Schistosomiasis infection among primary school students in a war zone, Southern Kordofan State, Sudan: a cross-sectional study

Assessment of the selected hematological profiles among malaria and Schistosoma mansoni co-infected patients, Northwest Ethiopia

Malaria and schistosomiasis are infectious diseases that cause hematological profiles abnormalities. Malaria and Schistosoma mansoni co-infection causes exacerbation of health consequences and co-morbidities. The aim of this study was to assess the selected hematological profiles among malaria and S. mansoni co-infected patients at Dembiya Selected Health Institutions. An institutional-based comparative cross-sectional study was conducted from March 30 to August 10, 2022. A total of 140 individuals were enrolled in the study using a convenient sampling technique. Wet mount and Kato Katz technique were conducted to detect S. mansoni in Stool sample. Blood films were prepared for the detection of plasmodium. The data was coded and entered into EpiData version 3.1 before being analyzed with SPSS version 25. A P-value of less than 0.05 was considered statistically significant. Mean of WBC, neutrophil, lymphocyte, eosinophil, RBC, hemoglobin, and hematocrit [4.IU/L,2.2 IU/L, 1.4 IU/L, 0.1 IU/L, 3.13 IU/L, 9.5 g/dL, and 28.7%, resepectively] in co-infected were significantly lower than [7.5 IU/L, 4.6 IU/L, 2.1 IU/L, 0.38 IU/L, 4.8 IU/L, 14.6 g/dL, and 43.7%, resepectively] in the healthy control participants. Mean of RBC, hemoglobin, and hematocrit [3.13 IU/L, 9.5 g/dL, 28.7%, resepectively] in co-infected were significantly lower compared to [3.8 IU/L, 11.5 g/dL, 33.9%, resepectively] in the malaria monoinfected participants and [3.7 IU/L,11.5 g/dL, 33.6%, resepectively] in the S. mansoni monoinfected participants. The result of hematological profiles in healthy participants had no significant difference compared to light,moderate and heavy S. mansoni infection intensity in coinfection. The number of S. mansoni eggs per gram of stool had been negatively correlated with hematological profiles of co-infected participants except lymphocyte and monocyte which correlated positively. Hematological profiles status in coinfection were significantly altered compared to malaria monoinfection, S. mansoni monoinfection, and healthy participants.Therefore, hematological tests should be used to monitor and manage coinfection related complications, and to reduce coinfection associated morbidity and mortality.

Urogenital schistosomiasis prevalence and diagnostic performance of urine filtration and urinalysis reagent strip in schoolchildren, Ethiopia

Background

Urogenital schistosomiasis has been known to be endemic in several lowland areas of Ethiopia. It is caused by Schistosoma haematobium and causes considerable public health problems to schoolchildren. Ethiopia, after mapping the distribution of the disease (2013 to 2015), launched school-based mass deworming program to treat schoolchildren for schistosomiasis and soil-transmitted helminthiasis (STH) across the country since 2015. However, there is no recent information about the prevalence of the disease among schoolchildren in the current study areas. Diagnostic performance of urine filtration method and urinalysis reagent strip is also lacking. Therefore, this study aimed to determine the prevalence of urogenital schistosomiasis in schoolchildren, and to evaluate diagnostic performance of urine filtration and urinalysis reagent strip in Amibara, Kurmuk and Abobo districts, Ethiopia.

Methods

Across-sectional study was conducted involving 1,171 schoolchildren in Abobo, Amibara and Kurmuk districts from October, 2020 to January, 2021. The study participants were selected using random sampling technique. From each study participant, 10 ml urine samples were collected and examined using urine filtration method and urinalysis reagent strip. Data obtained from the survey were entered into Microsoft Excel 2010 and analysed with SPSS version 20.0. Data was summarized using descriptive statistics. Chi-square, bivariate and multivariable logistic regression and Pearson correlation test were used to measure associations between urogenital schistosomiasis, age, sex and haematuria. Odds ratio was used to measure strengths of association between variables. Agreement between urine filtration method and urinalysis reagent strip was determined using Kappa statistics. P-value < 0.05 at 95% CI was considered as statistically significant.

