Control Of Urinary Schistosomiasis Research Articles

Effect of Schistosoma haematobium infection on the cognitive functions of preschool age children and benefits of treatment from an endemic area in Zimbabwe

BackgroundSchistosomiasis is known to affect the cognitive functions of children, however, but there is paucity of information on its impact on early childhood development in developing countries where the disease is endemic. This study aimed at determining the effects of schistosomiasis due to Schistosoma haematobium on early childhood development in children below 5 years old from Murewa District, Zimbabwe, including the benefits of treatment.MethodsPreschool age children (PSAC) under the age of 5 years were screened at baseline and at 6 months post-treatment for S. haematobium infections diagnosed using the urine filtration method. Cognitive domains were assessed using the Griffith Mental Developmental Scales III on 136 PSAC. Multivariate logistic regression was used to determine the level of association between S. haematobium infection and performance in the cognitive domains adjusting for confounding factors (i.e. nutrition, hemoglobin levels, gender and age). Median Development Quotient scores of each cognitive domain at baseline and at 6 months post-treatment were compared and quantified.ResultsAfter adjusting for confounding factors, PSAC infected with S. haematobium had greater odds of having lower scores in the Foundation of Learning Domain (OR = 3.9, p = 0.008), Language and Communication Domain (OR = 3.2, p = 0.017), Eye-Hand Coordination Domains (OR = 10.7, p = 0.001), Personal-Social-Emotional Domain (19.3, p = 0.001) and in the Overall General Development Domain (7.2, p = 0.011). Improvement of cognitive performance was observed at 6 months post treatment in the following Domains; Language and Communication Domain (p = 0.003), Eye-Hand Coordination Domain (p = 0.02) and General Development Domain (p = 0.006).ConclusionThe study showed that S. haematobium infection in PSAC is associated with lower cognitive scores in the Foundation of Learning, Language and Communication, Eye-Hand Coordination, Personal-Social-Emotional and in the Overall General Development domains. Our results strengthen the call for inclusion of PSAC in routine deworming programs for the control of urinary schistosomiasis and the need to develop locally validated tools to monitor early child development in endemic areas where resources are limited.

Implication of serum Nitric oxide and IgE in urinary schistosomiasis: The case of Bamendjing, Cameroon

BackgroundUrinary schistosomiasis (US), also known as bilharziasis is a waterborne parasitic infection most common in rural areas of developing countries. The infection is associated with haematuria but little or nothing is known about its association with other urinary parameters, induction of Nitric Oxide (NO) and IgE production around the Bamendjing Dam an area highly suspected of Schistosoma haematobium infections. The study sought to address this problem for possible future interventions and control. Materials and methodsUrine samples were collected from 301 randomly selected participants and analysed for the presence of S. haematobium using the syringe filtration concentration method. Sera from patients infected with S. haematobium and also from some uninfected individuals were analysed for IgE and NO using ELISA and colorimetric methods respectively. FindingsThe results showed a prevalence of 16.9% (51/301). Sixty percent of the 49 patients with nitrite in their urine, were infected with urinary schistosomiasis (US) (30/49; p = 0.00). Meanwhile only 40% of the 15 patients with bilirubinuria were infected with US (6/15; p = 0.0241). The risk of patients with US having leucocytes and nitrites was high (OR of 1.3 and 1.7 respectively). Total IgE serum levels were significantly higher in patients with US (648.872 ± 223.142) compared to uninfected individuals (275.682 ± 181.674) (p = 0.00). Infected persons had heightened mean NO levels (2,583,617.647 ± 1,100,678.786) than non-infected participants (1,689,766.667 ± 1,163,084.729). Urinary Schistosomiasis in association with urinary parameters had a significant impact on mean IgE levels (F = 4.248, p = 0.022). Patients infected with Urinary Schistosomiasis alone had significantly higher mean total IgE levels than non-infected participants (p = 0.004). ConclusionApart from haematuria, this study has demonstrated that Urinary Schistosomiasis is prevalent among inhabitants around the Bamendjing Dam and results in an increase of other urine parameters such as leucocytes and nitrates and high levels of serum NO and total serum IgE in patients. These parameters are important in the screening of patients for treatment and control of urinary schistosomiasis.

