Schistosomiasis with a Focus on Africa
Abstract
:1. Introduction
2. Pathogenesis
2.1. Life Cycle of Schistosoma sp.
2.2. Clinical Presentation of Schistosomiasis in Africa
2.2.1. Female Genital Schistosomiasis
2.2.2. Primary and Secondary Infertility in S. haematobium Infections
2.2.3. Male Genital Schistosomiasis
2.2.4. Bladder Cancer in S. haematobium Infections
2.3. Treatment and Control
2.4. Diagnosis
Environmental Monitoring
3. A Brief History of Schistosomiasis in Africa
3.1. Current Status of Schistosomiasis in Africa
Country | Method | Species | Prevalence % (n/tn) | Ss/sp (%) | Study Type | Age (years) | Intensity of Infection (%) | Study Year | Study Published | Ref | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Light | Mode rate | High | ||||||||||
Angola | Urine microscopy | S. haematobium | 61.18 (785/1283) | - | Cross-sectional survey | 9–10 | - | - | - | 2013–2014 | 2015 | [190] |
Urine dipstick | S. haematobium | 65.8 (844/1283) | 96/61 | - | - | - | ||||||
Haematuria | S. haematobium | 17.1 (219/1283) | 27.1/97.5 | - | - | - | ||||||
LAMP | S. haematobium | 73.8 (127/172) | - | Evaluation | 5–14 | - | - | - | 2015 | 2018 | [191] | |
Benin | KK | S. mansoni | 2.45 (472/19250) | - | Surveillance | 8–14 | 59.32 | 25.42 | 15.25 | 2013–2015 | 2019 | [192] |
Urine microscopy | S. haematobium | 17.60 (3388/19250) | - | 73.99 | - | 20.01 | ||||||
Burkina Faso | KK | S. mansoni | 5.38 (43/800) | - | Prevalence | 7–11 | - | - | - | 2013 | 2016 | [193] |
Urine microscopy | S. haematobium | 8.76 (287/3514) | - | - | - | 2.7 | ||||||
Cameroon | KK | S. mansoni | 61 (381/625) | - | Evaluation | 7–15 | - | - | - | 2010–2011 | 2012 | [110] |
Urine-CCA | S. mansoni | 66.6 (416/625) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 4.6 (29/625) | - | - | - | - | ||||||
Dipstick | S. haematobium | 9.8 (61/625) | - | - | - | - | ||||||
Chad | Urine microscopy | S. haematobium | 24.9 (467/1875) | - | Prevalence | 1–14 | - | - | - | 2015–2016 | 2019 | [194] |
Côte d’Ivoire | Urine microscopy | S. haematobium | 14 (166/1187) | - | Cross-sectional survey | 5–14 | - | - | - | 2018 | 2019 | [195] |
KK | S. mansoni | 6.1 (66/1089) | - | - | - | - | ||||||
CCA | S. mansoni | 73.8 (104/141) | - | Cross-sectional survey | 8–12 | - | - | - | 2010 | 2011 | [109] | |
Dipstick | S. haematobium | 4.1 (6/146) | - | - | - | - | ||||||
Democratic Republic of the Congo | KK | S. mansoni | 82.7 (277/335) | - | Epidemiology/parasitology | 8–16 | 43.2 | 32 | 24.7 | 2011 | 2014 | [196] |
KK | S. mansoni | 8.9 (47/526) | - | Cross-sectional survey | 7–13 | 8.8 | - | - | 2016 | 2017 | [197] | |
Urine microscopy | S. haematobium | 0 (0/526) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 17.4 (64/367) | - | Cross-sectional survey | >18 | - | - | 6.3 | 2016–2017 | 2019 | [198] | |
KK | S. mansoni | 89.3 (176/197) | - | Cross-sectional survey | 11–14 | 11.7 | 22.3 | 55.3 | 2011 | 2018 | [199] | |
KK | S. mansoni | 57.8 (231/400) | - | Cross-sectional survey | 9–14 | 18.6 | 28.6 | 52.8 | 2010 | 2016 | [200] | |
