An examination of periportal fibrosis development and progression in rural Uganda

background

An estimated 250 million people worldwide have schistosome infections, of which 90% are in sub-Saharan Africa. Blood flukes (parasitic worms) cause schistosomiasis—a set of conditions associated with acute and chronic infections. Chronic Schistosoma mansoni infections can cause liver fibrosis, diarrhoea, gastrointestinal haemorrhage, anaemia, malnutrition, and portal hypertension as well as other 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, poor drug efficacy, and complex co-infections, chronic infections can result in periportal fibrosis and in the most severe stages, portal hypertension. The risk factors for periportal fibrosis onset and transition from less severe to more severe stages are poorly understood. This knowledge gap is particularly of concern in the context of repeated mass drug administration where current infection is not a good proxy indicator of periportal fibrosis (https://doi.org/10.1101/2024.04.09.24305558).

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING

This project will use data from an ongoing prospective cohort study (SchistoTrack) in rural villages in Uganda. Ethical approvals have been obtained. Detailed information will be available on schistosomiasis, demographics, socioeconomic status, and water, sanitation, and hygiene access/behaviours, ecology, household location, health care access, and case management within primary health care centres. Data from point-of-care ultrasounds, following the WHO Niamey Protocol, are available for periportal fibrosis and collaterals related to portal hypertension. Clinical symptoms and health care access data also are available.

Aims:

1. model the onset of periportal fibrosis;
2. identify the temporal trends of periportal fibrosis staging and risk factors for transitioning between stages; and
3. examine the temporal associations of periportal fibrosis and hypersplenism with portal hypertension complications.

The student will gain skills in systematic literature review, primary data collection, clinical epidemiological data analysis, disease pathogenesis, community engagement, statistical programming, data cleaning, and research presentation.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

This DPhil project requires one to two months of fieldwork in rural Uganda. Experienced SchistoTrack teams will lead the primary data collection.

PROSPECTIVE  STUDENT

The ideal candidate will have a Master’s degree in statistics/epidemiology/public health or a related discipline. This post is particularly suited to someone with a clinical or biomedical background with a strong interest in statistics.