Results

Among the 1,171 urine samples from schoolchildren examined by urine filtration method, 143 (12.2%) were S.haematobium egg positive. Out of 143 positive children 126(88.1%) were lightly infected and 17 (11.9%) were heavily infected. Among the total of 1,171 urine samples tested by dipstick, 264(22.5%) were positive for haematuria. Prevalence of urogenital schistosomiasis by both urine filtration and urinalysis reagent strip method was higher in Abobo than Hassoba (Amibara) and Kurmuk (P< 0.001). The number of egg counts (intensity of infections) were significantly correlated with intensity of haematuria (r = 0.6, P < 0.001). Egg-positive children had significantly higher risk of having haematuria compared to S. haematobium egg negative children (OR; 6.96; 95%CI: 4.98, 8.940). Compared to urine filtration method, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of urinalysis reagent strip were 99.3%, 88.1%, 53.8% and 99.8%, respectively. Furthermore, its positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 8.34 and 0.008, respectively. The accuracy index and diagnostic odds ratio (DOR) of reagent strip were 0.89 and 1054, respectively. The agreement level between urine filtration methods and urinalysis reagent strip for detecting urogenital schistosomiasis was substantial (Kappa = 0.64).

Conclusion

This study showed that urogenital schistosomiasis was prevalent in schoolchildren in Abobo, Hassoba and Kurmuk districts. Urogenital schistosomiasis prevalence in Hassoba-bure and Kurmuk falls under low category whereas moderate in Abobo and is almost four times compared to Kurmuk and Hassoba-bure. Chemotherapy is needed in schoolchildren in such endemic areas and other measures like access to safe water, improved sanitation, hygiene, and health education should be implemented to control and prevent schistosomiasis effectively. The sensitivity, specificity, positive and negative predictive values of urinalysis reagent strip were higher and could serve as alternative for mass screening of urogenital schistosomiasis, for surveillance and evaluation of schistosomiasis intervention programs.

Comparison of the Change in the Prevalence and Intensity of Schistosoma haematobium Infection Between High and Low Prevalence Areas of White Nile State, Sudan

This study aimed to investigate whether mass drug administration (MDA) intervention has an equivalent effect on reducing the prevalence and intensity of Schistosoma haematobium infection regardless of the baseline values. A repeated cross-sectional survey was performed targeting students of 12 primary schools in Al Jabalain and El Salam districts of White Nile State, Sudan, at both 1 week before and 8 months after the MDA. Prior to the baseline survey, school-aged children in Al Jabalain had received MDA interventions twice in 4 years, while those in El Salam had not. The baseline prevalence was 9.1% in Al Jabalain and 35.2% in El Salam, which were reduced to 1.8% and 5.5% at 8 months after the MDA, respectively. The corresponding reduction rates were 80.3% and 84.4%, not significant difference between both districts. However, changes in the geometric mean intensity (GMI) of egg counts were significantly different between both districts. The baseline GMIs were 14.5 eggs per 10 ml of urine (EP10) in Al Jabalain and 18.5 EP10 in El Salam, which were reduced to 7.1 and 11.2 EP10 after treatment, respectively. The corresponding reduction rates were 51.0% and 39.5%. In conclusion, MDA interventions were found to bring about similar relative reduction in prevalence regardless of the baseline value; however, the relative reduction in infection intensity was more salient in the district with a low baseline value for both prevalence and intensity. This clearly points to the importance of repeated MDA interventions in endemic areas, which will eventually contribute to schistosomiasis elimination.

Epidemiological findings and policy implications from the nationwide schistosomiasis and intestinal helminthiasis survey in Sudan

BACKGROUND

The World Health Assembly endorsed the WHO Neglected Tropical Disease (NTD) Roadmap in 2013, in which NTDs were suggested as tracers of equity in the assessment of progress towards the Sustainable Development Goals. Nationwide surveys were undertaken in all 18 states of Sudan to identify the geographical distribution and to estimate the prevalence and intensity of schistosomiasis and other intestinal helminthiases from December 2016 to March 2017.

METHODS

We used two-stage random sampling. Each district was subdivided into one to three different ecological zones (EZs) based on proximity to water bodies. Probability-proportional-to-size sampling was used to select schools from each EZ. We estimated schistosomiasis and intestinal helminthiasis prevalence by the centrifugation method and Kato-Katz smears. Multi-level mixed-effect models were used to investigate the relationship between the prevalence of infections and risk factors, including improved water or latrine status at the household or school level. We estimated the cost-effectiveness of a one-time mass drug administration (MDA) intervention with 75% coverage at the district and EZ levels.