KK | S. intercalatum | 48 (24/50) | - | Prevalence | 9–15 | 50 | 20.8 | 29.2 | 2017 | [201] | ||
KK | S. intercalatum | 3.6 (6/167) | - | Epidemiological/parasitological survey | 8–18 | - | - | - | 1994 | 1997 | [202] | |
Egypt | KK | S. mansoni | 35.8 (355/993) | - | Cross-sectional survey | - | - | - | - | 1994–1996 | 2020 | [203] |
KK | S. mansoni | 1.8 (2/110) | - | Prevalence | 6–15 | - | - | - | - | 2016 | [204] | |
Formol-ether | S. mansoni | 0.9 (1/110) | - | - | - | - | - | |||||
CCA | S. mansoni | 11.4 (4/110) | - | - | - | - | - | |||||
Equitorial Guinea | KK | S. intercalatum | 31.9 (114/357) | - | Evaluation | 15–24 * | - | - | 4.7 | 1988 | 1991 | [205] |
KK | S. intercalatum | 9.6 (27/281) | - | - | - | 0.7 | 1989 | |||||
KK | S. intercalatum | 6.6 (23/345) | - | - | - | 0.2 | 1990 | |||||
KK | S. intercalatum | 13 (39/305) | - | Cross-sectional survey | 0–24 | - | - | 9 | 1990 | 1993 | [206] | |
Ethiopia | KK | S. mansoni | 42.9 (136/317) | - | Cross-sectional survey | 6–15 | 20.5 | 10.7 | 11.7 | 2017 | 2019 | [207] |
KK | S. mansoni | 76.3 (293/384) | - | 5–19 | 21.6 | 29.4 | 25.5 | 2013 | 2014 | [208] | ||
KK | S. mansoni | 24 (120/500) | - | 6–18 | 70 | 30 | 20 | 2014 | 2016 | [209] | ||
KK | S. mansoni | 58.6 (295/503) | - | 5–19 | 34.2 | 35.5 | 30 | 2015 | 2017 | [210] | ||
Gabon | Urine microscopy | S. haematobium | 77.7 (66/85) | - | Evaluation | 6–39 | - | - | 34.8 | - | 2014 | [211] |
qPCR | S. haematobium | 98.5 (65/66) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 39.9 (103/258) | - | Longitudinal | 6–30 | - | - | - | 2016–2018 | 2019 | [212] | |
Gambia | POC-CCA | S. haematobium | 23.3 (456/1954) | 47.98/79.44 | Prevalence | 7–14 | - | - | - | 2015 | 2017 | [213] |
Dipstick | S. haematobium | 17.1 (334/1954) | 47.01/81.54 | - | - | - | ||||||
Urine microscopy | S. haematobium | 10.1 (198/1954) | - | - | - | 2.7 | ||||||
KK | S. mansoni | 0.3 (5/1954) | 60/76.76 | - | - | 0 | ||||||
Ghana | qPCR | S. haematobium | 48.5 (79/163) | 100/59.2 | Prevalence | 2020 | [214] | |||||
S. mansoni | 28.7 (94/328) | - | Epidemiology/Prevalence | 7–17 | 50 | 35.1 | 11.7 | 2017 | ||||
S. mansoni | 70.1 (54/77) | - | Longitudinal | 0–4 | - | - | - | 2018 | 2020 | [215] | ||
7.9 (9/108) | ||||||||||||
13.7 (13/96) | ||||||||||||
S. mansoni | 80.1 (153/191) | - | 5–16 | - | - | - | ||||||
39.9 (89/224) | ||||||||||||
35.9 (86/240) | ||||||||||||
S. mansoni | 79.1 (200/253) | - | >17 | - | - | - | ||||||
32.1 (107/332) | ||||||||||||
34.8 (100/286) | ||||||||||||
Urine microscopy | S. haematobium | 5.2 (4/76) | - | 0–4 | - | - | - | |||||
0 (0/105) | ||||||||||||
13.2 (11/87) | ||||||||||||
S. haematobium | 23.8 (59/249) | - | 5–16 | - | - | - | ||||||
5.8 (14/236) | ||||||||||||
27.6 (63/230) | ||||||||||||
S. haematobium | 10.3 (32/308) | - | >17 | - | - | - | ||||||
2.9 (10/346) | ||||||||||||
15.1 (41/272) | ||||||||||||
Guinea | KK | S. mansoni | 66.2 (278/420) | - | Cross-sectional survey | 9–14 | 8.8 | 24 | 33.3 | - | 2011 | [216] |
