Table 4.
Advantages, limitations, and cost–benefit analysis of current diagnostic measures of UGS in the field setting.
| Diagnosis | Advantages | Limitations | Cost–Benefit Analysis |
|---|---|---|---|
| Urine microscopy | Standard method Familiar in most endemic areas High specificity (96.6–100%) |
Low sensitivity (25.9–46.4%) Very low sensitivity in ultra-light infections (<10%) |
Good Cheap cost Feasible |
| CCA/CAA | High sensitivity (89%) and moderate specificity (55%) for intestinal schistosomiasis Good for field surveys in areas with ultra-light infection |
Reliable for S. mansoni infections Not acceptable for diagnosis of UGS Cross reactions with other types of schistosomiasis Limited supply of the kit |
Moderate Moderate cost Most feasible in the field setting for IS |
| Urine reagent strips for microhematuria | High sensitivity (71–79%) High specificity (84–90%) Easy to implement |
Not standard, supplementary to UM | Good Cheap cost Most feasible in the field setting for UGS |
| Gross screening of macrohematuria | Cheap Easy High specificity Reflects acute infections |
Low sensitivity (<10%) with numerous false-negative cases | Most cheap |
| Serology (ELISA) | High sensitivity (87–96%) Optimal in non-endemic areas |
Low specificity (31–32%) Not practical in the endemic field setting in SSA |
Moderate Moderate cost Lab facilities required |
| Molecular diagnosis (PCR, qPCR, and LAMP) | High sensitivity (>90%) High specificity (>95%) Optimal for setting gold standard Expensive reagents and high technique |
Well-established lab support, not practical in the field setting Feasible for small-scale surveys |
Poor Expensive method and feasible only in lab |
| Ultrasound | High sensitivity (>80%) High specificity (>80%) Morbidity information of UGS on site Detection of other co-morbidities |
Experienced sonographer Expensive sonograph Feasible for small-scale surveys |
Poor Expensive method Feasible with a portable sonograph |
UGS = urogenital schistosomiasis, CCA = circulating cathodic antigen, CAA = circulating anodic antigen, UM = urine microscopy, ELISA = enzyme-linked immunosorbent assay, PCR = polymerase chain reaction, qPCR = quantitative polymerase chain reaction, LAMP = loop-mediated isothermal amplification.