Schistosomiasis In Schoolchildren Research Articles

Awareness towards urinary schistosomiasis and its relation with active infection among primary school pupils and students in North Kordofan state, Sudan 2022

ObjectivesThis study intends to evaluate the prevalence of active Schistosomiasis in school children, as well as their awareness, attitude, and behavior towards the illness in El-Rahad province. MethodsThis facility-based analytical cross-sectional study among 495 primary school children aged seven to 13 in five villages; Structured and pre-tested questionnaires were used to collect the data in face-to-face interviews, in addition, urine samples were collected from each pupil and then assessed microscopically for S. Haematobium eggs Presence. Data was analyzed using SPSS version 25.0. ResultsA total of 424 primary school students participated in the study. Almost all the students (96%) had poor knowledge about urinary schistosomiasis. In general, 100% of the students had poor practices. Attitude revealed that females have lower chance of having the infection than their male counterparts. About 27% (n = 115) of them had active urinary schistosomiasis infection at the time of the study. ConclusionThe study revealed poor level of awareness and knowledge, positive attitude, and poor practices among primary school students. There was also high level of active infection among participants.

Effect of environmental factors in reducing the prevalence of schistosomiasis in schoolchildren: An analysis of three extensive national prevalence surveys in Brazil (1950-2018).

Over seven decades, Brazil has made admirable progress in controlling schistosomiasis, and a frequent question about the explanation for this reduction refers to the effect of improving environmental factors in the country. This article seeks to identify factors related to the change in the epidemiological situation of schistosomiasis mansoni infection by analyzing three national prevalence surveys conducted since 1950. This is an ecological study analyzing an unbalanced panel of data based on national surveys and considering the municipality as the unit of analysis. The sample consisted of 1,721 Brazilian municipalities, in which a total of 1,182,339 schoolchildren aged 7-14 were examined during the three periods corresponding to each survey (1947-1953, 1975-1979, and 2010-2015). The percentage of municipalities with zero cases of schistosomiasis was: 45.4%, 54.2% and 73.7%, respectively for those periods. A zero-inflated Poisson regression model, with fixed and random effects, was fitted to assess the association between candidate factors and disease prevalence using a significance level of 5%. There was a significant decrease in disease prevalence between the first and last periods analyzed (RR 0.214, CI 0.184-0.249), with a protective association with access to sanitation (RR 0.996, CI 0.994-0.998), urbanization (RR 0.991, CI 0.989-0.993), and living in own households (RR 0.986, CI 0.983-0.989); and an inverse association with piped water supply (RR 1.010, CI 1.008-1.011). The findings of this study indicate a decrease in the prevalence of schistosomiasis over seven decades in schoolchildren from the analyzed Brazilian municipalities, associated with environmental factors and social conditions. The increased access to piped water in the municipalities apparently triggers other ways of contact with unsafe water bodies, generating new transmission routes and suggesting the need for a systemic approach concerning contact with water.

Sustainable Elimination of Schistosomiasis in Ethiopia-A Five-Year Follow-Up Study.

In 2009, Mekele, the capital of the Tigray Region in Ethiopia, presented a mean prevalence of 44.7% of schistosomiasis (S. mansoni) in school children. Termed a public health problem, NALA, an international public health non-governmental organization, and their partners implemented a novel model of intervention, which aimed to compliment mass drug administration (MDA) campaigns with behavioral change (BC) and improved sanitation to achieve sustained elimination of schistosomiasis. The four-year intervention (2009–2012) covered 38 primary schools. The objective of this study was to examine factors associated with control or resurgence of the disease, and the association between the behavioral change program and disease prevalence, ten years after initiation. Eleven primary schools were selected for this follow-up study. All students provided a stool sample and filled in a knowledge, attitude and practice (KAP) questionnaire. In seven out of eleven schools (63.6%) the prevalence of schistosomiasis was maintained below 2% ten years after the initiation of the intervention. In four schools, prevalence returned to pre-intervention levels, defining them as persistent hot spots (PHS). Students from PHS schools scored lower on KAP questionnaires compared to students from responder schools; 3.9 ± 0.9 vs. 4.2 ± 0.9 (p-value < 0.001) for practice questions and 4.4 ± 1.4 vs. 4.6 ± 1.5 (p-value = 0.03) for attitude questions. The prevalence of schistosomiasis correlated positively with age, (p-value = 0.049), sex (relative risk = 1.7, p-value < 0.001), and location. Semi-urban locations (n = 382) had higher disease prevalence than urban locations (n = 242), (22.7% vs. 5.5%, p-value < 0.001). Students residing in semi-urban areas and close to a river (<500 m) were at higher risk of contracting schistosomiasis than those living in urban areas far from the river (RR = 5.95, p-value < 0.001). Finally, a correlation between prevalence and proximity of schools to rivers was found (semi-urban areas; RR = −0.91, p-value = 0.001 vs. urban areas; RR = −0.51, p-value = 0.001). Soil-transmitted-helminths prevalence in 2009 was 8.1% and declined during the intervention years to 0.5%. Prevalence in 2018 was found to be stable at 0.8%. These results demonstrate the long-term success of NALAs’ comprehensive model of intervention for elimination of schistosomiasis in school children, combining behavioral change and improved sanitation with MDA.

