Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #120906

JL Finkelstein, BSc, MPH, Department of Community Health, Brown University, Box G-A4, 97 Waterman Street, Providence, RI 02912, 401-421-4982, julia.finkelstein@gmail.com, ST McGarvey, PhD, MPH, International Health Institute, Department of Community Health, Brown University, Box G - B495, 495 Biomedical Center, Providence, RI 02912, and MD Schleinitz, MD, MSc, DGIM, Rhode Island Hospital, Department of Community Health, Brown University, 593 Eddy St., MPB-1, Providence, RI 02903.

BACKGROUND: Schistosomiasis is one of the most prevalent parasitic diseases globally. However, World Health Organization disability-adjusted life year estimates indicate that the average population-level impact of schistosomiasis is minimal. The magnitude of burden due to the Asian strain, Schistosoma japonicum, remains particularly controversial. Comprehensive re-assessment of burden due to Schistosoma japonicum is urgently needed. METHODS: We constructed decision tree models to re-estimate the disability weight for schistosomiasis for all affected persons and age-specific cohorts. We identified estimates of morbidity prevalence and disability weights by searching electronic databases, reviewing bibliographies, and contacting S. japonicum research experts. To examine the robustness of findings, we conducted deterministic sensitivity analyses, considering baseline, conservative, and pessimistic scenarios. RESULTS: S. japonicum was associated with an overall disability weight of 0.130, with age-specific disability weights of 0.098 for those under 15 years and 0.198 for those 15 years and older. Hepatomegaly, hepatic fibrosis and cirrhosis, splenomegaly, and diarrhea were the most critical contributors to the overall disability weight. Using the most conservative estimate for each variable simultaneously resulted in overall disability weight of 0.047, and age-specific results of 0.033 (<15) and 0.091 (³15). CONCLUSIONS: Results suggest that a minimum disability weight of 0.033 to 0.091 would be a more appropriate measure of disability due to Schistosoma japonicum. Findings suggest that Global Burden of Disease methodologies severely underestimate global S. japonicum burden. Even our most conservative disability weight estimate remains ten times the international standard. Further research is urgently needed to re-examine the global burden of Schistosoma japonicum.

Learning Objectives: The learning objectives for this session are to

• investigate a broad spectrum of schistosomiasis-related morbidity and disability and with a focus on Global Burden of Disease methodologies;
• review decision tree model methodology estimation of disease burden;
• quantify disability weights associated with S. japonicum, considering overall and age-specific cohort populations (< 15, ³15 years);
• examine the extent to which individual probability and disutility estimates affect the overall model disability weights; and
• evaluate the applicability of Global Burden of Disease Methodologies to infectious disease burden assessment.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.