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Meta-Analysis
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Effectiveness of the New Integrated Strategy to Control the Transmission of Schistosoma Japonicum in China: A Systematic Review and Meta-Analysis

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Meta-Analysis

Effectiveness of the New Integrated Strategy to Control the Transmission of Schistosoma Japonicum in China: A Systematic Review and Meta-Analysis

Chunyan Qian et al. Parasite.

Abstract

Since 2004, the national schistosomiasis control strategy in China has shifted from the morbidity control strategy (conventional strategy) to an integrated strategy (new strategy). We investigated the effectiveness of the new strategy and compared it against the conventional strategy. We retrieved from electronic databases the literature regarding the new strategy published from 2000 to 2017. The effect of the new or conventional strategy on infection by Schistosoma japonicum of humans and snails (Oncomelania hupensis) was evaluated with pooled log relative risk (logRR). A total of only eight eligible publications were included in the final meta-analysis. The results showed that implementation of the new strategy reduced the infection risk by 3-4 times relative to the conventional strategy. More specifically, the conventional strategy caused a reduction in both human (logRR = 0.56, 95% CI: 0.12-0.99) and snail infections (logRR = 0.34, 95% CI: -0.69-1.37), while the new strategy also significantly reduced both human (logRR = 1.89, 95% CI: 1.33-2.46) and snail infections (logRR = 1.61, 95% CI: 1.06-2.15). In contrast to the conventional strategy, the new strategy appeared more effective to control both human (logRR difference = 1.32, 95% CI: 0.78-1.86) and snail infections (logRR difference = 1.53, 95% CI: 0.76-2.31). Our data demonstrate that the new integrated strategy is highly effective to control the transmission of S. japonicum in China, and this strategy is recommended for schistosomiasis elimination in other affected regions across the world, with adaptation to local conditions.

Figures

Figure 1.
Figure 1.
Flowchart of study selection.
Figure 1.
Figure 1.
Flowchart of study selection.
Figure 2.
Figure 2.
Funnel plot shows asymmetry for the studies included in this analysis. (A) the funnel plot of the studies reporting the effectiveness of the conventional strategy on the control of human Schistosoma japonicum infection; (B) the funnel plot of the studies reporting the effectiveness of the conventional strategy on the control of Oncomelania hupensis snail infection; (C) the funnel plot of the studies reporting the effectiveness of the new strategy on the control of human Schistosoma japonicum infection; (D) the funnel plot of the studies reporting the effectiveness of the new strategy on the control of Oncomelania hupensis snail infection; (E) the funnel plot of the studies comparing the effectiveness between the new strategy and the conventional strategy on the control of human Schistosoma japonicum infection; (F) the funnel plot of the studies comparing the effectiveness between the new strategy and the conventional strategy on the control of Oncomelania hupensis snail infection.
Figure 2.
Figure 2.
Funnel plot shows asymmetry for the studies included in this analysis. (A) the funnel plot of the studies reporting the effectiveness of the conventional strategy on the control of human Schistosoma japonicum infection; (B) the funnel plot of the studies reporting the effectiveness of the conventional strategy on the control of Oncomelania hupensis snail infection; (C) the funnel plot of the studies reporting the effectiveness of the new strategy on the control of human Schistosoma japonicum infection; (D) the funnel plot of the studies reporting the effectiveness of the new strategy on the control of Oncomelania hupensis snail infection; (E) the funnel plot of the studies comparing the effectiveness between the new strategy and the conventional strategy on the control of human Schistosoma japonicum infection; (F) the funnel plot of the studies comparing the effectiveness between the new strategy and the conventional strategy on the control of Oncomelania hupensis snail infection.
Figure 3.
Figure 3.
Effectiveness of the conventional strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).
Figure 3.
Figure 3.
Effectiveness of the conventional strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).
Figure 4.
Figure 4.
Effectiveness of the new strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).
Figure 4.
Figure 4.
Effectiveness of the new strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).
Figure 5.
Figure 5.
Comparison of the conventional strategy versus the new strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).
Figure 5.
Figure 5.
Comparison of the conventional strategy versus the new strategy on the control of human Schistosoma japonicum infection (A) and Oncomelania hupensis snail infection (B).

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