Schistosoma mansoni Epidemiology Among Snails, Rodents and Children: A One Health Approach.

BackgroundSchistosoma is one of the prevalent parasitic infection in humans and animals. Schistosomiasis in children is particularly serious and results in liver and spleen enlargement, anemia, stunting, reduced ability to learn and death. The aim of this study was to measure the prevalence and distribution of schistosomiasis in children, rodents and snail populations in Aleffa and Takusa districts, north-west Ethiopia.MethodsDisease status and exposure were simultaneously measured from December 2020 to December 2021. School children's stool specimens were collected for schistosomiasis examination by Kato Katz and formal-ether techniques. Live rodents and snails were trapped and collected in search of adult schistosoma, eggs, and cercariae, respectively. Multiple logistic regression analytic technique by using SPSS version 20 was conducted.ResultsOf 460 stool specimens examined, 116 (25.22) were found positive for S. mansoni infection. In the present finding, the possible determinants for the occurrence of intestinal schistosomiasis in school children were female sex (AOR = 1.09, 95% CI: 1.37–2.96); working with bare foot (AOR = 1.21, 95% CI: 1.08–1.52); skin cut/abrasion history (AOR = 3.6, 95% CI: 1.08–7.43) and swimming habit (AOR = 1.58, 95% CI: 1.33–1.99). The overall (n = 108) rodent prevalence of S. mansoniwas 23 (21.3%). Only 6 snails were shedding the infective stage of schistosoma cercariae.ConclusionThe study revealed that there is a moderate prevalence of schistosomiasis in different hosts. Thus, multi-host intervention is crucial to achieving the goal of interrupting transmission of schistosomiasis in the study area. Further research to better understand and exploit the broader environmental, ecological context and encompassing dynamic interactions between all hosts over time will be crucial for building predictive models beyond the known fact of having or not having reservoirs/hybridization of schistosoma in our study area.

Urogenital schistosomiasis prevalence and diagnostic performance of urine filtration and urinalysis reagent strip in schoolchildren, Ethiopia.

