Abstract
BackgroundUrinary schistosomiasis is responsible for a variety of debilitating conditions; foremost perhaps are urinary tract pathologies (UTPs). Although portable ultrasonography can be used to detect UTPs visually, there is still a need for rapid morbidity assessment (henceforth referred to as RaMA) tools that can be deployed in the field during implementation, monitoring and evaluation of control programmes. We therefore aimed to determine associations between excreted urine-albumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar.Methodology/Principal FindingsIn a survey of 140 school-children of both sexes (aged 9 to 15 yr) and 47 adult males (≥16 yr) on the island of Unguja, the prevalence of egg-patent urinary schistosomiasis was 36.4% (CI95 28.5–45.0%) and 46.8% (CI95 32.1–61.9%) (P = 0.14), and that of UTPs was 39.4% (CI95 31.0–48.3%) and 64.4% (CI95 48.8–78.1%) (P = 0.006), respectively. In school-children, raised urine-albumin concentrations (>40 mg/L) were associated, albeit non-significantly, with prevalence of infection (OR = 3.1, P = 0.070), but more specifically and significantly with the prevalence of micro-haematuria (OR = 76.7, P<0.0001). In adults, elevated urine-albumin excretion was associated with UTPs, particularly lesions of the bladder wall (OR = 8.4, P = 0.013). Albuminuria showed promising diagnostic performance, especially in school-aged children with sensitivity of 63.3% and specificity of 83.1% at detecting lower UTPs, i.e. bladder-wall lesions (ultrasonography as ‘gold standard’).Conclusion/SignificanceThis study indicates that albuminuria assays could be used as a RaMA tool for monitoring UTP prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography.
Highlights
Urinary schistosomiasis is caused by infection with the parasitic trematode Schistosoma haematobium
Conclusion/Significance: This study indicates that albuminuria assays could be used as a RaMA tool for monitoring urinary tract pathologies (UTPs) prevalence during control programmes, as well as a tool for selecting those with more chronic bladder-wall lesions without resorting to ultrasonography
Urinary schistosomiasis and urinary tract pathologies Urinary schistosomiasis was more prevalent in the adult males surveyed at the Health Centre [46.8%, GMW = 2.84 (CI95 2.36–3.31) eggs/10 ml of urine] than in the school-children [36.4%, GMW = 2.17 (CI95 1.90–2.44) eggs/10 ml of urine]
Summary
Urinary schistosomiasis is caused by infection with the parasitic trematode Schistosoma haematobium. There are several control initiatives working at national levels within endemic zones in sub-Saharan Africa administering regular distribution of praziquantel, the drug of choice to combat urinary schistosomiasis [5,6] One such example is the Zanzibar programme on Unguja Island for the reduction of urinary schistosomiasis and prevention of morbidity This process involves assessing the temporal and spatial trends of infection prevalence and intensity in the presence of treatment, as well as that of morbidity indicators The latter is typically conducted through the use of cost-effective and simple (rapid assessment) techniques, of which the most appropriate and commonly used for urinary schistosomiasis is the screening of individuals for macroand micro-haematuria [2,11,12]. We aimed to determine associations between excreted urinealbumin, as measured using a HemoCue photometer, and UTPs, as detected by ultrasonography, in children and adults from an urinary schistosomiasis endemic area in Zanzibar
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