Retraction Note: The epidemiology and chemotherapeutic approaches to the control of urinary schistosomiasis in school-age children (SAC): a systematic review

The authors have retracted this article [1] because of methodological inaccuracies and incorrect use of the PRISMA/PROSPERO guidelines of systematic reviews and meta-analyses in the article.

Efficacy of artesunate and praziquantel combination on the prevalence of urinary schistosomiasis among children in Abua/Odual Local Government Area, Rivers State, Nigeria

A study to evaluate the efficacy of artesunate and praziquantel on urinary schistosomiasis was conducted in children between ages of 5-19 years in some communities in Abua/Odual Local Government Area of Rivers State, Nigeria. A total of three hundred and two (302) individuals who gave consent were assessed for the disease using the concentration technique. 55 (18.21%) infected individuals were exposed to the drugs in various regimens; Artessunate (4mg/kg x 3 times daily = 12mg/kg); Praziquantel (single oral dose of 40mg/kg) and Artesunate + Praziquantel combination (single oral dose of 40mg/kg + 4mg/kg x 3 times daily = 12mg/kg). A 40 (74.43%) reduction in the geometric egg count (eggs/ 1ml of urine) was recorded in the study with Artesunate single oral dose recording 11(64.70) cure, Praziquantel; 15(88.24) and the Artesunate + Praziquantel Combination; 14 (82.35). The three drug regimens variably reduced the clinical symptoms; heamaturia and proteinuria in the infected children. Sex and age of the children did not influence efficaciousness of the drugs. Praziquantel was more efficacious followed by the Artesunate + Praziquantel regimen. Arsunate single dose can substitute effectively for the chemotherapy of urinary schistosomiasis in endemic malarious regions of Nigeria. The study had revealed Artesunate as a cost effective intervention in the control of urinary schistosomiasis in the sampled areas of Abua/ Odua LGA of Rivers State.Keywords: Urinary schistosomiasis; Artesunate; Praziquantel; haematuria; proteinuria; geometric mean egg count

Mapping of Urinary Schistosomiasis in Anambra State, Nigeria.

Background:Mapping the distribution of parasitic diseases in time and space has a pivotal role to play in their control.Objectives:This study mapped urinary schistosomiasis in Anambra State.Methods:Sampling covered the three senatorial districts, Anambra North, Anambra Central and Anambra South. However, only nine of the 21 local government areas (LGAs) and one town in each LGA were covered. A geographic information system (GIS) was used to map the distribution of schistosomiasis in the state. With the aid of GIS, the distance of the towns to water bodies was calculated. A total of 450 urine samples collected from the nine LGAs were examined for haematuria and Schistosoma haematobium eggs. A questionnaire was used to assess exposure and risks status to infection. The urine samples were examined for haematuria using dipstick and microscopy.Findings:Overall prevalence of infection in the study was 2.9% and 5.5% for microscopy and haematuria, respectively. Prevalence of schistosomiasis was different between the districts, and this was statistically significant (χ2 = 7.763, p = 0.021). Prevalence of urinary schistosomiasis in the towns had a significant negative linear relationship with distance to water body (r = –0.767, p = 0.016). Based on infection status from microscopy, the adjusted odds of infection in fishers was over 103 times higher than in students; the difference was significant statistically (AOR = 103.0443, 95% CI = 4.6278–7093.972, p = 0.0114). People who washed things in stream had 12 times significantly greater odds of infection than those that did not (AOR = 12.4585, 95% CI = 1.9590–258.8108, p = 0.02542). The distance of respondents to stream was a major determinant of infection with urinary schistosomiasis in the state. Those who lived close to water were approximately 1131% more likely to be infected than those who lived far from water bodies (AOR = 11.3157, 95% CI 2.2473–90.6889, p = 0.00713).Conclusions:Anambra State is endemic for urinary schistosomiasis. There is therefore a need for focal studies; and there may probably be a need to design a health program aimed at controlling the infection in focal areas in the state. The study also provides relevant information for designing a plan of action for the selective integrated and targeted control of urinary schistosomiasis in the LGAs.