BackgroundUrogenital schistosomiasis has been known to be endemic in several lowland areas of Ethiopia. It is caused by Schistosoma haematobium and causes considerable public health problems to schoolchildren. Ethiopia, after mapping the distribution of the disease (2013 to 2015), launched school-based mass deworming program to treat schoolchildren for schistosomiasis and soil-transmitted helminthiasis (STH) across the country since 2015. However, there is no recent information about the prevalence of the disease among schoolchildren in the current study areas. Diagnostic performance of urine filtration method and urinalysis reagent strip is also lacking. Therefore, this study aimed to determine the prevalence of urogenital schistosomiasis in schoolchildren, and to evaluate diagnostic performance of urine filtration and urinalysis reagent strip in Amibara, Kurmuk and Abobo districts, Ethiopia.MethodsAcross-sectional study was conducted involving 1,171 schoolchildren in Abobo, Amibara and Kurmuk districts from October, 2020 to January, 2021. The study participants were selected using random sampling technique. From each study participant, 10 ml urine samples were collected and examined using urine filtration method and urinalysis reagent strip. Data obtained from the survey were entered into Microsoft Excel 2010 and analysed with SPSS version 20.0. Data was summarized using descriptive statistics. Chi-square, bivariate and multivariable logistic regression and Pearson correlation test were used to measure associations between urogenital schistosomiasis, age, sex and haematuria. Odds ratio was used to measure strengths of association between variables. Agreement between urine filtration method and urinalysis reagent strip was determined using Kappa statistics. P-value < 0.05 at 95% CI was considered as statistically significant.ResultsAmong the 1,171 urine samples from schoolchildren examined by urine filtration method, 143 (12.2%) were S.haematobium egg positive. Out of 143 positive children 126(88.1%) were lightly infected and 17 (11.9%) were heavily infected. Among the total of 1,171 urine samples tested by dipstick, 264(22.5%) were positive for haematuria. Prevalence of urogenital schistosomiasis by both urine filtration and urinalysis reagent strip method was higher in Abobo than Hassoba (Amibara) and Kurmuk (P< 0.001). The number of egg counts (intensity of infections) were significantly correlated with intensity of haematuria (r = 0.6, P < 0.001). Egg-positive children had significantly higher risk of having haematuria compared to S. haematobium egg negative children (OR; 6.96; 95%CI: 4.98, 8.940). Compared to urine filtration method, the sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of urinalysis reagent strip were 99.3%, 88.1%, 53.8% and 99.8%, respectively. Furthermore, its positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 8.34 and 0.008, respectively. The accuracy index and diagnostic odds ratio (DOR) of reagent strip were 0.89 and 1054, respectively. The agreement level between urine filtration methods and urinalysis reagent strip for detecting urogenital schistosomiasis was substantial (Kappa = 0.64).ConclusionThis study showed that urogenital schistosomiasis was prevalent in schoolchildren in Abobo, Hassoba and Kurmuk districts. Urogenital schistosomiasis prevalence in Hassoba-bure and Kurmuk falls under low category whereas moderate in Abobo and is almost four times compared to Kurmuk and Hassoba-bure. Chemotherapy is needed in schoolchildren in such endemic areas and other measures like access to safe water, improved sanitation, hygiene, and health education should be implemented to control and prevent schistosomiasis effectively. The sensitivity, specificity, positive and negative predictive values of urinalysis reagent strip were higher and could serve as alternative for mass screening of urogenital schistosomiasis, for surveillance and evaluation of schistosomiasis intervention programs.

Impact of a Novel, Low-Cost and Sustainable Health Education Program on the Knowledge, Attitudes, and Practices Related to Intestinal Schistosomiasis in School Children in a Hard-to-Reach District of Madagascar.

ABSTRACT.Schistosomiasis control requires multisectoral approaches including praziquantel treatment, access to safe water, sanitation and hygiene, and health education. Community input can help ensure health education programs are culturally appropriate to effectively direct protective behavior change. This study reports on the three-stage development of an education program for Malagasy children, with an impact evaluation on their knowledge, attitudes, and practices (KAP) related to intestinal schistosomiasis. A cross-sectional study took place in 2017 with follow-up in 2018 in the hard-to-reach Marolambo district, Madagascar. A novel schistosomiasis education program (SEP) was designed in collaboration with researchers, stakeholders, and local community and included cartoon books, games, songs, puzzles, and blackboard lessons, costing $10 USD per school. KAP questionnaires were completed by 286 children pre-SEP and 273 children post-SEP in 2017, and by 385 and 337 children pre-SEP and post-SEP, respectively, in 2018. Improvements were observed in responses to all questions between pre- and post-education answers in 2017 (53–77%, P < 0.0001) and 2018 (72–98%, P < 0.0001) and in the pre-education answers between years (53–72%, P < 0.0001). Praziquantel mass drug administration attendance improved, rising from 64% to 91% (P < 0.0001), alongside improved latrine use, from 89% to 96% (P = 0.005). This community-consulted and -engaged SEP resulted in substantial improvements in children’s understanding of schistosomiasis, with improvements in praziquantel uptake and latrine use. Socioculturally tailored education programs can help gain schistosomiasis control. Continued investment in SEP will help promote the future well-being of children through increased participation in control and treatment activities.

