[en] The WHO recently issued guidelines for public health control of Strongyloides stercoralis in endemic areas. We aimed to evaluate the feasibility of implementing the WHO recommendations in Rwanda, and our secondary objective was to estimate S. stercoralis prevalence. We conducted a community-based cross-sectional study in two Rwandan districts (Gisagara and Rubavu) including a training session focused on diagnostics for S. stercoralis: parasitological assays (Baermann and agar plate culture, APC) and a novel rapid diagnostic test (RDT). Technicians' perceptions of each assay were evaluated via a questionnaire; 1,415 individuals were screened. A critical aspect of the parasitological assays was the length of training, but there was no issues with RDT implementation. Based on the combination of Baermann and APC diagnostics, prevalence was 1.1% (95% CI 0.5-2.3) in Gisagara, and 3.9% (95% CI 2.6-5.7) in Rubavu, which was similar for the RDT. Overall, we found the implementation of S. stercoralis-specific tests was feasible, though intense training was crucial.
Disciplines :
Entomology & pest control
Author, co-author :
Shema, Eliah; School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
Tamarozzi, Francesca; Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
Mbonigaba, Jean Bosco; Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
Scarso, Salvatore; Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
Mazzi, Cristina ; Clinical Research Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
Gasana, Paul ; Université de Liège - ULiège > Fundamental and Applied Research for Animals and Health (FARAH) ; School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
Turatsinze, Benon ; Department of Biomedical Laboratory Sciences, University of Rwanda, Kigali, Rwanda
Uwayezu, Leonard; Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
Mukamigambi, Delphine; Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
Uwayo, Henri Desire; Nation Reference Laboratory Division, Rwanda Biomedical Centre, Kigali, Rwanda
Nshimiyimana, Ladislas; Neglected Tropical Diseases and Other Parasitic Diseases Unit, Rwanda Biomedical Center, Ministry of Health, Kigali, Rwanda
Rujeni, Nadine; School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
Buonfrate, Dora ; Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy. dora.buonfrate@sacrocuore.it
This work received funds from the Italian Ministry of Health: \u201C5\u2009\u00D7\u20091000, 2021\u201D, and \u201CRicerca Corrente\u201D, project: L2P12. We acknowledge all the study participants, and District authorities who facilitated this study.
Buonfrate, D, et al. The global prevalence of strongyloides stercoralis infection. Pathogens (Basel, Switzerland)9, 468 (2020).
P.E. Fleitas et al. The Strongyloides stercoralis-hookworms association as a path to the estimation of the global burden of strongyloidiasis: a systematic review PLoS Negl. Trop. Dis. 14 e0008184 10.1371/journal.pntd.0008184 32282827 7188296
A. Hall D.J. Conway K.S. Anwar M.L. Rahman Strongyloides stercoralis in an urban slum community in Bangladesh: factors independently associated with infection Trans. R. Soc. Trop. Med. Hyg. 88 527 530 1:STN:280:DyaK2M%2FosVCnug%3D%3D 10.1016/0035-9203(94)90146-5 7992327
T.H. Jember et al. Prevalence of Strongyloides stercoralis infection and associated clinical symptoms among schoolchildren living in different altitudes of Amhara National Regional State, northwest Ethiopia PLoS Negl. Trop. Dis. 16 e0010299 10.1371/journal.pntd.0010299 35482629 9049318
D. Buonfrate R.S. Bradbury M.R. Watts Z. Bisoffi Human strongyloidiasis: complexities and pathways forward Clin. Microbiol. Rev. 36 e0003323 10.1128/cmr.00033-23 37937980
O. Rojas A. Montoya H. Villanueva-Lozano D. Carrion-Alvarez Severe strongyloidiasis: a systematic review and meta-analysis of 339 cases Trans. R. Soc. Trop. Med. Hyg. 117 682 696 10.1093/trstmh/trad032 37300462
E. Nieves et al. Comparison of parasitological methods for the identification of soil-transmitted helminths, including Strongyloides stercoralis, in a regional reference laboratory in northwestern Argentina: an observational study Parasite Epidemiol. Control 26 10.1016/j.parepi.2024.e00370 39139793 11321430 e00370
WHO. WHO guideline on preventive chemotherapy for public health control of strongyloidiasis. CC BY-NC-SA 3.0 IGO: Geneva, Switzerland (2024).