RETRACTED ARTICLE: The epidemiology and chemotherapeutic approaches to the controlof urinary schistosomiasis in school-age children (SAC): a systematicreview

BackgroundHuman schistosomiases are acute and chronic infectious diseases ofpoverty. Currently, epidemiological data of urinary schistosomiasis (US) inschool-age children (SAC) and adults are often reported together making itdifficult to ascertain the true status of the disease. Based on this premise, weset out to carry out this review.MethodTo achieve this aim, we carried out a computer-aided search ofPubMed, Web of Science, Science Direct, African Journals OnLine (AJOL) and thedatabase of World Health Organization. However, the information obtained fromthese sources was supplemented with additional literatures from Mendeley,Research Gate, and Google.ResultsThe search yielded 183 literatures of which 93 full text research,review and online articles were deemed fit for inclusion. Our key findingsshowed that: (1) of all World Health Organization (WHO) Regions, Africa is themost endemic zone for US, with Kenya and Senegal recording the highestprevalence and mean intensity respectively; (2) SAC within the range of5–16 years contribute most significantly to the transmission cycle of USglobally; (3) gender is a factor to watch out for, with male often recording thehighest prevalence and intensity of infection; (4) contact with open,potentially infested water sources contribute significantly to transmission; (5)parental factors (occupation and education status) predispose SAC to US; (6)economic vis a vis ecological factors play akey role in infection transmission; and (7) in the last decade, a treatmentcoverage of 45% was never achieved globally for SAC or non-SAC treatmentcategory for urinary schistosomiasis.ConclusionIn view of the WHO strategic plan to eliminate schistosomiasis by2020 and the findings from this review, it is obvious that this goal, in theface of realities, might not be achieved. It is imperative that annual controlprogrammes be scaled up marginally, particularly in the African region of WHO.While US-based researches should be sponsored at the grass-root level to unveilhidden endemic foci, adequate facilities for Water, Sanitation, and Hygiene(WASH) should be put in place in all schools globally.

Spatial Distribution of Urinary Schistosomiasis in Cross River State, Nigeria Using Geographical Information System and School Based Questionnaire

Urinary schistosomiasis is a serious disease in Cross River State, Nigeria. Dearth of information on its distribution has hampered the implementation of focused control of the disease. The availability of a rapid method for mapping the disease necessitated this research to provide data for control of Urinary schistosomiasis in Cross River State, Nigeria. The study used a rapid validated school-based questionnaire method in mapping schistosomiasis. Geographical information system (GIS) software tools were used to produce a spatial map for prevalence of infection and areas at risk for urinary schistosomiasis in Cross River State. Data analysis with SPSS package revealed that 9,993 (10.2%) female and 10,328 (10.0%) male pupils in 218 schools passed blood in urine in one month out of 199,794 pupils interviewed. There was no statistically significant difference in the prevalence between male and female pupils with infection (p < 0.005). The prevalence of urinary schistosomiasis using questionnaire method correlated positively with the filtration method used in determining the egg output (r = 0.71, p < 0.001). Endemic schools were distributed in thirteen Local Government Areas of Cross River State, Nigeria. Yala and Yakurr LGAs had the highest number of schools that reported schistosomiasis with 39 (59%) and 13 (59%), respectively. Odukpani LGA had the lowest prevalence of 1 (0.2%). The overall results showed a mean urinary schistosomiasis prevalence of 10.2% for Cross River State, Nigeria. The findings of this study would guide Government and other relevant agencies in the implementation of control strategies for the treatment of urinary schistosomiasis in Cross River State, Nigeria.

Prevalence and risk factors of Schistosoma haematobium infections among primary school children in Igbokuta Village, Ikorodu North Local Government, Lagos State.

