Assessing liver multimorbidities for individuals with schistosome infections in rural Uganda

Background

An estimated 250 million people worldwide have schistosomiasis infections, of which 80% are in sub-Saharan Africa. In 2019, schistosomiasis caused at least 1.64 million disability-adjusted life years lost. Blood flukes (parasitic worms) cause schistosomiasis. It is a chronic infection where individuals are affected over their life course. Schistosoma mansoni infections, if left untreated, can cause liver fibrosis, diarrhoea, gastrointestinal haemorrhage, anaemia, malnutrition, and portal hypertension as well as long-term impairments such as reduced cognitive development, educational attainment, and work productivity.

Due to the long lifespan of the parasite, lack of protective treatment against reinfection, and complex social-ecological risk factors, multiple concurrent conditions are on the rise in areas endemic with schistosomiasis. Yet, the presence of multimorbidities, i.e. two or more chronic conditions, is poorly understood. Morbidities are often studied in isolation for schistosomiasis. This approach ignores that conditions often interact, have similar aetiologies, share treatment strategies, or have shared socioeconomic determinants (despite distinct biological causes).

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

This project will use a cross-section of data from an ongoing study in rural villages in Uganda where Schistosoma mansoni is endemic. Ethical approvals have been obtained. It is expected that this data will be collected prior to the start of this DPhil project. This DPhil analysis will focus on a random sample of approximately 1600 households from 39 villages. To measure infection status/intensity and morbidities, one child (aged 5+ years) and one adult (aged 18+ years) will be sampled from each study household (3120 individuals). Ultrasounds following WHO Niamey Protocols and clinical palpations will be completed to identify liver pathologies. Household surveys will be used to collect information on non-communicable diseases following the WHO STEPS survey, socioeconomic status, and water, sanitation, and hygiene access/behaviours.

Aims:

1)      Identify common clusters of liver morbidities associated with schistosomiasis infections

2)      Assess how liver multimorbidity prevalence varies by schistosomiasis prevalence and intensity

3)      Examine the variation in liver multimorbidities over a lifespan by assessing the variation against age in a cross-sectional manner

The student will gain skills in literature review, study design, primary data collection, clinical epidemiological data analysis, statistical programming, data cleaning, and research presentation. Training in schistosomiasis epidemiology and fieldwork will be provided.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

The DPhil candidate will have the opportunity to contribute to the cohort through follow-up studies. This project requires approximately 1-2 months of fieldwork in rural Uganda over the course of the DPhil project. The study is in close collaboration with the Uganda Ministry of Health. Experienced field teams from Uganda will co-lead the primary data collection with the primary supervisor.

PROSPECTIVE STUDENT

Candidates ideally will have postgraduate training in global health, epidemiology, or a related discipline as well as experience in statistical/quantitative analyses of health data which could include machine learning. Interest in parasitic infections and good communication skills are necessary.