RESULTS

A total of 105,167 students from 1772 schools were surveyed. The overall egg-positive rates were: Schistosoma haematobium, 5.2%; S. mansoni, 0.06%; and intestinal helminths, 5.47%. Severe endemic areas were concentrated in East and South Darfur States. Children living in a house or attending schools with an improved latrine were less likely to be infected with schistosomiasis than those without a latrine (adjusted odds ratio, aOR: 0.45, 95% confidence interval, CI: 0.41-0.51 and aOR: 0.75, 95% CI: 0.70-0.81 at the household or the school levels, respectively). Open defecation was strongly associated with schistosomiasis (aOR: 1.50, 95% CI: 1.35-1.66). In community-wide mass treatment at the district level with an 8% threshold for schistosomiasis, 2.2 million people would not benefit from MDA interventions with 75% coverage despite high endemicity, whilst 1.7 million people would receive the MDA intervention unnecessarily. EZ-level MDA was estimated to be more cost-effective than district-level administration under all circumstances.

CONCLUSIONS

Our findings provide updated prevalence figures to guide preventive chemotherapy programmes for schistosomiasis and intestinal helminthiasis in Sudan. Schistosomiasis was found to be common among the inhabitants of fragile and conflict-affected areas. In addition, we found that MDA interventions would be more cost-effective at the sub-district level than at the district level, and there was a strong association between schistosomiasis prevalence and latrine status, at both the household and school levels. This study will help the Sudanese government and its neighbouring countries develop adequate control and elimination strategies.

Prevalence and Risk Factors for Schistosomiasis among Schoolchildren in two Settings of Côte d'Ivoire

Schistosomiasis is a parasitic disease affecting more than 250 million people, primarily in sub-Saharan Africa. In Côte d’Ivoire both Schistosoma haematobium (causing urogenital schistosomiasis) and Schistosoma mansoni (causing intestinal schistosomiasis) co-exist. This study aimed to determine the prevalence of S. haematobium and S. mansoni and to identify risk factors among schoolchildren in the western and southern parts of Côte d’Ivoire. From January to April 2018, a cross-sectional study was carried out including 1187 schoolchildren aged 5–14 years. Urine samples were examined by a filtration method to identify and count S. haematobium eggs, while stool samples were subjected to duplicate Kato-Katz thick smears to quantify eggs of S.mansoni and soil-transmitted helminths. Data on sociodemographic, socioeconomic, and environmental factors were obtained using a pretested questionnaire. Multivariate logistic regression was employed to test for associations between variables. We found a prevalence of S. haematobium of 14.0% (166 of 1187 schoolchildren infected) and a prevalence of S. mansoni of 6.1% (66 of 1089 schoolchildren infected). In the southern part of Côte d’Ivoire, the prevalence of S. haematobium was 16.1% with a particularly high prevalence observed in Sikensi (35.6%), while S. mansoni was most prevalent in Agboville (11.2%). Swimming in open freshwater bodies was the main risk factor for S. haematobium infection (adjusted odds ratio (AOR) = 127.0, 95% confidence interval (CI): 25.0–634.0, p < 0.001). Fishing and washing clothes in open freshwater bodies were positively associated with S. haematobium and S. mansoni infection, respectively. Preventive chemotherapy using praziquantel should be combined with setting-specific information, education, and communication strategies in order to change children’s behavior, thus avoiding contact with unprotected open freshwater.

Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad

BACKGROUND

Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease.

OBJECTIVE

The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed.

METHODS

This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children.

RESULTS

Direct microscopic examination of urine found 467 positive cases (24.9% of the total sample). Of all male and female samples, 341 (34%) and 127 (14.4%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8%) from an estimated total of 25,000 children in the target group.

CONCLUSIONS

The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis.

Epidemiological Survey on Schistosomiasis and Intestinal Helminthiasis among Village Residents of the Rural River Basin Area in White Nile State, Sudan

There have been some reports on schistosomiasis of school children in Sudan’s Nile River basin area; however, information about the infection status of Schistosoma species and intestinal helminths among village residents of this area is very limited. Urine and stool samples were collected from the 1,138 residents of the Al Hidaib and Khour Ajwal villages of White Nile State, Sudan in 2014. The prevalence of overall schistosomiasis and intestinal helminthiasis was 36.3% and 7.7%, respectively. Egg positive rates were 35.6% for Schistosoma haematobium, 2.6% for S. mansoni, and 1.4% were mixed. The prevalence of schistosomiasis was significantly higher in men (45.6%) than in women (32.0%), in Khou Ajwal villagers (39.4%) than in Al Hidaib villagers (19.2%), and for age groups ≤15 years old (51.5%) than for age groups >15 years old (13.2%). The average number of eggs per 10 ml urine (EP10) of S. haematobium infections was 18.9, with 22.2 eggs in men vs 17.0 in women and 20.4 in Khou Ajwal villagers vs 8.1 in Al Hidaib villagers. In addition to S. mansoni eggs, 4 different species of intestinal helminths were found in the stool, including Hymenolepis nana (6.6%) and H. diminuta (1.0%). Collectively, urinary schistosomiasis is still prevalent among village residents in Sudan’s White Nile River basin and was especially high in men, children ≤15 years, and in the village without a clean water system. H. nana was the most frequently detected intestinal helminths in the 2 villages.