Background: Urinary Schistosomiasis (US) caused by Schistosoma haematobium constitutes a major public health problem in Nigeria. Efforts in this study were devoted to evaluate the current prevalence and associated risk factors on the intensity of disease burden. Methods: A survey was conducted with the use of semi-structured questionnaires to collect sociodemographic and anthropometric data of the pupils. Urine samples were collected from One hundred and two (102) pupils for microscopic analysis for the detection of S.haematobium eggs. Results: Of the 102 children (age ranges between 5-15 years) examined, prevalence of infection was (80/102) 78 % of which (44/102) 43 % were heavy and (36/102) 35 % mild while (22/102) 22 % were negative (p washing of clothes in streams > playing / bathing in rivers> unknown > mosquito bites > fresh water snail. No significant difference exists between the risk factors (p>0.05). The mean age, weight, height, waist circumference and hip circumference of the negative individuals (both males and females) were significantly higher than that of their positive counterpart (p 0.05). Similarly, there was no significant difference in the mean hip circumference of the heavy and mild infected male and female (p>0.05). Correlation analysis showed that there is significant correlation between infection status and age (r= 0.385, p>0.01), weight (r = 0.404, p>0.01), height (r=0.401, p>0.01), waist (r=0.396, p>0.01), hip circumference (r=0.415, p>0.01) and risk factor (r=-0.231, p>0.05). Risk factor is not significant to age, weight, height, waist, hip circumference and infection status (p>0.05). Conclusion: Prevalence rate obtained in the study was high, an indication that the region is endemic by WHO classification. This calls for an urgent effective urinary schistosomiasis control programme in the zone.

The epidemiology and control of urinary schistosomiasis and soil-transmitted helminthiasis in schoolchildren on Unguja Island, Zanzibar

As part of a 4-year control programme beginning in 2003 and entitled Piga Vita Kichocho, around 140,000 school-aged children on Unguja Island, Zanzibar were treated annually with a combination of praziquantel and albendazole. To provide information on the impact of this intervention, a subset of children, originating from 24 sentinel schools, were monitored in 2004, 2005 and 2006 using both parasitological and behavioural questionnaire methods. Overall, prevalence of urinary schistosomiasis fell by 52%, intensity by 55% and gross haematuria by 82%. There was a positive and statistically significant correlation between areas of elevated disease prevalence and areas of predicted high transmission based upon local occurrence of the permissive intermediate snail host. In areas of low transmission, urinary schistosomiasis was greatly reduced, but, by contrast, other intervention strategies are needed to complement and synergise with chemotherapy in high transmission areas. Whereas significant reductions were documented in the prevalence of both Trichuris trichiura and hookworm, prevalence of Ascaris lumbricoides significantly increased over the monitoring period. Through a detailed analysis of named child records, evidence of predisposition to helminth (re)infection and individual bias towards polyparasitism was detected, highlighting the often overlapping distribution of these parasites within the school-aged child.

Geographical information system and predictive risk maps of urinary schistosomiasis in Ogun State, Nigeria

BackgroundThe control of urinary schistosomiasis in Ogun State, Nigeria remains inert due to lack of reliable data on the geographical distribution of the disease and the population at risk. To help in developing a control programme, delineating areas of risk, geographical information system and remotely sensed environmental images were used to developed predictive risk maps of the probability of occurrence of the disease and quantify the risk for infection in Ogun State, Nigeria.MethodsInfection data used were derived from carefully validated morbidity questionnaires among primary school children in 2001–2002, in which school children were asked among other questions if they have experienced "blood in urine" or urinary schistosomiasis. The infection data from 1,092 schools together with remotely sensed environmental data such as rainfall, vegetation, temperature, soil-types, altitude and land cover were analysis using binary logistic regression models to identify environmental features that influence the spatial distribution of the disease. The final regression equations were then used in Arc View 3.2a GIS software to generate predictive risk maps of the distribution of the disease and population at risk in the state.ResultsLogistic regression analysis shows that the only significant environmental variable in predicting the presence and absence of urinary schistosomiasis in any area of the State was Land Surface Temperature (LST) (B = 0.308, p = 0.013). While LST (B = -0.478, p = 0.035), rainfall (B = -0.006, p = 0.0005), ferric luvisols (B = 0.539, p = 0.274), dystric nitosols (B = 0.133, p = 0.769) and pellic vertisols (B = 1.386, p = 0.008) soils types were the final variables in the model for predicting the probability of an area having an infection prevalence equivalent to or more than 50%. The two predictive risk maps suggest that urinary schistosomiasis is widely distributed and occurring in all the Local Government Areas (LGAs) in State. The high-risk areas (≥ 50% prevalence) however, are confined to scatter foci in the north western part of the State. The model also estimated that 98.99% of schools aged children (5–14 years) are living in areas suitable for urinary schistosomiasis transmission and are at risk of infection.ConclusionThe risk maps developed will hopefully be useful to the state health officials, by providing them with detailed distribution of urinary schistosomiasis, help to delineate areas for intervention, assesses population at risk thereby helping in optimizing scarce resources.

