Critique paper on “The Effect of Snail Control on the Prevalence

of Schistosoma japonicum Infection in the Philippines”

Alexandra Baldoza, Sam Cabidog, Paul Dalomias

I. Introduction
Schistosomiasis, also known as snail fever or bilharzia, is a chronic disease transmitted
through the flatworms of the genus Schistosoma and carried by a plethora of freshwater
snails species.[7] It is estimated that 251.4 million people worldwide required preventive
treatment for schistosomiasis in 2021, out of which only 75.3 million people were reported
to have been treated.[7] In the Philippines, schistosomiasis is currently endemic in the
provinces of Mindoro Oriental, Sorsogon, the islands of Samar, Leyte and Bohol, and the
entirety of Mindanao barring the Misamis Oriental, Davao Oriental, and Maguindanao[6]. It is
is considered to be among ten neglected tropical diseases (NTD) associated with drastic
health, social, and economic consequences within the country and one of six NTD’s
considered to be of public health importance.[3][4] Internationally, preventative treatment of
schistosomiasis achieves disease transmission reduction through a regular, population-wide
distribution of praziquantel, an oral medication however, snail control, or the act of
inhibiting populations of the intermediate host Oncomelania quadrasi, remains a popular
option, enjoying sporadic use in the Philippines.[1][2] In order to properly administer snail
control, the managers of the program must be adequately knowledgeable about the local
snail genera.[2] The paper to be critiqued is a 1961 paper that sought to fill a previously
unaccounted for information gap by looking into the effectiveness of snail control in
addressing schistosomiasis transmission in Palo, Leyte, as part of a series of research papers
that sought to gauge the effectiveness of the practice when it was at its most popular from
the 1950’s to the 1970’s.[2][5]

II. Summary
Pesigan and Hairston on Effect of Snail Control on the Prevalence of Schistosoma
Japonicum Infection in the Philippines, specifically focused and undertook snail control in
the locality of Palo, Leyte, Philippines. They observed the effects of a conducted snail control
project from 1957 to 1958, where it was observed that 50% of the snails were eliminated by
July 1957 and up to 80% by July 1958. The researchers recorded data into different age
groups, divided into intervals of 5 with the youngest being 0 - 4, followed by 5 - 9, and 10 -
14 year olds. The higher age group being 15 - 19, 20 - 24, and 25 - 29 year olds. For the result
of the two data, the researchers used a chi-squared test to assess before and after the snail
control, the squared value for the data was 15.79 with 1 degree of freedom, and it indicates
that the observed difference between two proportions is highly significant reduction to
those individuals aged 15 and above years old. However, the disproportionate
representation in different age-groups may have led to a significant reduction in the disease
particularly among children aged below 10 years old while there is no significant reduction
among individuals aged 15 and above years old. To have better results the researchers
combined 0 - 14 year olds, because this is the age group which decline occurred in Palo
while data from the 15 - 29 year olds were no longer mentioned. Additionally, the study also
compared examinations of Schistosoma Japonicum in the neighboring municipality of
Tanauan; it served as a control area and demonstrated an insignificant rise in prevalence.
 III. Analysis of Strengths and Weaknesses

The paper demonstrated several weaknesses in its experimental set-up. First, the
strategies implemented for snail control failed to encompass specific inland areas that can
potentially compromise the overall efficacy of the intervention. Second, there was a lack of
control over the experiment area.

Furthermore, it was stated in the article that the comparison between the overall
percentages on age-prevalence of Schistosoma japonicum in the Palo survey is invalid due to
the significant over-representation of 5-9 year olds, and significant under-representation of
15-19 and 20-24 year olds in the 1959 survey. With the given limited number of positive
cases in both surveys, it was mentioned that the sample size affected the comparison of
participants under 30 years old in the two surveys. The researchers were able to compare
the youngest age-groups from two different periods but the treatment of data throughout
the research paper is inconsistent. It was claimed that in order to control for the possibility
of infection prior to the snail control it was better to record results from younger individuals
but not only did they continue to gather data from older age groups only to disregard them,
they also included an age group (5-9) in the final analysis that could have been infected prior
to the snail control program in the first place. The study stated that they included this age
group in order to account for the aforementioned overrepresentation and to equalize the
number of participants between the before and after samples. However, the 5-9 age group
was the source of the over-representation and there may not have been a need to equalize
sample sizes as the comparison was being made on a rate basis and not on total infection
numbers.

Finally, the use of the chi-squared test may not have been communicated properly.
Chi-squared tests work to check if the recorded results deviate from the expected results in
such a way that the researchers could claim that the change was not due to chance.
However the paper appears to not have given how the expected results were computed,
making it unclear as to whether or not the expected results were surmised from ongoing
infection trends or from the control set-up.

On the control set-up: there may be risks in placing the control so close to the
experimental set-up, when the researchers are unable to completely control the totality of
the area. Thus, the control results may have been affected by contamination from the
experimental set-up in the form of the migration of disease vectors or infected individuals.