Urine microscopy | S. haematobium | 21.0 (88/420) | - | 12.1 | - | 8.8 | ||||||
Guinea-Bissau | Urine microscopy | S. haematobium | 20 (18/90) | - | Prevalence | 6–15 | - | - | - | 2011 | 2016 | [217] |
Haematuria | S. haematobium | 61.1 (11/18) | - | |||||||||
Kenya | Urine microscopy | S. haematobium | 83.3 (95/114) | - | Evaluation | 6–15 | - | - | - | 1996–2010 | 2014 | [218] |
Hematuria | S. haematobium | 86.0 (98/114) | - | - | - | - | ||||||
cSEA-ELISA | S. haematobium | 79.8 (91/114) | - | - | - | - | ||||||
PCR | S. haematobium | 100 (114/114) | - | - | - | - | ||||||
KK | S. mansoni | 93.9 (1731/1844) | - | Evaluation | 8–12 | 10.2 | 46.9 | 42.9 | 2015 | [219] | ||
KK | S. mansoni | 60.5 (2458/4064) | - | Prevalence | 5–19 | 49 | 35.8 | 15.2 | 2012 | 2012 | [220] | |
Liberia | KK | S. mansoni | 87 (333/384) | - | Prevalence | 1–>40 | 25.3 | 29.2 | 31.8 | 1980 | 1985 | [221] |
Urine microscopy | S. haematobium | 42 (177/423) | - | |||||||||
KK | S. mansoni | 78 (276/353) | - | Prevalence | - | - | - | - | - | 2018 | [222] | |
Madagascar | Urine microscopy | S. haematobium | 100 (79/79) | 100/100 | Prevalence | 15–33 | - | - | - | 2010 | 2020 | [223] |
qPCR | 81 (64/79) | - | - | - | - | |||||||
KK | S. mansoni | 5 (97/1934) | - | Baseline sentinel study | 7–10 | - | - | 0.9 | 2015 | 2016 | [224] | |
Urine microscopy | S. haematobium | 30.5 (594/1946) | - | - | - | 15.1 | ||||||
KK | S. mansoni | 73.6 (215/292) | - | Prevalence | 5–14 | 36.7 | 31.2 | 32.1 | 2015 | 2017 | [225] | |
Malawi | Urine microscopy | S. haematobium | 13 (18/143) | - | Cross-sectional survey | 0.6–6 | 58 | 33 | 9 | 2012 | 2016 | [226] |
Urine microscopy | S. haematobium | 12.5 (50/400) | Prevalence | 7–12 | 8.25 | 1.75 | 2.5 | 2012 | 2017 | [227] | ||
Mali | Urine microscopy | S. haematobium | 51.2 (173/338) | - | Prevalence | 1–4 | 35.5 | - | 15.7 | 2011 | [228] | |
Urine microscopy | S. haematobium | 88 (570/648) | - | Cross-sectional | 7–14 | - | - | 48.8 | 2004 | 2012 | [229] | |
KK | S. mansoni | 17.3 (112/648) | - | - | - | 15.6 | ||||||
KK | S. mansoni | 12.7 (81/640) | - | - | - | 9.4 | 2010 | 2012 | ||||
Urine microscopy | S. haematobium | 61.7 (395/640) | - | - | - | 13.8 | ||||||
Mauritania | Urine microscopy | S. haematobium | 4 (86/2162) | - | Cross-sectional survey | - | - | - | - | 2014–2015 | 2017 | [230] |
KK | S. mansoni | 7.1 (92/1297) | - | Epidemiological survey | 5–12 | - | - | - | - | 1997 | [231] | |
Urine microscopy | S. haematobium | 15.6 (48/307) | - | Prevalence | 7–17 | - | - | - | - | 2019 | [232] | |
Mozambique | Urine microscopy | S. haematobium | 60.4 (11492/19039) | - | Cross-sectional survey | 5–55 | - | - | 17.7 | - | 2018 | [233] |
Urine microscopy | S. haematobium | 59.1 (600/1015) | - | Cross-sectional survey | 5–12 | - | - | - | 2005–2007 | 2014 | [234] | |
Urine microscopy | S. haematobium | 47 (39166/83331) | - | Prevalence | 7–22 | - | - | 17.9 | - | 2009 | [235] | |
KK | S. mansoni | 8.7 (7250/83331) | - | - | - | - | ||||||
Namibia | KK | S. mansoni | 4.4 (913/17896) | - | Mapping | 3–19 | - | - | - | - | 2015 | [236] |
