Abstract
BackgroundRenal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. The aim of this study was to assess the burden of urinary tract pathology and morbidity due to schistosomiasis in Zanzibar and identify reliable clinical predictors of schistosomiasis associated renal disease.MethodsA cross-sectional comparison of Ungujan men and women living within either high or low endemic areas for urinary schistosomiasis was conducted. Using urine analysis with reagent strips, parasitological egg counts, portable ultrasonography and a qualitative case-history questionnaire. Data analysis used single and multiple predictor variable logistic regression.ResultsOne hundred and sixty people were examined in the high endemic area (63% women and 37% men), and 101 people in the low endemic area (61% women and 39% men). In the high endemic area, egg-patent schistosomiasis and urinary tract pathology were much more common (p = 1 × 10-3, 8 × 10-6, respectively) in comparison with the low endemic area. Self-reported frothy urine, self-reported haematuria, dysuria and urgency to urinate were associated with urinary tract pathology (p = 1.8 × 10-2, p = 1.1 × 10-4, p = 1.3 × 10-6, p = 1.1 × 10-7, respectively) as assessed by ultrasonography. In a multi-variable logistic regression model, self-reporting of schistosomiasis in the past year, self-reporting of urgency to urinate and having an egg-positive urine sample were all independently associated with detectable urinary tract abnormality, consistent with schistosomiasis-specific disease. Having two or more of these features was moderately sensitive (70%) as a predictor for urinary tract abnormality with high specificity (92%).ConclusionHaving two out of urgency to urinate, self reporting of previous infections and detection of eggs in the urine were good proxy predictors of urinary tract abnormality as detected by ultrasound.
Highlights
Renal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden
There have been good attempts at estimating the totality of disease burden due to schistosomiasis at a global level [3], it is often difficult to translate these estimates into local communities, not least because of significant geographical heterogeneity of the disease set against other confounding factors
Most of the urinary tract pathology visualized on ultrasound was classifiable within the WHO criteria for schistosomiasis induced urinary tract pathology
Summary
Renal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. Schistosomiasis is a chronic infection causing significant morbidity. Renal tract involvement is implicated in both early and late disease, leading to increased disease burden which is likely to impact activities of daily living and the countries' economy and welfare. There have been good attempts at estimating the totality of disease burden due to schistosomiasis at a global level [3], it is often difficult to translate these estimates into local communities, not least because of significant geographical heterogeneity of the disease set against other confounding factors
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