Schistosomiasis Burden and Its Association With Lower Measles Vaccine Responses in School Children From Rural Cameroon.

Background and Methods: Schistosomiasis is debilitating and reported to impair immune responsiveness of infected hosts. In Cameroon, mass drug administration (MDA) is used in schoolchildren to reduce transmission of S. haematobium and S. mansoni. The effects of MDA and the impact of schistosomiasis on the titers of antibodies in vaccinated children have been poorly studied. We therefore assessed the prevalence of schistosomiasis in schoolchildren, eight months after MDA, in two locations: Barombi Koto (BK), endemic for S. haematobium (N = 169) and Yoro (Y), endemic for S. mansoni (N = 356). Age, gender, residence time and frequency of contact with river water were assessed as risk factors for infection and morbidity in both localities. In 70 schoolchildren from BK and 83 from Y, ultrasound was used to assess morbidity according to the WHO guidelines. Evaluation of measles antibodies was performed in previously vaccinated schoolchildren (14 with S. haematobium and 12 egg-negative controls from BK and 47 with S. mansoni and12 egg-negative controls from Y).Principal Findings and conclusions: The prevalence of S. haematobium was 25. 4% in BK (43/169) and 34.8% for S. mansoni in Y (124/356), indicating the persistent transmission of schistosomiasis despite MDA. Older age (AOR 1.31; 95%CI 1.12–1.54) and higher frequencies of exposure to river water (AOR 1.99; 95%CI 1.03–3.86) were identified as risks for infection in BK whereas only older age (OR 1.15; 95%CI 1.04–1.27) was a risk for infection in Y. Bladder pathology (score 2 to 5) was observed in 29.2% (7/24) of egg-positive children in BK and liver pathology (pattern C) in 31.1% (19/61) of egg-positive children in Y. There was a positive correlation between S. haematobium egg burden and bladder pathology (AOR 1.01; 95% CI 0.99–1.02) and positive correlation between S. mansoni-driven liver pathology and female gender (AOR 3.01; 95% CI 0.88–10.26). Anti-measles antibodies in vaccinated children were significantly lower in S. mansoni-infected when compared to egg-negative controls (p = 0.001), which was not observed in the S. haematobium-infected group from BK. Our results demonstrate a questionable efficacy of MDA alone in halting schistosomiasis transmission and confirm a possible immunomodulatory effect of S. mansoni on response to vaccines.

Development and testing of Schisto and Ladders\u2122, an innovative health educational game for control of schistosomiasis in schoolchildren

BackgroundSchistosomiasis remains a public health problem in many regions of the world, including Nigeria. Current control strategy involves mass drug administration with praziquantel to the endemic population. To complement and sustain on-going preventive chemotherapy, we developed a health educational game named Schisto and Ladders™ and tested its potential for the control of schistosomiasis among schoolchildren living in Imala-Odo, a highly endemic community near Abeokuta, Nigeria.MethodsOne hundred school children were randomly selected and divided into intervention and control groups through balloting. Their knowledge, attitudes and practices (KAP) concerning schistosomiasis transmission, control and prevention were assessed using structured questionnaires. Schisto and Ladders™ game were given to the intervention group and the popular Snake and Ladders™ game to the control group. Both games were played for 2 months under the supervision of their class teachers. A post-KAP assessment was carried out in both groups, including focus group discussions (FGDs) to investigate knowledge and the impact of the games.ResultsKnowledge about urinary schistosomiasis and its transmission significantly improved (P = 0.000) in the intervention group (68.0%) compared to the control group (8.0%). FGDs showed that the frequency of visits to dam water also significantly reduced (P = 0.048) in the intervention group (18.0%) compared to the control group (40.0%). There was a significant increase in knowledge regarding risk behaviours, prevention and control of schistosomiasis among the intervention group, but no new knowledge gained in the control group.ConclusionsThis study demonstrates the potential of the health education game Schisto and Ladders™ for teaching basic health education and promoting behavioural changes among schoolchildren in endemic communities.

Urinary schistosomiasis in school children of a southern nigerian community 8 years after the provision of potable water.