Analysis of Schistosomiasis and soil-transmitted helminths mixed infections among pupils in Enugu State, Nigeria: Implications for control

BACKGROUND

Schistosomiasis and Soil-transmitted helminthiasis cause considerable morbidity and mortality in developing countries, especially among children. To this end it, a cross-sectional survey to determine the pattern of Schistosomiasis and Soil-transmitted helminthiasis co-infection was undertaken among primary school pupils in Oduma Community in Enugu State, Nigeria.

METHODS

Fresh urine and stool samples were collected from pupils. The urine and stool samples were examined using sedimentation and Kat-Katz techniques respectively.

RESULTS

Of the 236 pupils examined, 137 (58.1%) were found positive for at least one helminth infection. Ascaris lumbricoides was the most prevalent soil-transmitted helminth (STH), with a prevalence rate of 40.3%, followed by Trichuris trichiura (15.3%) and hookworm (8.9%). Infection with Schistosoma haematobium was detected in 13.6% of the pupils while Schistosoma mansoni infection prevalence was 7.2%. Age group 4 -7 years recorded the highest prevalence for S. haematobium, A. lumbricoides, T. Trichiura and hookworm infections. Multiple infections were also recorded, with 22.9% having double infections and 2.5% having triple infections. The most common double infection was A. lumbricoides with T. trichiura (8.9%), while the most common triple infection was A. lumbricoides, S. haematobium and hookworm (1.7%).

CONCLUSION

The results from the present study revealed an evident need for the systematic and sustained administration of school-based chemotherapy program targeting the control of STH infection and Schistosomiasis using Albendazole and Praziquantel respectively in the community, instead of a one-off approach that was carried out.

Prevalence of schistosomiasis and associated risk factors among school children in Um-Asher Area, Khartoum, Sudan

Objective

Schistosomiasis remains one of the most common parasitic diseases worldwide. This is a cross-sectional study aimed to determine the prevalence of schistosomiasis and its associated risk factors among primary school children in Um-Asher area. The study was conducted among 170 primary school students in Um-Asher area from November 2017 to February 2018. Urine and stool samples were collected and examined for schistosomiasis infections. Moreover, data on sociodemographic characteristics and associated risk factors were obtained using a questionnaire.

Results

The overall prevalence of Schistosoma haematobium was 12.9%, whereas that of Schistosoma mansoni was 2.95%. Additionally, the males had higher prevalence (60%) of S. mansoni than females (40%). However, both gender were equally infected with S. haematobium (50%). With regard to risk factors, distance of residence from water source and source of drinking water are relatively associated with the infection.

Comparison of ELISA and Urine Microscopy for Diagnosis of Schistosoma haematobium Infection

BACKGROUND

Schistosoma haematobium which causes urogenital schistosomiasis (UGS) is highly prevalent in African countries. Urine microscopy (UM) is the first-line diagnostic method of UGS. Enzyme-linked immunosorbent assay (ELISA) is a common method for screening many parasite infections primarily or alternatively. The present study established an in-house diagnostic system by ELISA and evaluated its diagnostic efficacy in comparison with UM for screening UGS in White Nile State, Republic of Sudan, 2011-2013.

METHODS

A total of 490 participants were screened by UM or ELISA, and 149 by both. The in-house ELISA system was established employing soluble egg antigen of S. haematobium and the cut-off absorbance was set at 0.270.

RESULTS

Of the 149 subjects, 58 participants (38.9%) were positive by UM, 119 (79.9%) were positive by ELISA and 82 (55.0%) showed consistently positive or negative results by both methods. The diagnostic sensitivity of ELISA was 94.8% and specificity was 29.7% based on UM results. The ELISA positive serum samples also cross-reacted with egg antigens of Schistosoma mansoni and Schistosoma japonicum.

CONCLUSION

We have established in-house ELISA for screening serum immunoglobulin (Ig) G antibodies by employing soluble egg antigen of S. haematobium for diagnosis of UGS with 94.8% sensitivity and 29.7% specificity. The ELISA system can supplement the conventional diagnosis by UM.

