Understanding risk factors for malaria and schistosomiasis in Tanzania.
Claudia Duguay (PhD cand.), February 2023
I started the PhD Epidemiology at the University of Ottawa under the guidance of Dr. Manisha Kulkarni in May of 2020. I entered the program with a focus on non-malarial febrile illnesses in Tanzania, but with the uncertainty of the COVID-19 pandemic and travel restrictions, I quickly had to pivot and develop a new plan. This new plan focused on understanding risk factors for malaria and schistosomiasis in Tanzania by leveraging an ongoing bed-net trial in Northwestern Tanzania. For this project, I added additional questions and a schistosomiasis testing component to the final cross-sectional survey of the study in January 2022. To proceed with these additions, I had to amend the ethics approval which took longer than anticipated. I boarded my flight to Tanzania on January 2 with the hopes that we would receive ethics approval on time before the start of the study. Our options were limited if we did not receive ethics approval for this add-on component since this was the final cross-sectional survey of the main trial. It was now or never.
It was with great excitement that I received the amended ethics certificate on January 4th. I was finally able to train the field workers on the new schistosomiasis questions and ensure that the tablets were ready for data collection. I felt so relieved… but little did I know, this would not be my final hurdle with this project.
The first week of data collection went well. At the end of each day, I would review the schistosomiasis questions and testing results since these were new components for the trial. After the first week, I quickly realized that there were a lot more people who were exposed to schistosomiasis than I had initially hypothesized. My initial thought was that the rapid tests (green test below) that we were using were faulty, but after a small validation study, we quickly realized that we had underestimated the severity of schistosomiasis in Northwestern Tanzania.
To accurately assess risk factors that are associated with malaria and schistosomiasis, a more accurate representation of larval breeding sites and snail habitats were imperative. Thanks to the Global 1 Health Network Research Assistance Grant, I was able to return to Tanzania to conduct this follow-up study to really understand what could explain such high exposure to malaria and schistosomiasis in the study area.