Focalisation de la transmission de Schistosoma haematobium au sein des périmètres irrigués de la vallée du Niger (Niger) : importance des facteurs malacologiques

Background Currently, the control of urinary schistosomiasis is mostly based on mass treatment. Characterization of Schistosoma haematobium transmission could lead to adding new methods to the control strategy. Methods We carried out malacological and cercariometrical surveys in irrigated perimeters of the Niger River valley. A semi-monthly follow-up was performed in three main sites of human-water contact in a village located at the border of the irrigated perimeter. Bulinids were collected during 20 min; after identification based on the shell morphology, their parasites were characterized by isoelectrofocalisation. The cercariometrical technique by differential filtration was used to evaluate the density of cercariae in every site with two 20 litres samples of water collected at various periods of the day (9, 12, 15 and 18 h). Results In the arm of the river, the cercariometry never showed cercariae whereas only some Bulinus truncatus, all negative, were collected. In the channels, B. truncatus and B. globosus were observed and highest density was found during the dry season. Only B. truncatus was naturally infested. Homozygote BB phenotype (characteristic of S. haematobium) was observed in all positive molluscs. Using cercariometry, more than two third of cercariae were collected at 3:00 PM. Conclusion Transmission of S. haematobium was primarily focused in the irrigating channels during the dry hot season at the beginning of afternoon. These results should lead to improve the output of S. haematobium control methods within irrigated areas.

Urinary schistosomiasis epidemiological survey of urinary schistosomiasis among children in selected schools: A preliminary study in Minna, Nigeria

The study was carried out in Minna Metropolis, between August and December, 2005, with a total of 387 school children interviewed and 217 urine samples analysed. This research employs the use of questionnaires, validation of questionnaires by urinalysis and the microscopic examination of the urine samples. The research is aimed at appreciating prevalent level of urinary schistosomiasis in Minna metropolis. The overall prevalence of urinary schistosomiasis, as confirmed by the presence of egg of Schistosoma haematobium was 12.9%, reported blood in the urine 34.4%, microhaematuria 52.5%, protenuria 32.7% and red blood cells 24.6%. The frequency of gross haematuria, and the degree of microhaematuria and proteinuria detectable by chemical reagent strips was observed to correlate with intensity of infection. The urinary schistosomiasis prevalence, confirmed by urine microscopy, of 12.9% in the selected school children within Minna, in spite its urban status, suggests that Minna is an endemic area, and the state requires an effective urinary schistosomiasis control programme. A major concern which represents a serious issue in the study includes the very poor level of awareness about the possible cause of urinary schistosomiasis or reported blood in the urine, as only 0.78% of the children have knowledge about the infection and 12% of the children that reported having blood in their urine have visited a health center.

Hemastix® is a useful diagnostic tool for urinary schistosomiasis control programs

Hemastix® is a useful diagnostic tool for urinary schistosomiasis control programs

School-based control of urinary schistosomiasis on Zanzibar, Tanzania: Monitoring micro-haematuria with reagent strips as a rapid urological assessment