Urinary schistosomiasis, one of the neglected tropical diseases, is a major infection of public health importance in Nigeria. Control measures include the provision of potable water as the main strategy, population-based chemotherapy and health education. The aim of this study was to determine the effect of the provision of potable water on the prevalence and intensity of infection with Schistosoma haematobium in Adim community, Cross River State, Nigeria. A cross-sectional survey was carried out among school and children aged 5-14 years in Adim community in Cross River State using the polyamide millipore filter technique and ova detection and count compared with the situation that obtained 8 years earlier before the provision of potable water. The prevalence and intensity of haematuria and proteinuria by reagent strips were also compared between the two eras. The prevalence of schistosomiasis was 14.5% compared to 51% in the prepotable water era (P = 0.001). The intensity of the infection was also significantly reduced between the two eras with 1.3% of the children having a severe intensity compared to 4.5% in the prepotable water era. The prevalence and intensity of S. haematobium have significantly reduced in this community though not yet eliminated. More boreholes need to be provided to make the water more accessible. This could be combined with other measures to eradicate S. haematobium from this community.

Impact of praziquantel mass drug administration campaign on prevalence and intensity of Schistosoma haemamtobium among school children in Bahi district, Tanzania.

As part of the Tanzania National Schistosomiasis Control Programme, Bahi district in central Tanzania, received two annual rounds of praziquantel mass drug administration (MDA) to control urinary schistosomiasis in schoolchildren. The objectives of this study were to assess the impact of the two rounds of MDA on prevalence and intensity of Schistosoma haemamtobium and the impact of MDA campaigns on knowledge of urinary schistosomiasis, safe water use and contact with potentially unsafe water bodies. A quantitative cross-sectional study was carried out among schoolchildren in March and April, 2013. A structured questionnaire was used to collect information on MDA uptake, knowledge of schistosomiasis, sources of water for domestic and other uses. Urine samples were collected from each pupil to examine prevalence and intensity of S. haematobium. Transmission of schistosomiasis was assessed by sampling Bulinus spp snails for cercarial shedding. Uptake of MDA was 39.5% in 2011 and 43.6% in 2012. Prevalence of S. haematobium significantly dropped by 50.0% from 26% in 2011 to 15% in 2012 (p = 0.000). Prevalence of S. haematobium was significantly low in MDA participating (3.1%) than non-participating (28.5%) schoolchildren (p = 0.000). MDA campaigns had significant impact on knowledge of the disease (p = 0.02) and borderline impact on safe water use (p = 0.04) but had no impact on avoidance of contact with unsafe water bodies (p = 0.06). Bulinus spp. snails were found shedding schistosome cercariae indicating environmental contamination with viable S. haematobium eggs. In conclusion, though MDA significantly reduced prevalence of S. haematobium, uptake was below 50.0% and below the World Health Assembly resolution 54.19 target of 75.0% for 2010. Non-participation in MDA was the likely source of S. haematobium eggs in the environment hence the observed 15.0% prevalence of S. haematobium infection; and cercarial shedding Bulinus spp. snails indicating continuity of transmission hence the need for further health promotion campaigns.

Proteinuria as a Morbidity Marker of Urinary Schistosomiasis in School Children Living in Onchocerciasis Endemic Areas of Benue State, Nigeria

Proteinuria is an indirect marker of urinary schistosomiasis in endemic areas but cases of misdiagnosis could occur in areas where other diseases that produce proteinuria overlap with urinary schistosomiasis. The study was conducted to assess whether proteinuria measured by urine reagent strips could be used as a rapid screening technique of urinary schistosomiasis in onchocerciasis endemic areas. Urine reagent strips and filtration technique were used to screen proteinuria and to determine Schistosoma haematobium eggs in 1,124 school children respectively. Our findings demonstrate that proteinuria positively correlated with intensity of infection (rho=0.71, p<0.01), highly sensitive (95.7%) and moderately specific (67.7%). We suggest that measuring proteinuria using urine reagent strips may be useful for diagnostic purposes, monitoring and evaluating urinary schistosomiasis in onchocerciasis endemic areas. Furthermore, we recommend that additional research should be done to further elucidate the relationship between proteinuria and pathological changes of the urinary tract that may be attributed to infection with Schistosoma haematobium in onchocerciasis endemic areas.

