Abstract
BackgroundLarge-scale schistosomiasis control programs are implemented in regions with diverse social and economic environments. A key epidemiological feature of schistosomiasis is its small-scale heterogeneity. Locally profiling disease dynamics including risk factors associated with its transmission is essential for designing appropriate control programs. To determine spatial distribution of schistosomiasis and its drivers, we examined schoolchildren in Kwale, Kenya.Methodology/Principal findingsWe conducted a cross-sectional study of 368 schoolchildren from six primary schools. Soil-transmitted helminths and Schistosoma mansoni eggs in stool were evaluated by the Kato-Katz method. We measured the intensity of Schistosoma haematobium infection by urine filtration. The geometrical mean intensity of S. haematobium was 3.1 eggs/10 ml urine (school range, 1.4–9.2). The hookworm geometric mean intensity was 3.2 eggs/g feces (school range, 0–17.4). Heterogeneity in the intensity of S. haematobium and hookworm infections was evident in the study area. To identify factors associated with the intensity of helminth infections, we utilized negative binomial generalized linear mixed models. The intensity of S. haematobium infection was associated with religion and socioeconomic status (SES), while that of hookworm infection was related to SES, sex, distance to river and history of anthelmintic treatment.Conclusions/SignificanceBoth S. haematobium and hookworm infections showed micro-geographical heterogeneities in this Kwale community. To confirm and explain our observation of high S. haematobium risk among Muslims, further extensive investigations are necessary. The observed small scale clustering of the S. haematobium and hookworm infections might imply less uniform strategies even at finer scale for efficient utilization of limited resources.
Highlights
Schistosomiasis and soil-transmitted helminthiases are among neglected tropical diseases targeted for control by the World Health Organization (WHO) [1]
The World Health Organization is spearheading the war on neglected tropical diseases, including helminth infections, by encouraging its member states to intensify control efforts
This call has recently been answered in most endemic regions of helminthiasis and governments are scaling up chemotherapy-based control programs in collaboration with private and public partners
Summary
Schistosomiasis and soil-transmitted helminthiases are among neglected tropical diseases targeted for control by the World Health Organization (WHO) [1]. In Kenya, approximately 17.4 million people are at risk of schistosomiasis [3] and approximately 9.1 million Kenyans are in danger of soil-transmitted helminthiases [4]. Disease distribution depends on the presence of Bulinus spp. and Biomphalaria spp. as intermediate host snails for S. haematobium and S. mansoni, respectively [5]. Along the Kenyan coast, schistosomiasis is almost entirely caused by S. haematobium. The constant high temperature along the coast restricts the proliferation of Biomphalaria spp. host snails in the area [6]. Seasonal pools, quarry pits and drainage canals are primary habitats for Bulinus spp. along the Kenyan coast [7]. Large-scale schistosomiasis control programs are implemented in regions with diverse social and economic environments. To determine spatial distribution of schistosomiasis and its drivers, we examined schoolchildren in Kwale, Kenya
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