Objective To evaluate micro-haematuria, detected by Haemastix ® reagent strips, for diagnosis of urinary schistosomiasis during a 3-year period of school-based control on Zanzibar. Patients and methods A sub-set of school children, from a total of 135,000 who were receiving treatment for urinary schistosomiasis and soil-transmitted helminthiasis, were monitored by parasitological and questionnaire methods for Schistosoma haematobium infections: at treatment baseline in 2004 ( n = 2002), follow up with re-treatment in 2005 ( n = 3278) and further follow up with re-treatment in 2006 ( n = 3993). Standard diagnostic scores for micro-haematuria were calculated against parasitological assessment. Results Diagnostic scores of Haemastix ® remained strong throughout the 3-year period. In 2006, scores were: sensitivity (SS) = 0.86 (95% CI: 0.86–0.88), specificity (SP) = 0.99 (0.98–1.00), positive predictive value (PPV) = 0.90 (0.88–0.91), negative predictive value (NPV) = 0.98 (0.98–0.99) in boys; and SS = 0.84 (0.82–0.86), SP = 0.98 (0.98–0.99), PPV = 0.77 (0.75–0.79) and NPV = 0.99 (0.99–1.00) in girls. By comparison, reported blood in urine and pain upon urination were much lower and not as informative. Conclusion At a cost of approximately £0.20/test, further use of reagent strips for monitoring of urinary schistosomiasis during ongoing control programmes should be advocated as a rapid, cost-effective and informative disease surveillance tool.

Control of urinary schistosomiasis on Zanzibar (Unguja Island): a pilot evaluation of the educational impact of the Juma na Kichocho health booklet within primary schools

To improve health education within primary schools, the health education booklet "Juma na kichocho" was evaluated during a study within 5 schools using key-informant questionnaires that recorded children's knowledge and attitude (KA) towards schistosomiasis before and after daily structured-use of booklets. A total of 229 schoolchildren (114 boys : 115 girls) of between 11 and 15 years of age were interviewed and re-assessed after a working school week. Existing and putative booklet-induced changes in KA scores for schistosomiasis were compared directly against equivalent KA scores for malaria. In total 47.4% of children were already aware that schistosomiasis was a water-borne disease while only 10.5% knew of its exact aetiology; after booklet intervention these levels increased to 54.6 and 15.7%, respectively. The majority of children still failed, however, to realise that re-infection could take place soon after treatment. While a positive increase was observed for children's total KA questionnaire scores for both malaria and schistosomiasis after booklet intervention, these were not statistically significant. In the context of control, further educational efforts are needed to promote and guide behavioural change, especially in relation to reduction of environmental water contact.

Long-term outcomes of school-based treatment for control of urinary schistosomiasis: a review of experience in Coast Province, Kenya

Urinary schistosomiasis remains a significant burden for Africa and the Middle East. The success of population-based control programs will depend on their impact, over many years, on Schistosoma haematobium reinfection and associated disease. In a multi-year (1984-1992) control program in Kenya, we examined risk for S. haematobium reinfection and late disease during and after annual school-based treatment. In this setting, long-term risk of new infection was independently associated with location, age, hematuria, and incomplete treatment, but not with sex or frequency of water contact. Thus, very local environmental features and age-related factors played an important role in S. haematobium transmission, such that population-based control programs should optimally tailor their efforts to local conditions on a village-by-village basis. In 2001-2002, the late benefits of earlier participation in school-based antischistosomal therapy were estimated in a cohort of formerly-treated adult residents compared to never-treated adults from the same villages. Among age-matched subjects, current infection prevalence was lower among those who had received remote therapy. In addition, prevalence of bladder abnormality was lower in the treated group, who were free of severe bladder disease. Treatment of affected adults resulted in rapid resolution of infection and any detectable bladder abnormalities. We conclude that continued treatment into adulthood, as well as efforts at long-term prevention of infection (transmission control) are necessary to achieve optimal morbidity control in affected communities.

Urinary Schistosomiasis Control Programme: a case study of some selected school children in the Lower Volta Basin

A Schistosomiasis Control Programme was initiated in selected communities in the Lower Volta Basin among school children to assess the disease situation 30 years after the construction of the Akosombo Dam. It combined two tools, chemotherapy and health education. The work was carried out in selected communities in the Lower Volta Basin (Asutsuare, Adidome, Tsetsekpo, Agbeve, Dalive, Mepe, Big Ada and Ada Foah) from October 1997 to October 1998. Prevalence rates were first determined before selective chemotherapy; the gains of chemotherapy were maintained with health education which involved the use of a song and picture booklet. Prevalence rates at baseline of 3.6 - 41.7 per cent were reduced to 0.0-15.6 per cent after chemotherapy, showing a cure rate of 80-84 per cent. The parameters after baseline studies were investigated 3, 6 and 9 months after intervention. A combination of chemotherapy, using praziquantel and health education, has proven to be successful in controlling schistosomiasis in the Lower Volta Basin area. Ghana Journal of Science Vol. 45, 2005: 3-8