The role of artesunate for the treatment of urinary schistosomiasis in schoolchildren: a systematic review and meta-analysis

Objective: Efficacy of artemisinin derivatives alone or in combination compared to praziquantel alone for the treatment of urinary schistosomiasis in schoolchildren.Methods: Randomized clinical trials comparing praziquantel with artemisinin derivatives in the treatment of urinary schistosomiasis in schoolchildren were included. Medline, EMBASE, LILACS, CENTRAL, African Index Medicus, and Scielo were searched. We also analyzed the abstracts of the main conferences on infectious diseases and tropical medicine during the years 2009–2011. Google Scholar and OpenSIGLE were also searched. The last search was performed in July 2012. The primary endpoint was the cure rate. The main outcome data were retrieved using a standardized form; three independent researchers (WP, HC, and SS) performed the search, retrieved data, and evaluated the risk of bias. Disagreements were resolved by discussion. Risk ratios were used and heterogeneity was evaluated. A fixed or random-effects model was used according to the results of heterogeneity testing. An intention-to-treat analysis was done. Data were analyzed using Revman 5·0·24 (Copenhagen: The Nordic Cochrane Centre).Results: Seven studies were selected for full text review and only five studies were finally included. The cure rate for praziquantel was superior to that of artesunate (RR: 1·66; 95% CI: 1·18–2·33). Artesunate was not clearly superior to placebo (artesunate versus placebo, RR: 3·21; 95% CI: 0·50–20·74). Combination of artesunate with praziquantel could prove more beneficial than praziquantel alone (RR: 1·15; 95% CI: 1·01–1·31). The frequency of adverse events was equivalent for both drugs (praziquantel versus artesunate, RR: 1·11; 95% CI: 0·80–1·55).Conclusions: Our meta-analysis showed that praziquantel was significantly more effective than artesunate for the treatment of urinary schistosomiasis in schoolchildren. Artesunate at best had a marginal role in combination therapy.

Coinfection with Malaria, Hookworm and Schistosomiasis among School Children in Zambezi: A School-based Rapid Survey

Introduction: A school based rapid survey was conducted th th from the 17 to the 19 of May 2011in Zambezi District of Zambia to determine the prevalence and coinfection rate of malaria, hookworm and schistosomiasis in schoolchildren in other to inform decision maker. Methodology: The study design, sampling methods, sample collection and processing used have been described in WHO's guidelines for the evaluation of soiltransmitted helminthiasis and schistosomiasis at community level. Additionally height, weight and haemoglobin were measured and malaria screened. Results: We report high prevalence of parasitic infections in schoolchildren in Zambezi district with 79.4% (n = 253; 95% CI: 74.1% - 84.1%) of the children tested positive at least to one parasitic infection. Estimated prevalence of malaria, hookworm, haematuria, S. haematobium, S. mansoni, and E. vermicularis were 50.6% (95% CI: 44.5-56.6%), 42.4% (95% CI: 36.448.5%), 37.9% (95% CI: 32.2-43.9%), 29.5% (95% CI: 24.2-35.2%), 14.5% (95% CI: 10.6-19.2%), and 1.2% (95% CI: 0.3-3.2%) respectively. Generally these were low intensity infections with the exception of S. haematobium. High prevalence of anaemia (46%; 95%CI: 40-52.1) and nutritional deficiency (79.1%; 73.983.7) were also detected. The prevalence of multiparasitism was 44.3% (95%CI: 38.2-50.4%) representing 55.7% of all parasitic infections.

Effect of Mass Chemotherapy with Praziquantel on the Prevalence of Schistosomiasis in School Children in Langai Community of Plateau State