Dipstick | S. haematobium | 5.0 (895/17896) | - | - | - | - | ||||||
CCA | S. mansoni | 4.4 (787/17896) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 5.1 (913/17896) | - | - | - | - | ||||||
Niger | Hematuria | S. haematobium | 58.4 (52/89) | - | Evaluation | 10–15 | - | - | - | - | 2011 | [237] |
Urine microscopy | S. haematobium | 49.4 (44/89) | - | - | - | - | ||||||
PCR | S. haematobium | 57.3 (51/89) | 100/86 | - | - | - | ||||||
Nigeria | Urine microscopy | S. haematobium | 21.3% (26/122) | - | Comparative | 31–55 | - | - | - | - | 2018 | [238] |
Urine microscopy | S. mansoni | 8.9 (49/551) | - | Cross-sectional survey | 1–90 | 80.8 | 15.4 | 3.8 | 2013 | 2016 | [237] | |
Urine microscopy | S. haematobium | 8.3 (46/551) | - | Cross-sectional survey | 69.4 | 0 | 30.6 | |||||
Urine microscopy | S. intercalatum | 5.7 (98/1709) | - | Malacological survey | 5–15 | - | - | - | 1987 | 1989 | [184] | |
Urine microscopy | S. haematobium | 44.1 (64/145) | - | Cross-sectional survey | 5–59 | 2 | 26 | 11 | 2017 | 2019 | [239] | |
Urine microscopy | S. haematobium | 22.7 (163/718) | - | Cross-sectional survey | 10–23 | 89.57 | - | 10.43 | 2015 | 2016 | [187] | |
Urine microscopy | S. haematobium | 50.0 (220/443) | - | Cross-sectional survey | 5–14 | 39.5 | 7 | 4.5 | 2003 | 2008 | [240] | |
Urine microscopy | S. haematobium | 14.5 (55/380) | - | Cross-sectional survey | 5–14 | 11.3 | 1.8 | 1.3 | 2011 | 2017 | [241] | |
Rwanda | KK | S. mansoni | 2.7 (82/3052) | - | Cross-sectional survey | - | - | - | - | 2007 | 2008 | [242] |
São Tomé and Príncipe | KK | S. intercalatum | 11 (332/3030) | - | Cross-sectional survey | 5–15 | 54 | 38 | 8 | 1991 | 1994 | [44] |
Senegal | KK | S. mansoni | 80 (70/88) | - | Evaluation | 2–83 | 54.55 | 15.9 | 9.1 | 2006 | 2008 | [243] |
Urine microscopy | S. haematobium | 72 (63/88) | - | 50 | - | 21.6 | ||||||
qPCR | S. mansoni | 73 (64/88) | - | - | - | - | ||||||
qPCR | S. haematobium | 55 (48/88) | - | - | - | - | ||||||
South Africa | Urine microscopy | S. haematobium | 19.8 (78/394) | - | Prevalence | 16–23 | - | - | - | 2010–2012 | 2020 | [223] |
qPCR | 23.1 (91/394) | - | - | - | - | |||||||
Urine microscopy | S. haematobium | 1.0 (11/1143) | - | Cross-sectional survey | 1–5 | - | - | - | 2018 | 2019 | [244] | |
KK | S. mansoni | 0.9 (9/998) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 40.2 (169/380) | - | Prevalence | 10–15 | 61 | - | - | 2014 | 2018 | [245] | |
Urine microscopy | S. haematobium | 31.8% (225/708) | - | Cross-sectional survey | 10–12 | - | - | 26.7 | 2009–2010 | 2014 | [246] | |
qPCR | S. haematobium | 25.4 (180/708) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 37.5 (120/320) | - | Prevalence | 10–15 | - | - | - | 2015 | 2017 | [247] | |
Sudan | KK | S. mansoni | 36 (1020/2832) | - | Cross-sectional | 10–24 | - | - | - | - | 1993 | [248] |
Urine microscopy | S. haematobium | 38.9 (58/149) | - | Comparative | 5- >20 | - | - | 2 | 2011–2013 | 2018 | [249] | |
ELISA | S. haematobium | 81.2 (119/149) | - | - | - | - | ||||||