Impact of school health programme on urinary schistosomiasis control in schoolchildren in Kilosa, Tanzania

1996).Thus interventions aimed at school-aged childrenfocusing on delivery through schools are stronglyencouraged (WHO, 1993). School-basedprogrammes provide an infrastructure for deliveringtreatment against geohelminths and schistosomiasis(PCD, 1999). Such programmes have been shown toimprove health and well-being of schoolchildren inTanzania (Guyatt

Urinary schistosomiasis on Zanzibar: application of two novel assays for the detection of excreted albumin and haemoglobin in urine

As part of a urinary schistosomiasis control programme on Zanzibar, an aged cross-sectional survey of 305 children from three schools on Unguja was conducted to investigate the relationships between levels of excreted albumin and haemoglobin in urine and Schistosoma haematobium infection status. Diagnosis was determined by standard parasitological methods, dipstick reagents for microhaematuria, visual inspection for macrohaematuria as well as collection of case-history questionnaire data for self-diagnosis. Prevalence of infection as determined by parasitology was 53.9% and approximately, one quarter of the children examined were anaemic (<11 g dl(-1)). A statistically significant negative association of blood haemoglobin levels of boys and S. haematobium infection intensity status was observed (rs=-0.23, P=0.005). Through sensitivity analysis of urine-albumin values it was determined that a concentration of above >40 mg l(-1), as measured with the HemoCue urine-albumin photometer, had sensitivity, specificity, positive and negative predictive values of 0.90, 0.83, 0.86 and 0.89 respectively against 'gold-standard' parasitology. There was a clear association of reported pain upon micturition for children with elevated urine-albumin levels, with an odds ratio of 20 to 1. Levels of excreted blood in urine were quantified with the HemoCue Plasma/Low Hb photometer. However, dipsticks remain the method of choice for urine-haemoglobin of 0.1 g l(-1) and below. Urine parameters over a 24-h period were assessed in a small sub-sample. Reductions in both albumin and haemoglobin excretion were observed in 11 children 54 days after praziquantel treatment. It was concluded that these rapid, high-through-put, portable HemoCue assays could play a role in better describing and monitoring the occurrence, severity and evolution of urinary schistosomiasis disease. The urine-albumin assay has particular promise as a biochemical marker of S. haematobium induced kidney- and upper urinary tract-morbidity.

Health education strategy in the control of urinary schistosomiasis.

The purpose of this study was to determine the impact of health education intervention on the perception and prevalence of urinary schistosomiasis among school children in endemic rural communities in Cameroon. The rapid assessment technique method was used to determine the prevalence of Schistosoma heamatobium infection in Gounougou (experiment 1), Ouro-Doukoudje (experiment 2), and Lagdo (control). There was a positive correlation between the questionnaire approach, the biochemical testing, and ova detection rate (r dispersed between 0.98 and 1.00) In the first phase of the study, after collection of the baseline data, school children of the experimental villages recieved health education. Unlike in Gounougou where children were given a predesigned control procedure, those in Ouro-Doukoudje were asked to design their own control procedure under the supervision of the investigators. A second investigation conducted eight months after the end of the first intervention showed a significant drop of prevalence in Gounougou (53.2% vs 29.6%, p <0.0005) and Ouro-Doukoudje (39.4% vs 17.7%, p < 0.0005) but not in Lagdo (31.4% vs 30.4%, p>0.25). It also showed a significant increase of the awareness in Gounougou (14.5% vs 94.7%, p<0.0005) and Ouro-Doukoudje (4.5% vs 98.5%, p<0.0005) but not in Lagdo (18.4% vs 19.4%, p>10); with the greater increase in Ouro-Doukoudje (94.0%) as compared to Gounougou (80.2%, p<0.05). The investigators concluded that health education through the framework of school could be adopted as a national policy for urinary schistosomiasis control programs in tropical developing countries, planned with school children as full partners, proveded they recieve appropriate orientation.