Biosocial Determinants of Persistent Schistosomiasis among Schoolchildren in Tanzania despite Repeated Treatment

Schistosomiasis is a parasitic disease endemic to Tanzania and other countries of the global south, which is currently being addressed through preventive chemotherapy campaigns. However, there is growing recognition that chemotherapy strategies will need to be supplemented to sustainably control and eventually eliminate the disease. There remains a need to understand the factors contributing to continued transmission in order to ensure the effective configuration and implementation of supplemented programs. We conducted a cross-sectional questionnaire, to evaluate the biosocial determinants facilitating the persistence of schistosomiasis, among 1704 Tanzanian schoolchildren residing in two districts undergoing a preventive chemotherapeutic program: Rufiji and Mkuranga. A meta-analysis was carried out to select the diagnostic questions that provided a likelihood for predicting infection status. We found that self-reported schistosomiasis continues to persist among the schoolchildren, despite multiple rounds of drug administration.Using mixed effects logistic regression modeling, we found biosocial factors, including gender, socio-economic status, and water, sanitation, and hygiene (WASH)-related variables, were associated with this continued schistosomiasis presence. These findings highlight the significant role that social factors may play in the persistence of disease transmission despite multiple treatments, and support the need not only for including integrated technical measures, such as WASH, but also addressing issues of poverty and gender when designing effective and sustainable schistosomiasis control programs.

Risk factors for schistosomiasis transmission among school children in Gwanda district, Zimbabwe

INTRODUCTION

A nationwide cross sectional schistosomiasis survey conducted in 2011 in 280 primary schools found a prevalence rate of 22.7%. This warranted an intervention with Mass Drug Administration at all schools in line with WHO guidelines. This study aimed to identify risk factors for schistosomiasis transmission among Grade 3 children at two primary schools in Gwanda district.

METHODS

A descriptive cross sectional survey which was part of a larger study on Malaria and Bilharzia in Southern Africa (MABISA) was conducted. Grade 3 children (n=120) attending two purposively selected rural primary schools in Dombo and Ntalale in Gwanda were respondents. Data on socio-demographic characteristics and risk factors which included knowledge and practices were collected using a pretested interviewer administered questionnaire.

RESULTS

Of the 120 children, 98 (81.7%) of the children indicated that they did not consistently use the toilet. The other risk factors for schistosomiasis were bathing and swimming in rivers and dams 80 (66.7%), watering the vegetable gardens using unprotected water sources 77 (64.7%) and crossing rivers on their way to school barefooted 31.7%. History of schistosomiasis cases based on self-reporting indicated that of the 9 children 7 were girls. There was poor knowledge of schistosomiasis among the children with 54% of the children indicating that they had never heard about the disease. Misconceptions on the causes of schistosomiasis which included drinking dirty water, mosquitoes and flies as the causes of schistosomiasis were reported by the children. Parents were cited as the least disseminators of information on schistosomiasis with only 4 out of the 120 children having received information from their parents.

CONCLUSION

Frequent contact with unprotected water sources, non-use of the toilet, and lack of information on schistosomiasis could predispose the children to infection. There is need to raise awareness about schistosomiasis in schools and the community to reduce the risk of contracting schistosomiasis due to risky behaviour.

Significance of Echogenic Snow Sign as an Ultrasonography Finding for Diagnosis of Urogenital Schistosomiasis

Urogenital schistosomiasis (UGS) is one of the important neglected tropical diseases, which requires global elimination programs. It is primarily diagnosed by urine microscopy (UM), but its sensitivity is not satisfactory. Ultrasonography (US) is an alternative screening method of UGS. The present study investigated the diagnostic feasibility of new criteria including echogenic snow sign, innumerable scattered small echogenic foci floating in bladder lumen, for UGS in White Nile State, Republic of Sudan, 2013-2014. A total of 1,462 participants were screened by US or UM, and 948 by both. The 948 subjects were 1-80 years of age, 485 (51.2%) of them were boys or men, and 648 (68.4%) were less than 15 years of age. Eggs were detected from 133 (14.0%) by UM. The US findings of bladder wall thickening, polypoid mass, and ureter dilatation were regarded as positive for UGS following the World Health Organization (WHO) guidelines. Of the 948 subjects, 155 (16.4%) were positive for US by the WHO criteria. The echogenic snow sign was detected in 75 participants, and was most frequently observed in age group of 10-14. It was more commonly observed in UM-positive participants (35/133; 26.3%) than in UM-negative participants (40/815; 4.9%), and the difference was statistically significant with an odds ratio of 6.92 (4.20-11.41). When the echogenic snow was added to the WHO criteria, 42 participants were additionally revealed to have UGS-related morbidity, reaching a total of 198 (20.9%) participants. The echogenic snow sign can be suggested as a new finding to the criteria of US for UGS.