Background: One of the main control measures for Schistosomiasis in Nigeria is mass chemotherapy with Praziquantel tablets in areas where the disease is prevalent. This study was carried out to determine the effect of drug treatment with Praziquantel on the prevalence of urinary and intestinal Schistosomiasis among school children. Methodology: Multi-staged sampling technique was used to select 218 school children. A structured interviewer administered questionnaire was used to gather data from the children; their urine and stool samples were assayed for Schistosoma haematobium and Schistosoma mansoni ova using the sedimentation method, before and after drug treatment with orally administered Praziquantel tablets at 40mg/kg body weight. Results: Before treatment with Praziquantel tablets, 14 subjects (6.4%) had S. haematobium ova in their urine samples while 17 subjects (7.8%), had S. mansoni ova in their stool samples. Male subjects of the ages 10-14year old had the highest prevalence of the disease. Six weeks after treatment, the prevalence of urinary schistosomiasis had been significantly reduced (with P = 0.03 and 0.05 respectively) to 0.5% in the studied population (cure rate of 92.9%) while that of intestinal schistosomiasis was 1.4% (cure rate of 82.4%). Conclusion: It was concluded that the prevalence of urinary and intestinal schistosomiasis among school children in Langai pre-intervention was 6.4% and 7.8 % respectively and drug treatment with Praziquantel, reduced these to 0.5% and 1.4% respectively. Praziquantel was also more effective in reducing the prevalence of urinary than intestinal schistosomiasisKey Words Prevalence, Schistosoma haematobium, Schistosoma mansoni, Praziquantel, Effectiveness

A simple approach improving the performance of urine reagent strips for rapid diagnosis of urinary schistosomiasis in Nigerian schoolchildren

In Nigeria, schistosomiasis, caused predominantly by the species Schistosoma haematobium, is highly endemic in resource-poor communities. We performed a school-based survey in two rural communities in Osun State (Southwestern Nigeria) and assessed macrohaematuria, microhaematuria and proteinuria as indirect indicators for the presence of disease. Urine samples were inspected macroscopically for haematuria and screened for microhaematuria and proteinuria using urine reagent strips. The microscopic examination of schistosome eggs was used as the gold standard for diagnosis. In total, 447 schoolchildren were included in this study and had a 51% prevalence of urinary schistosomiasis. The sensitivity of microhaematuria (68%) and proteinuria (53%) for infection with S. haematobium was relatively low. In patients with a heavy infection (>or= 500 eggs/10 mL), the sensitivity of microhaematuria was high (95%). When the presence of macrohaematuria and the concomitant presence of microhaematuria and proteinuria were combined, it revealed a sensitivity of 63%, a specificity of 93% and a positive predictive value of 91%. Macrohaematuria also showed high specificity (96%) and a positive predictive value of 92%, while sensitivity was < 50%. These data show that combining urine reagent strip tests (presence of proteinuria and microhaematuria) and information on macrohaematuria increased the accuracy of the rapid diagnosis of urinary schistosomiasis in an endemic rural West African setting. This simple approach can be used to increase the quality of monitoring of schistosomiasis in schoolchildren.

An evaluation of urine-CCA strip test and fingerprick blood SEA-ELISA for detection of urinary schistosomiasis in schoolchildren in Zanzibar

To develop better monitoring protocols for detection of urinary schistosomiasis during ongoing control interventions, two commercially available diagnostic tests – the urine-circulating cathodic antigen (CCA) strip and the soluble egg antigen enzyme-linked immunosorbent assay (SEA-ELISA) – were evaluated for detection of Schistosoma haematobium infections in 150 schoolchildren from Zanzibar. The children originated from five primary schools representative of different levels of disease endemicity across the island; using standard urine filtration assessment with microscopy, mean prevalence of S. haematobium was 30.7% (95% confidence interval (CI) = 23.4–38.7%) and a total of 35.3% (95% CI = 27.7–43.5%) and 8.0% (95% CI = 4.2–13.6%) children presented with micro- and macro-haematuria, respectively. Diagnostic scores of the urine-CCA strip were not satisfactory, a very poor sensitivity of 9% (95% CI = 2–21%) was observed, precluding any further consideration. By contrast, the performance of the SEA-ELISA using sera from fingerprick blood was good; a sensitivity of 89% (95% CI = 76–96%), a specificity of 70% (95% CI = 60–79%), a positive predictive value of 57% (95% CI = 45–69%) and a negative predictive value of 90% (95% CI = 86–98%) were found. At the unit of the school, a positive linear association between prevalence inferred from parasitological examination and SEA-ELISA methods was found. The SEA-ELISA holds promise as a complementary field-based method for monitoring infection dynamics in schoolchildren over and above standard parasitological methods.

