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Assessing the co-epidemiology of Hepatitis B and Schistosoma mansoni in rural Uganda

OPH/23/14

background

Hepatitis B (HBV) and Schistosoma mansoni are both chronic infections—the former caused by a virus and the latter by a parasitic blood fluke—that affect the liver and are highly prevalent in sub-Saharan Africa. Coinfections exacerbate liver pathologies including surface irregularities and the severity of liver fibrosis that may ultimately lead to liver failure. In Northwestern Uganda, the prevalence of Schistosoma mansoni is over 50% in children and adults, and HBV is estimated at 15-20% in adults. Both HBV infection and schistosomiasis have been separately associated with low socioeconomic status. The infections both cause fibrosis of liver tissues. The two infections can be misdiagnosed or confused with one another based on the morbidity presentation, as primary health care centres may often lack formal diagnostics. Despite their shared biological and social pathways, little is known about the co-distribution of these infections and their shared social risk factors.

RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING 

This project will use data from an ongoing cohort study (SchistoTrack/EpiMM-Schisto) in rural villages in Uganda where S. mansoni is endemic. Ethical approvals have been obtained. The baseline and first annual follow-up will be collected prior to the start of this DPhil project. Three more years of follow-up will occur during the timeframe of this DPhil. This analysis will focus on a random sample of approximately 1800 households from 45 villages. To measure infection status/intensity, one child (aged 5+ years) and one adult (aged 18+ years) will be sampled from each study household (~3600 individuals). Rapid diagnostics for HBV and schistosomiasis will be available with also microscopy data for schistosome infections. Detailed information will be available on 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 is available to evaluate liver pathologies.

Aims:

  1. Establish the epidemiology (key risk factors) for HBV infections in the study population, including an assessment of the prevalence in children and evaluation of current HBV vaccine reach.
  2. Estimate the co-distribution of HBV and schistosomiasis, mainly in adults, and the key risk factors of concurrent infections.
  3. Examine the influence of HBV and schistosomiasis interactions on liver fibrosis, stiffness, and surface irregularities.

There is scope to tailor the project to the student’s interest. The student will gain skills in literature review, primary data collection, clinical epidemiological data analysis, statistical programming, data cleaning, and research presentation.

FIELD WORK, SECONDMENTS, INDUSTRY PLACEMENTS AND TRAINING

This DPhil project requires 1-2 months of fieldwork in rural Uganda. Experienced field teams from the Uganda Ministry of Health will co-lead the primary data collection with the primary supervisor.

PROSPECTIVE STUDENT

The ideal candidate will have a Master’s degree in statistics/epidemiology/public health or a related quantitative discipline in computer science, mathematics, engineering, or economics.

Supervisor

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