Abstract
BackgroundThe recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school children (PSC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ.Methodology/Principal findings400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. Adverse events were assessed 24 hours post-treatment through questionnaires administered to the parents or guardians. Acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment. Efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group’s geometric mean egg counts per 10 ml of urine) following treatment expressed as a proportion of the pre-treatment infection intensity. Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4–24.2%). Of these, 41 had infections of heavy intensity (51.3%) while the rest (48.7%) were of light intensity. Five weeks post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5–4.9%). Infection intensities decreased significantly from 45.9 (95% CI: 31.0–68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1–1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. There were no severe adverse events during follow up 24 hours post treatment. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study.Conclusion/SignificanceThe study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County.
Highlights
Human schistosomiasis is a major neglected public health problem caused by trematodes of the genus Schistosoma
The majority of infections in sub-Saharan Africa are caused by S. mansoni and S. haematobium which reside in intestinal mesenteric veins and bladder respectively, leading to intestinal and urogenital schistosomiasis
The design of our study did not allow estimating the proportion of infections after treatment that were due to juvenile stages of the parasite, which are largely insensitive to praziquantel. This is in line with a study in Mali assessing urinary schistosomiasis in preschool aged children showing that, the presence of S. haematobium eggs five weeks post-treatment could be explained by factors such as high pretreatment worm load that could not be completely cleared by the treatment that remained in the treated children and started producing eggs, and the presence of high numbers of immature worms less sensitive to praziquantel that escaped drug action and matured to egg producing worms during subsequent follow-ups [26]; praziquantel is refractory against immature worms [24]
Summary
Human schistosomiasis is a major neglected public health problem caused by trematodes of the genus Schistosoma. In Kenya, nearly 6 million people are infected and an additional 15 million are at high risk of infection in endemic areas [2, 3]. Schistosomiasis (Bilharzia) is classified as one of the neglected tropical diseases (NTDs) These are a group of diseases found predominantly in tropical areas that are associated with poor sanitation and poverty and which have historically received insufficient attention towards their control. The majority of infections in sub-Saharan Africa are caused by S. mansoni and S. haematobium which reside in intestinal mesenteric veins and bladder respectively, leading to intestinal and urogenital schistosomiasis. Pre-school children (PSC) are excluded from population treatment programs. These children are at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ
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