Epidemiological profile of the schistosomiasis in school children in the Agneby Region (south-east of Côte-d'Ivoire)

A parasitological survey was conducted in the Agnéby region (south-east Côte-d'Ivoire) from November 2000 to February 2001 in order to establish the epidemiological profile of schistosomiasis in school children in this region. Stools and urines of 724 school children were examined. Faeces were examined by direct analysis completed by Kato and Ritchie methods. Analysis of urine samples was made through the technique of centrifugation (2.000 g for 10 minutes). This survey revealed the importance of schistosomiasis. 20.6% of the subjects were found carriers of Schistosoma mansoni eggs, 12.6% carriers of Schistosoma haematobium eggs and 3.2% were found carriers of eggs of two Schistosoma species. Prevalence was higher in Adzope than in Agboville and Schistosoma mansoni was globally prevalent. Males were significantly more infected than females and older children were more infected than young children. The prevalence distribution among people could be explained by behaviour and occupations.

Prevalence and Intensity of Schistosomiasis in School Children in a Large Sugar Irrigation Estates of Zimbabwe

Prevalence and Intensity of Schistosomiasis in School Children in a Large Sugar Irrigation Estates of Zimbabwe

A six-year follow-up of schoolchildren for urinary and intestinal schistosomiasis and soil-transmitted helminthiasis in Northern Tanzania

Two cross-sectional studies with a 6-year interval were undertaken in two primary schools in neighbouring villages in Mwanga District, Tanzania, to determine the prevalence of schistosome and soil-transmitted helminth infections before and 6 years after treatment. Within this interval, health-related interventions such as one mass treatment of the villagers, health education, improvement of sanitation and access to safe water were undertaken in the villages. In 1996, urinary schistosomiasis occurred in Kileo ( n = 284) and Kivulini ( n = 350) in 37.0 and 86.3% of the schoolchildren. Intestinal schistosomiasis was found in 22.9 and 43.5% of the children. The infection with soil-transmitted helminths ranged between 2.7 and 18.1% in both villages. After 6 years, the prevalence of urinary schistosomiasis in schoolchildren remained nearly constant in Kileo (33.5%; n = 544), but dropped from 86.3% to 70.0% in Kivulini ( n = 514). In the latter village the proportion of children heavily infected with Schistosoma haematobium (≥50 eggs/10 ml urine) decreased from 53.8% to 34.4%. With the exception of hookworm infection, soil-transmitted helminthiasis and intestinal schistosomiasis were significantly less seen in 2002 compared to the baseline. The previous chemotherapy of schoolchildren and villagers in 1996 and 1998, respectively, might have led to a reduced transmission of schistosomiasis in the following years. However, the reduction of prevalence of soil-transmitted helminthiasis is more likely to be the result of health-related interventions.

Urinary schistosomiasis in schoolchildren on Zanzibar Island (Unguja), Tanzania: a parasitological survey supplemented with questionnaires

The distribution of urinary schistosomiasis in schoolchildren on Zanzibar Island (Unguja) was surveyed in May 2001 to test a potential correlation with the distribution of snail species of the Bulinus africanus group and to record contemporary baseline epidemiological data. Quasi-random samples of 40 schoolchildren of mixed sexes were selected from each of 10 schools. Schistosoma haematobium infections were detected upon the basis of micro-haematuria with subsequent confirmation by microscopy examination for schistosome eggs. At the time of urine collection, each child was interviewed with a suite of 12 questions prepared as a standardized questionnaire. Total prevalence of urinary schistosomiasis (known locally as kichocho) was 12% although schistosome infections were absent in 5 schools. Schools located west of 39 °19′E and north of 6 °10′S harboured nearly all of the infections; the highest prevalence (55%) was found at Kinyasini where many B. globosus habitats occur nearby. The general level of understanding of kichocho was low (24%) and individual self-diagnosis was poor (sensitivity, 8·5%; specificity, 85%). Grouped freshwater-contact patterns of schoolchildren differed significantly between schools and correlated well with prevalence of infections within schools. Across the island the area of active transmission of S. haematobium to humans appears confined within the distribution of B. globosus. There was no epidemiological evidence to suggest any involvement of B. nasutus in local transmission, confirming previous laboratory findings. In areas where B. globosus occurs, targeted snail control should be considered, to reduce schistosome transmission.