategies.

## Abstract

In Guinea, N’Zérékoré region has historically been endemic for both Schistosoma mansoni and S. haematobium. Following eight years of mass treatment with praziquantel to treat schistosomiasis, as part of a multi-country project, the country was selected to pilot the Schistosomiasis Practical and Precision Assessment (SPPA) approach. The SPPA pilot was conducted in five health districts in the forest region. The main objectives were to determine the current infection status and treatment strategy for each health sub-district and to evaluate the feasibility of the SPPA approach.

A cross-sectional study among children aged 10–14 years of age was conducted. In each health district, a systematic sample of 15 schools were selected with 32 school children selected randomly from each. Stool and urine samples were collected from each child. Two Kato-Katz slides were examined for S. mansoni and soil transmitted helminthiasis (STH) and one urine filtration slide and one hemastix for S. haematobium infections and microhaematuria, respectively.

Of the 2400 children targeted for inclusion, 2325 provided samples (96.9%). The combined prevalence of Schistosoma species across the five health districts was 66.4%. S. mansoni had a high prevalence of 66.1% with four health districts above 50%. S. haematobium had a low prevalence of 4.3%. The overall prevalence of any combined STH (Ascaris lumbricoides, Trichuris trichiura or hookworm) was 11.7%. Sex, age and contact with a freshwater body during the last week before the survey, were not statistically significant in their association with schistosomiasis.

The results of the SPPA indicate that schistosomiasis remains homogeneously high across all five health districts. Consequently, it is recommended to maintain annual treatment in each sub-health district, and to extend treatment to whole communities aged two years of age and over, while strengthening critical cross-sectoral interventions such as behaviour change and environmental management.

The manuscript presents a pilot study of the Schistosomiasis Practical and Precision Assessment (SPPA) approach in five health districts of the N’zérékoré region, Republic of Guinea. The SPPA is an evidence-based approach for the monitoring and evaluation of schistosomiasis programme progress through impact assessments. The study aimed to pilot and test the SPPA approach in terms of its feasibility when implemented by national programmes and its ability to support classification of sub-districts according to treatment needs. The results of this study will provide crucial information to improve schistosomiasis control strategies and optimize precision public health interventions in endemic regions.