An Epidemiology Survey For Schistosomiasis Among Adults

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An Epidemiology Survey For Schistosomiasis Among Adults


Abstract


An epidemiology survey for schistosomiasis was carried out among adults in Birnin Gwari Local Government Area of Kaduna State. Questionnaire as administered to obtain to demographic data. A total of 300 stool and urine were examined, comprising of 215 from males and 85 from females. The Formol-ether concentration and sedimentation techniques were used for laboratory analysis of the stool and urine samples respectively. The overall prevalence of Schistosoma haematobium was (36.0%) with 29.3% in males and 6.7% in females. Similarly, overall prevalence was higher in male than females. The highest prevalence was recorded in 36 – 40 age group. The overall prevalence of Schistosoma mansoni was 61(20.3%). The intensity of the disease was light (1-18 eggs per gram of feaces). The prevalence in males was 13.3% while in females it was 7.0%. higher prevalence was recorded in 6-8 years and 36 – 40 years age groups. There was an association between Schistosoma haematobium infection and terminal Haematuria (OR = 7.8) there was association between S.haematobium, S. mansoni infection and source of water (OR = 2.8). Other intestinal parasites were encountered in the faecal samples which includes Hookworm 25(8.3%), Hymenolepis nana 7 (2.3%), Enterobius vermicularis 4 (1.3%)and Ascaris lumbricoides 1 (0.7%).

 


Table of Content


Chapter One

1.0 Introduction

  • 1.1 Background Information
  • 1.2 Statement of Problem
  • 1.3 Research Objectives
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organization of the Study

Chapter Two

2.0 Literature Review

  • 2.1 Conceptual Review
  • 2.2 The Parasite – Schistosoma
  • 2.2.1 Classification
  • 2.2.2 Diversity of Schistosoma Species and their Geographical Distribution
  • 2.3 Life Cycle of Schistosoma
  • 2.4 Diagnosis of Schistosomiasis
  • 2.5 Prevalence of Schistosomiasis in Nigeria and Other Parts of the World
  • 2.5.1 Age and Sex Specific Prevalence of Schistosomiasis
  • 2.5.2 Intermediate Hosts of Schistosomes
  • 2.6 Pathology of Schistosomiasis
  • 2.6.1 Acute Phase of Schistosomiasis
  • 2.6.2 Chronic Schistosomiasis
  • 2.7 Socioeconomic Importance of Schistosomiasis
  • 2.8 Treatment of Schistosomiasis
  • 2.9 Prognosis of Schistosomiasis
  • 2.10 Prevention and Control of Schistosomiasis

Chapter Three

3.0 Materials and Methods

  • 3.1 Study Area
  • 3.2 Study Population
  • 3.3 Determination pf Sample Size
  • 3.4 Collection of Samples
  • 3.5 Administration of Questionnaires
  • 3.6 Laboratory Analysis of Samples
  • 3.6.1 Urine Samples
  • 3.6.2 Faecal Samples
  • 3.6.3 Intensity of Infection
  • 3.7 Statistical Analysis

Chapter Four

4.0 Results and Discussion

  • 4.1 Results
  • 4.2 Schistosoma Mansoni Survey
  • 4.3 Prevalence of Schistosoma Mansoni and Other Intestinal Parasites
  • 4.4 Response from the Questionnaire
  • 4.5 Discussion