Swaziland | Urine microscopy | S. haematobium | 5.3 (21/395) | - | Prevalence | 6–12 | - | - | - | 2010 | 2011 | [250] |
Urine microscopy | S. haematobium | 6.1 (18/295) | - | <5- >19 | - | - | - | - | 2010 | [251] | ||
Tanzania | KK | S. mansoni | 85.2 (253/297) | 89.7/72.8 | Cross-sectional survey | 7–16 | 30.6 | 39.1 | 15.5 | 2015 | 2018 | [252] |
qPCR | 92.9 (276/297) | 98.7/81.2 | - | - | - | |||||||
POC_CCA | 94.9 (282/297) | 99.5/63.4 | - | - | - | |||||||
KK | S. mansoni | 68.9 (641/930) | - | Cross-sectional survey | 1–95 | 55.2 | 20.4 | 12.9 | 2016 | 2019 | [253] | |
POC_CCA | S. mansoni | 94.5 (878/929) | - | - | - | - | ||||||
KK | S. mansoni | 90.6 (752/830) | - | Cross-sectional survey | 5–19 | 24.1 | 38.4 | 28.1 | 2017 | 2020 | [254] | |
KK | S. mansoni | 15.1 (898/5952) | - | Cross-sectional survey | 7–16 | - | - | - | - | 2015 | [255] | |
Urine microscopy | S. haematobium | 8.9 (519/5952) | - | - | - | - | - | |||||
KK | S. mansoni | 84.01 (431/513) | - | Cross-sectional survey | 6–16 | 34.11 | 39.91 | 25.99 | - | 2016 | [256] | |
Urine microscopy | S. haematobium | 11.6 (13/112) | - | Prevalence | - | - | - | 2009–2010 | 2020 | [223] | ||
qPCR | S. haematobium | 19.6 (22/112) | - | - | - | - | - | |||||
KK | S. mansoni | 1.3 (4/310) | - | - | - | - | - | |||||
Uganda | Urine-CCA Dipstick | S. mansoni | 56.7 (146/258) | 99.1/89.3 | Surveillance | 5–10 | - | - | - | - | 2018 | [257] |
SEA ELISA | S. mansoni | 75.1 (193/258) | 97.7/49.5 | - | - | - | - | |||||
KK | S. mansoni | 39.3 (1203/3058) | - | Prevalence | 1–5 | 60.7 | 21.8 | 17.5 | 2012–2013 | 2015 | [258] | |
KK | S. mansoni | 40.8 (1850/4534) | - | Prevalence | 10–14 | - | - | - | 2009–2010 | 2011 | [259] | |
KK | S. mansoni | 27.2 (352/1295) | - | Prevalence | 0.4–6.5 | 18.7 | 6 | 2.5 | 2009 | 2010 | [260] | |
ELISA | S. mansoni | 66 (38/58) | - | - | - | - | ||||||
KK | S. mansoni | 47.6 (342/719) | - | 15–70 | 29.2 | 12.7 | 5.7 | |||||
ELISA | S. mansoni | 41.0 (34/83) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 2.51 (24/955) | - | 5–17 | - | - | - | 2007–2011 | 2018 | [261] | ||
Zambia | Urine microscopy | S. haematobium | 61 (90/147) | - | Evaluation | 7–14 | 26 | - | 19 | - | 2020 | [262] |
KK | S. mansoni | 0.01 (2/147) | - | - | - | - | ||||||
DDIA | S. haematobium | 51 (75/146) | 60/61 | - | - | - | ||||||
IHA | 56 (82/146) | 74/72 | - | - | - | |||||||
Urine microscopy | S. haematobium | 20.7 (328/1583) | - | Prevalence | 5–17 | - | - | - | 2007 | 2010 | [263] | |
Urine microscopy | S. haematobium | 28.6 (279/975) | - | Prevalence | 9–16 | 84.9 | - | 15.1 | (2007–2015) | 2018 | [264] | |
Urine microscopy | S. haematobium | 31.5 (494/1570) | - | Prevalence | 9–15 | 75.5 | - | 24.3 | 2011–2015 | |||
KK | S. mansoni | 42.4 (304/719) | - | Cross-sectional survey | 7–50 | 61.2 | 26 | 12.8 | - | 2014 | [265] | |
Zimbabwe | KK | S. mansoni | 11.0 (10/91) | - | Comparative | 1–12 | 2.1 | 8.8 | - | 2012 | 2014 | [266] |
Urine microscopy | S. haematobium | 52.8 (48/91) | - | 41.8 | - | 11 | ||||||