Prevalence and intensity of genito-urinary schistosomiasis and associated risk factors among junior high school students in two local government areas around Zobe Dam in Katsina State, Nigeria

BACKGROUND

The national burden of genito-urinary schistosomiasis in Nigeria has been expressed by an estimate of 101.3 million people at risk with an alarming figure of 29 million infected. Report obtained from respondents about Praziquantel® distribution and the obviously prevalent haematuria without any control programme in place justified the need for data on the prevalence, intensity of infection and associated risk factors which were the objectives this cross-sectional survey sought to address.

METHODS

A total of 718 students aged 10-23 years from the study area were surveyed between May and August, 2015. Data on socio-demographic and risk factors were obtained using structured questionnaires. Clean universal bottles with corresponding labels were offered for sample collection between 10:00 am and 13:30 pm. Centrifuged samples were microscopically examined and intensity of infection was recorded per 10 ml of each sample.

RESULTS

Prevalence of genito-urinary schistosomiasis was 22.7 % with a mean intensity of 25.05 (± standard deviation, ± 71.51) eggs/10 ml of urine. Higher prevalence (19.5 %) and mean intensity (28.7 eggs/10 ml of urine) was recorded among boys. Sex (χ (2) = 77.065, P < 0.0001), age group 16-18 (χ (2) = 5.396, P = 0.0202), altitude (χ (2) = 8.083, P = 0.0045), unwholesome water sources (χ (2) = 27.148, P < 0.0001), human recreational activities (χ (2) = 122.437, P < 0.0001), mothers' occupation (χ (2) = 6.359, P = 0.0117), farming (χ (2) = 6.201, P = 0.0128) and other brown collar jobs (χ (2) = 4.842, P = 0.0278) in fathers' occupational category were found to be significantly associated with urogenital schistosomiasis. Boys were seven times more likely to be infected compared to girls [AOR (95 % CI): 7.3 (4.26-12.4)]. Age group 16-18 years was four times more likely to be infected compared to age group 10-12 years [AOR (95 % CI): 4.43 (2.62-7.49)]. Similarly, respondents with farming as fathers' occupation were twice more likely to be infected than those whose fathers were civil servants [AOR (95 % CI): 2.08 (1.2-3.59)].

CONCLUSIONS

Dutsin-Ma and Safana were classified as moderate-risk Local Government Areas (LGA). Sex, altitude, unwholesome water sources and mothers' occupation were identified as the determining epidemiological factors in the prevalence of the disease. Sustainable chemotherapeutic intervention with Praziquantel®, good network of treated pipe-borne water, health education and waste disposal facilities are highly recommended to reduce its prevalence below the threshold of public health significance.

Prevalence and clinical correlates of Schistosoma mansoni co-infection among malaria infected patients, Northwest Ethiopia

BACKGROUND

In Ethiopia, where malaria and schistosomiasis are co-endemic, co-infections are expected to be high. However, data about the prevalence of malaria-schistosomiasis co-infection and their clinical correlation is lacking. Therefore, the aim of this study was to assess prevalence of Schistosoma mansoni co-infection and associated clinical correlates in malaria patients.

METHODS

A cross-sectional study was conducted in 2013 at Chwahit Health Center, in northwest Ethiopia. Blood film positive malaria patients (N = 205) were recruited for the study. Clinical, parasitological, hematological, and biochemical parameters were assessed from every study participant. Stool samples were also collected and processed with Kato-Katz technique to diagnose and classify intensity of Schistosoma mansoni.

RESULTS

The prevalence of Schistosoma mansoni and malaria co-infection was 19.5%. The age group of 16-20 years old was significantly associated with co-infection. Co-infected patients with a moderate-heavy egg burden of Schistosoma mansoni had significantly high mean Plasmodium parasitemia. On the other hand, age group of 6-10 years old and moderate-heavy Schistosoma mansoni co-infection were significantly associated with severe malaria.

CONCLUSIONS

Prevalence of malaria and Schistosoma mansoni co-infection in the study area was considerably high. Severity of malaria and parasitemia of Plasmodium were associated with certain age groups and intensity of concurrent Schistosoma mansoni. Further study is needed to explore the underlying mechanisms of interaction between malaria and Schistosoma mansoni.

Prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella Regional State, southwestern Ethiopia: a cross sectional study

Background

In Ethiopia, urinary schistosomiasis caused by Schistosoma haematobium has been known to be endemic in several lowland areas of the country where it causes considerable public health problems, mainly among school-age children. However, information on recent magnitude and risk factors of the disease is lacking, particularly for Gambella area. Therefore, this study aimed to assess the prevalence of urinary schistosomiasis and associated risk factors among Abobo Primary School children in Gambella, southwestern Ethiopia.

Methods

A cross-sectional study involving 304 school children was conducted in Abobo Primary School, Gambella Regional State, southwestern Ethiopia, from February to June 2014. Ten ml of urine sample was collected from each study participant and processed for microscopic examination by the urine filtration method; egg load for positive individuals was determined per 10 ml of urine. Data on socio-demographic characteristics and risk factors were collected using an interview-based questionnaire. The data were entered into and analyzed with SPSS version 20. Logistic regression and odds ratio were used to measure association and strength between variables, respectively. P-value < 0.05 at 95% CI was considered as statistically significant.

Results

The prevalence of urinary schistosomiasis was 35.9% (109/ 304) with a mean egg intensity of 8.76 per 10 ml of urine. Being male [AOR (95%CI) = 2.15(1.31, 3.52)], having father as a farmer [AOR (95%CI) = 1.96(1.19, 3.22)] and children living apart from parents [AOR (95% CI): 3.09 (1.14, 8.4)] were significantly associated with urinary schistosomiasis.

Conclusion

The present study area in Gambella Regional State, southwestern Ethiopia, represents moderate-risk community for urinary schistosomiasis. Sex, father’s occupation and living apart from parents were found to be associated with infection. Treatment of all school-age children and fishermen is required once every 2 years until the prevalence of infection falls below the level of public health importance. It is also recommended to complement praziquantel treatment with supplementary measures such as provision of sanitation facilities and health education.

Reduction of urogenital schistosomiasis with an integrated control project in Sudan

Purpose

Schistosomiasis remains a major public health concern in Sudan, particularly Schistosoma haematobium infection. This study presents the disease-reduction outcomes of an integrated control program for schistosomiasis in Al Jabalain locality of White Nile State, Sudan from 2009 through 2011.

Methods

The total population of the project sites was 482,902, and the major target group for intervention among them was 78,615 primary school students. For the cross-sectional study of the prevalence, urine and stool specimens were examined using the urine sedimentation method and the Kato cellophane thick smear method, respectively. To assess the impacts of health education for students and a drinking water supply facility at Al Hidaib village, questionnaire survey was done.

Results

The overall prevalence for S. haematobium and S. mansoni at baseline was 28.5% and 0.4%, respectively. At follow-up survey after 6–9 months post-treatment, the prevalence of S. haematobium infection was reduced to 13.5% (95% CI = 0.331–0.462). A higher reduction in prevalence was observed among girls, those with moderately infected status (around 20%), and residents in rural areas, than among boys, those with high prevalence (>40%), and residents in urban areas. After health education, increased awareness about schistosomiasis was checked by questionnaire survey. Also, a drinking water facility was constructed at Al Hidaib village, where infection rate was reduced more compared to that in a neighboring village within the same unit. However, we found no significant change in the prevalence of S. mansoni infection between baseline and follow-up survey (95% CI = 0.933–6.891).

Conclusions

At the end of the project, the prevalence of S. haematobium infection was reduced by more than 50% in comparison with the baseline rate. Approximately 200,000 subjects had received either praziquantel therapy, health education, or supply of clean water. To consolidate the achievements of this project, the integrated intervention should be adapted continuously.

Schistosomiasis remains a major public health concern and is one of the major causes of morbidity among school-aged children in Sudan. To control schistosomiasis in White Nile State of Sudan, the Korea International Cooperation Agency (KOICA) implemented an integrated control program including mass chemotherapy with praziquantel and health education to school children and village residents, and construction of a drinking water supply facility at Al Hidaib village from 2009 to 2011. As a result of this project, the overall prevalence of S. haematobium infection was reduced by >50% in comparison with the baseline rates (95% CI = 0.331–0.462). The infection reduction rates were higher among girls, those with moderate infection status (around 20%), and residents of rural areas; than for those of boys, subjects with high infection status (>40%) and residents of urban areas. A supply of clean water at Al Hidaib village contributed significantly to the reduction in the prevalence of urogenital schistosomiasis in comparison to Khour Ajwal village, which is similar natural environment and lifestyle of Al Hidaib village. However, the prevalence of S. mansoni infection did not significantly change. Also, the awareness of knowledge about schistosomiasis and health improvement was apparently improved by the results of questionnaires survey. Through this project, approximately 200,000 individuals benefited from either drug treatment, health education, or a clean water supply. To consolidate the achievements of the project, sustainable integrated control activities should be implemented in the near future.