N.C. Lo et al. Review of the WHO guideline on preventive chemotherapy for public health control of strongyloidiasis Lancet Infect. Dis. 25 e146 e152 1:CAS:528:DC%2BB2cXisVWrs7nE 10.1016/S1473-3099(24)00595-4 39481419
A. Forrer et al. Strongyloides stercoralis and hookworm co-infection: spatial distribution and determinants in Preah Vihear Province, Cambodia Parasites Vectors 11 33 10.1186/s13071-017-2604-8 29329561 5767026
D.A. Zainol et al. Systematic review of strongyloides stercoralis infection diagnosis in Southeast Asia: insights from parasitological, molecular, and serological approaches Am. J. Trop. Med. Hyg. 111 724 735 1:CAS:528:DC%2BB2cXivVSgtrrP 39137756
WHO. Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030. Geneva, Switzerland: CC BY-NC-SA 3.0 IGO (2020).
A. Tuyizere et al. Prevalence of Strongyloides stercoralis infection and other soil-transmitted helminths by cross-sectional survey in a rural community in Gisagara District, Southern Province, Rwanda Trans. R. Soc. Trop. Med. Hyg. 112 97 102 10.1093/trstmh/try036 29726969 5961251
M. Montes C. Sawhney N. Barros Strongyloides stercoralis: there but not seen Curr. Opin. Infect. Dis. 23 500 504 10.1097/QCO.0b013e32833df718 20733481 2948977
F. Tamarozzi et al. Accuracy, acceptability, and feasibility of diagnostic tests for the screening of Strongyloides stercoralis in the field (ESTRELLA): a cross-sectional study in Ecuador Lancet Glob. health 11 e740 e748 1:CAS:528:DC%2BB3sXmtFWrtrY%3D 10.1016/S2214-109X(23)00108-0 36972722
WHO. Call for public consultation – Target Product Profiles (TPP) for Strongyloides stercoralis diagnostics. May 16, 2025.
A. Montresor et al. The global progress of soil-transmitted helminthiases control in 2020 and World Health Organization targets for 2030 PLoS Negl. Trop. Dis. 14 e0008505 10.1371/journal.pntd.0008505 32776942 7446869
Kazienga, A. et al. Target product profiles for new diagnostics to inform strongyloidiasis control programs. PLoS Negl Trop Dis. 19, e0012774 (2025).
W. Gelaye et al. Performance evaluation of Baermann techniques: the quest for developing a microscopy reference standard for the diagnosis of Strongyloides stercoralis PLoS Negl. Trop. Dis. 15 e0009076 1:CAS:528:DC%2BB3MXkslalu7Y%3D 10.1371/journal.pntd.0009076 33600434 7891789
K. Koga et al. A modified agar plate method for detection of Strongyloides stercoralis Am. J. Trop. Med. Hyg. 45 518 521 1:STN:280:DyaK38%2FlvFKksA%3D%3D 10.4269/ajtmh.1991.45.518 1951861
S. Scarso et al. Evaluation of novel recombinant antigen-based (NIE/SsIR) immunochromatographic rapid tests for Strongyloides stercoralis: an accuracy study Parasites Vectors 17 535 1:CAS:528:DC%2BB2cXivVKntbjI 10.1186/s13071-024-06569-y 39716196 11668118
B. Levecke L.E. Coffeng C. Hanna R.L. Pullan K.M. Gass Assessment of the required performance and the development of corresponding program decision rules for neglected tropical diseases diagnostic tests: monitoring and evaluation of soil-transmitted helminthiasis control programs as a case study PLoS Negl. Trop. Dis. 15 e0009740 10.1371/journal.pntd.0009740 34520474 8480900