SmCTF-RDT | Schistosoma spp | 83.5 (76/91) | - | - | - | - | ||||||
Urine microscopy | S. haematobium | 18.0 (2347/13037) | - | Cross-sectional survey | 10–15 | 12.4 | - | 5.6 | 2010–2011 | 2014 | [267] | |
KK | S. mansoni | 7.2 (882/12249) | - | 3.6 | 1.4 | 0.3 | ||||||
Urine microscopy | S. haematobium | 18.7 (61/325) | - | Cross-sectional survey | 17–49 | 93.4 | - | 6.6 | 2016–2017 | 2019 | [268] | |
Urine microscopy | S. haematobium | 13.3 (71/535) | - | <5 | 93 | - | 7 |
3.2. Stigmatisation Associated with Schistosomiasis, Particularly in Women Is still a Crucial Issue in Africa
3.3. Hybrid Schistosomes
3.4. Control Measures in addition to MDA Utilised in Africa
3.4.1. Mapping Studies and Snail Control
3.4.2. Education and Knowledge
4. Factors That Determine the Distribution of Schistosomiasis in Africa
4.1. Climate Change
4.2. Artificial (Man-Made) Activities
4.3. Human Migration
5. COVID-19
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Species | Intermediate Host | Definitive Hosts | Site of Infection | Geographical Distribution | References | |
---|---|---|---|---|---|---|
Intestinal schistosomiasis | S. mansoni | Biomphalari spp. | Humans, rodents | Intestinal mesenteric veins | Sub-Saharan Africa, Madagascar, the Middle East, the Caribbean, South America | [1,10] |
S. intercalatum and S. guineensis | Bulinus spp. | Humans, non-human primates (excluding apes) | Intestinal mesenteric veins | Central Africa, West Africa, Madagascar | [1,10,11] | |
Urogenital schistosomiasis | S. haematobium | Bulinus spp. | Humans, non-human primates (excluding apes) | Urogenital veins | Sub-Saharan Africa, the Middle East, Corsica (France) | [1,10] |
Animal intestinal schistosomiasis | S. mattheei | Bulinus spp. | Cattle, sheep, goats | Intestinal mesenteric veins | Southeastern and Central Africa | [12,13,14,15] |
S. curassoni | Bulinus spp. | Cattle, sheep, goats | Intestinal mesenteric veins | West Africa | [12,13,14,15] | |
S. bovis | Bulinus spp. | Cattle, goats, sheep, horses, camels, pigs | Intestinal mesenteric veins | North, East, West and Central Africa, the Middle East and Mediterranean (Europe) region | [12,13,14,15] |
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Aula, O.P.; McManus, D.P.; Jones, M.K.; Gordon, C.A. Schistosomiasis with a Focus on Africa. Trop. Med. Infect. Dis. 2021, 6, 109. https://doi.org/10.3390/tropicalmed6030109
Aula OP, McManus DP, Jones MK, Gordon CA. Schistosomiasis with a Focus on Africa. Tropical Medicine and Infectious Disease. 2021; 6(3):109. https://doi.org/10.3390/tropicalmed6030109
Chicago/Turabian StyleAula, Oyime Poise, Donald P. McManus, Malcolm K. Jones, and Catherine A. Gordon. 2021. "Schistosomiasis with a Focus on Africa" Tropical Medicine and Infectious Disease 6, no. 3: 109. https://doi.org/10.3390/tropicalmed6030109
APA StyleAula, O. P., McManus, D. P., Jones, M. K., & Gordon, C. A. (2021). Schistosomiasis with a Focus on Africa. Tropical Medicine and Infectious Disease, 6(3), 109. https://doi.org/10.3390/tropicalmed6030109