All that being said, the paper excelled in several regards. The research study
employed an observational method for data gathering. Stool examinations were conducted
on age-stratified samples of the population before implementing snail control measures.
This approach was suitable for assessing the prevalence of Schistosoma japonicum, and
enabled the authors to collect necessary information on the presence of Schistosoma
japonicum in specific age groups within the community, given that they were not able to
exercise complete control over the extraneous variables in the area.
 Additionally, while the results of the survey in the adjacent municipality of Tanauan
may have run the risk of being contaminated from the experimental set-up, they
nevertheless strengthen the validity of the findings.

The data analysis in the article may present complexity: however, the authors
comprehensively address the intricacies and effectively articulate their argumen by
conducting an assessment of the proportional representation of each age group in the
survey. The comparison of prevalence rates between 1959 and 1954 proved that it is a valid
comparison as there is proportional representation of the two age-groups. The participants
ranged from 0-29 year olds, the researchers considered that this will allow them for the
assessment they need, for both younger individuals who may have been infected recently
and older individuals who may have been infected prior to the implementation of snail
control measures. As a result, though the data may have been overtreated in regards to the
objectives of the study - i.e. the data underwent too much manipulation when the goal was
to simply see if the snail control caused a drop in infection - the given analysis nevertheless
provided invaluable insight on the data and methodology of the researchers and could help
guide future studies on the topic and helped mitigate for areas outside of the researchers
control.

IV. Suggestions for Improvement

There are several things that may be improved in the research paper.

First, the research design. Research objectives are generally specific, measurable,
attainable, and time-bound in order for them to know what they are dealing with and how
they would conduct the experiment properly in order to get the results they need. Knowing
what they are dealing with will allow them to see that they also needed a change of
perspective and focus. This will let them know specifically what they need to accomplish in
conducting the research, which will enable them to get better control of their research. Thus
the researchers could've gotten better control on the variables had they focused on whether
snail population density has an effect on the presence of schistosomiasis.

Second is the experimental set-up. It would be better if the researchers chose more
inland zones for snail control since snails are more common inland rather than on urban and
coastal areas which the researchers focused on instead. In addition to that, the researchers
needed to have better account for the extraneous variables because stating that there are
“factors beyond the researcher’s control” many times will be hardly considered to be
experimental because the researcher's lack of control of the research will hamper the
reliability and replicability of the research. Plus, it will be better if the researchers chose
young participants instead, knowing that the research would be better if the individuals
recorded are young.

Third is the control set-up. Having Tanauan as the control set-up will have been
justified more by stating in what ways Tanauan is similar to Palo as a comparison area. Plus,
the researchers need to consider that the control set-up cannot be isolated from the
experimental set-up since they are too close with one another, it would have been better if
the researchers have chosen an another area as a control set-up that is isolated from the
experimental set-up in order to eliminate the possibility of the latter affecting the former or
they could have also used the same area as the experimental set-up, only in a different time
interval before and during the experiment.

V. Conclusion
Ultimately, the research paper’s lack of control over the experimental set-up may
lead to doubts regarding the reliability and actionability of the study performed. However,
the various data analyses could provide insight to any reader researching snail control and
snail control efficacy, as well as providing awareness on the possible problems one might
face in their research. The paper also serves well as a case study on extracting value from a
research. It can be surmised that outside of the objective of the paper the analysis provided
may give future researchers a guide on how to interpret their data in such a way as to
account for uncontrolled nuisance variables.

References

[1] Belizario, Jr., V. Y., de Cadiz, A. E., Navarro, R., Flores, M. J., Molina, V. B., Dalisay, S.
N., Medina, J. R., & Lumangaya, C. R. (2022). The status of schistosomiasis
japonica control in the Philippines: The need for an integrated approach to
address a multidimensional problem. International Journal of One Health,
8(1), 8-19. https://www.onehealthjournal.org/Vol.8/No.1/2.pdf

[2] King, C. H., & Bertsch, D. (2023, April 23). Historical perspective: Snail control to
prevent schistosomiasis. PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408102/

[3] Leonardo, L., Hernandez, L., Magturo, T. C., Palasi, W., Rubite, J. M., de Cadiz, A.,
Moendeg, K., Fornillos, R. J., Tabios, I. K., Mystica, M., & Fontanilla, I. K. (2019,
November 28). Current status of neglected tropical diseases (NTDs) in the
Philippines. PubMed. https://pubmed.ncbi.nlm.nih.gov/31786109/

[4] Neglected tropical diseases. (2021, July 27). World Health Organization (WHO).
Retrieved March 15, 2024, from
https://www.who.int/health-topics/neglected-tropical-diseases#tab=tab_1

[5] Pesigan, T. P., & Hairston, N. G. (1961). The effect of snail control on the
prevalence of Schistosoma japonicum infection in the Philippines. Bulletin of
the World Health Organization, 25(4-5), 479-82.
https://pubmed.ncbi.nlm.nih.gov/14485669/

[6] Santos, Jr., A. T. (n.d.). Prevalence and distribution of schistosomiasis in the

Philippines: A review. PubMed. https://pubmed.ncbi.nlm.nih.gov/1035982/

[7] Schistosomiasis. (2023, February 1). World Health Organization (WHO). Retrieved
March 15, 2024, from
https://www.who.int/news-room/fact-sheets/detail/schistosomiasis