Prevalence, risk factors, and clinical manifestations of schistosomiasis among school children in the White Nile River basin, Sudan

Background

We investigated the prevalence, risk factors, and clinical manifestations of schistosomiasis in White Nile State, Sudan, to determine the local characteristics of schistosomiasis in the White Nile River basin.

Methods

Urine and stool samples were collected from 338 students (176 boys, 162 girls) at three primary schools and were examined using the urine filtration method and the Kato-Katz technique, respectively. Of the students, 200 were interviewed using a semi-structured questionnaire to assess water-contact patterns and health conditions related with urinary schistosomiasis.

Results

Of the 338 students, egg-positive rates for S. haematobium and S. mansoni were 45.0% and 5.9%, respectively, and 4.4% were mixed. The intensities of S. haematobium and S. mansoni infection were 1.091 ± 0.744 log EP10 (eggs per 10 mL of urine, mean ± SD = 57 ± 172 EP10) and 1.787 ± 0.844 log EPG (eggs per gram of stool, mean ± SD = 156 ± 176 EPG), respectively. The prevalence and intensity of S. haematobium infection differed significantly among the three schools, but not by gender or age. Urinary schistosomiasis was significantly associated with the frequencies of contaminated water contact, taking baths, swimming, and wading the stream; however, frequencies of these events were not significantly correlated with infection intensity. Self-reported hematuria and dysuria also correlated significantly with urinary schistosomiasis.

Conclusions

The overall prevalence of schistosomiasis, especially urinary schistosomiasis, is high in the White Nile River basin, Sudan, and is closely associated with frequencies of water contact, taking baths, swimming, and wading the stream. We strongly recommend implementation of an integrated schistosomiasis control program in this area.

Schistosoma haematobium hotspots in south Nyanza, western Kenya: prevalence, distribution and co-endemicity with Schistosoma mansoni and soil-transmitted helminths

BACKGROUND

Schistosomiasis studies in western Kenya have mainly focused on the intestinal form, with evidence of urinary schistosomiasis remaining anecdotal. Detailed disease mapping has been carried out predominantly along the shores of Lake Victoria, but there is a paucity of information on intestinal and urinary schistosomiasis in inland sites.

METHODS

This cross-sectional survey of 3,487 children aged 7-18 years from 95 schools in south Nyanza, western Kenya determined the prevalence, infection intensity, and geographical distribution of Schistosoma haematobium, evaluating its co-endemicity with Schistosoma mansoni and soil-transmitted helminths (STHs). Helminth eggs were analyzed from single urine (for S. haematobium) and stool (for S. mansoni and STHs) samples by centrifugation and Kato-Katz, respectively. Hematuria was used as a proxy indicator for S. haematobium. Schools and water bodies (ponds, water-points, streams, dams and rivers) were mapped using Geographical Information System and prevalence maps obtained using ArcView GIS Software.

RESULTS

S. haematobium infections with an overall prevalence of 9.3% (95% CI = 8.4-10.2%) were mostly prevalent in Rachuonyo, 22.4% (95% CI = 19.2-25.9% and 19.7 eggs/10 ml) and Migori, 10.7% (95% CI = 9.2-12.3% and 29.5 eggs/10 ml) districts, particularly around Kayuka pond and Ongoche river respectively. Overall infections correlated with hematuria (r = 0.9, P < 0.0001) and were more likely in boys (P < 0.0001, OR = 0.624). S. mansoni infections with an overall prevalence of 13% (95% CI =11.9-14.1%) were majorly confined along the shores of Lake Victoria. STH infections were homogenously distributed with A. lumbricoides occurring in 5.4% (95% CI = 4.7-6.3%) and T. trichiura in 2.8% (95% CI = 2.3-3.4%) of the children. Although S. mansoni infections were more co-endemic with S. haematobium, only A. lumbricoides infections were positively associated with S. haematobium (P = 0.0295, OR = 0.4585). Overall prevalence of S. haematobium monoinfection was 7.2% (95% CI = 6.4-8%), S. mansoni monoinfection was 12.3% (95% CI = 10.4-12.5%), and S. haematobium-S. mansoni coinfection was 1.2% (95% CI = 0.9-1.6%). There was no significant difference in infection intensity between mono and coinfections.

CONCLUSION

Prevalence distribution maps obtained are important for planning and implementing disease control programs in these areas.