Effective control of Schistosoma haematobium infection in a Ghanaian community following installation of a water recreation area.

Karen C Kosinski,Kwabena M Bosompem,John L Durant,David M Gute,Miguel J Stadecker,Mark Woodin,Jonathan J Crocker,Jeanine D Plummer,Michael N Adjei,Anjuli D Wagner,Dickson Osabutey,Guo-Jing Yang

doi:10.1371/journal.pntd.0001709

Abstract

BackgroundUrogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact.MethodsWe designed a water recreation area (WRA) to prevent transmission to school-aged children. The WRA features a concrete pool supplied by a borehole well and a gravity-driven rainwater collection system; it is 30 m2 and is split into shallow and deep sections to accommodate a variety of age groups. The WRA opened in 2009 and children were encouraged to use it for recreation as opposed to the local river. We screened children annually for S. haematobium eggs in their urine in 2008, 2009, and 2010 and established differences in infection rates before (2008–09) and after (2009–10) installation of the WRA. After each annual screening, children were treated with praziquantel and rescreened to confirm parasite clearance.Principal FindingsInitial baseline testing in 2008 established that 105 of 247 (42.5%) children were egg-positive. In 2009, with drug treatment alone, the pre-WRA annual cumulative incidence of infection was 29 of 216 (13.4%). In 2010, this incidence rate fell significantly (p<0.001, chi-squared) to 9 of 245 (3.7%) children after installation of the WRA. Logistic regression analysis was used to determine correlates of infection among the variables age, sex, distance between home and river, minutes observed at the river, low height-for-age, low weight-for-age, low Body Mass Index (BMI)-for-age, and previous infection status.Conclusion/SignificanceThe installation and use of a WRA is a feasible and highly effective means to reduce the incidence of schistosomiasis in school-aged children in a rural Ghanaian community. In conjunction with drug treatment and education, such an intervention can represent a significant step towards the control of schistosomiasis. The WRA should be tested in other water-rich endemic areas to determine whether infection prevalence can be substantially reduced.

Highlights

Urogenital Schistosomiasis Schistosomiasis is a neglected tropical disease caused by parasitic trematodes of the genus Schistosoma
Urogenital schistosomiasis is a disease caused by the parasite Schistosoma haematobium; it is often characterized by bloody urine and tends to disproportionately affect school-aged children in rural tropical regions
We collaborated with community members to design a water recreation area (WRA) featuring a concrete pool supplied by a borehole well and a rainwater collection system

Summary

Introduction

Urogenital Schistosomiasis Schistosomiasis is a neglected tropical disease caused by parasitic trematodes of the genus Schistosoma. In 2006, Steinmann et al estimated that globally, 207 million people live with schistosomiasis [1], but later estimates by King suggest that the number is between 391 and 587 million people [2]. Morbidity may result from chronic or acute infection and may be independent of worm burden [3]. Hematuria is not exclusive to S. haematobium. Urogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact

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