Chapter Five

5.0 Summary, Conclusion, Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • Appendix

Chapter One


1.0 Introduction

1.1 Background Information

Schistosomiasis is a major disease of public health concern. It ranks second to malaria as the most important and devastating parasitic disease (Waknine-Grinberg et al., 2010), with high morbidity and mortality. It is responsible for approximately 280,000 deaths in sub-Saharan Africa (NyatiJokomo & Chimbari, 2017). Of the 800 million people at risk of schistosomiasis globally, more than 200 million have contracted the disease in 76 countries (Nyati-Jokomo & Chimbari, 2017). Africa alone houses up to 85% of the infected population (Mose, Kutima, Waihenya, & Yole, 2013), if not more (Sady et al., 2013; World Health Organization, 2018; Yirenya-Tawiah, Ackumey, & Bosompem, 2016). Studies have shown that in the year 2009, about 112 million people contracted active urogenital schistosomiasis while about 54 million people had Schistosomiasis (Senghor et al., 2014). Schistosomiasis is detected mainly in rural and peri-urban deprived areas with dams and irrigation systems, which also have fishing and agriculture as their major occupation. Poor housing units without toilet facilities and lack of potable water, indicating poor sanitation usually characterize these areas (Njenga et al., 2014).

Schistosomiasis is the second most prevalent tropical parasitic disease next to malaria, and is a leading cause of morbidity in endemic areas of Africa, Asia and South America (WHO, 1995). In some parts of Africa, the onset of haematuria due to urinary Schistosomiasis is very common in adolescent boys, and due to lack of knowledge, it is seen as a normal phenomenon in some communities (Deswitz, 1981). It is estimated that over one third of the world’s population, mainly those individuals living in the tropics and sub-tropics, are infected by parasitic worms (Schall et al., 1993).

The disease is said to be responsible for the annual loss of between 1.7 and 4.5 million disability adjusted life years (DALYs), but recent meta-analysis challenges these burden estimates; they could be several-fold higher (Chitsulo et al., 2000). Most of the burden of Schistosomiasis is concentrated in sub-saharan Africa with the highest prevalence and intensities usually found in school-age children, adolescent and young adults (Jordan et al., 1993).

Schistosomiasis has a negative impact on school performance of the pupils and the debilitation caused by untreated infections undermines social and economic development in heavily affected areas (Huang and Manderson, 1992).
After more than 20 years of Schistosomiasis control programmes, chemotherapy has been shown to be a very important tool. Nevertheless, in medium and long term infections, good sanitary habits, good water supply, proper sewage drainage and health education seem to be the real tool in definitive Schistosomiasis control (Katz et al., 1998).Several environmental and socio-economic factors have been identified to be responsible for the continued persistence of intestinal parasitic infection in children. Some of these factors include poor sanitary conditions, unhygienic practices, lack of potable water, poor housing and poverty

(WHO 1991, Edungbola and Obi 1992; Savioli et al., 2003; Amuta et al., 2004).Recent global estimate have indicated than more than a quarter of the world’s populations are infected with one or more of the most common parasites; Ascaris lumbricoides, hookworm and Trichuris trichuira (Nawal 2010; WHO 2010a).

Helminth infections are more prevalent among school-aged children (Bundy and Medley, 1992). Maximum prevalence and intensities for Ascaris lumbricoides and Trichuris trichiura are achieved in children from 5-15 years of age while hookworm and schistosome infections are usually at their peak in late childhood to early adulthood (Bundy and Medley, 1992).

Five species of schistosomes are pathogenic parasites of humans. Out of which Schistosoma mansoni and Schistosoma haematobium are the most common worms while Schistosoma japonicum, Schistosoma mekongi and Schistosoma intercalatum have a more limited distribution. Other species, such as Schistosoma matheei and Schistosoma bovis are occasional parasites of human and Schistosoma incognitum may also prove infective to humans. The disease caused by schistosomes, Schistosomiasis (=bilharziasis), is the most important disease of helminth origin and causes untold misery in about 75 countries (WHO, 1985). About 200 million people are said to be infected and 500-600 million people are exposed to the infection (Webbe, 1981). The Center for Disease Control and Prevention estimates that 150 to 200 million persons throughout the world are afflicted with Schistosomiasis (CDC, 2010).

Control of Schistosomiasis depends basically on the control of the snail vectors, a problem which presents an extremely complex ecological situation, and one which has been reviewed in a number of major publications (Jordan et al., 1993; WHO, 1985; Nmorsi et al., 2005; John et al., 2008). Snails of the family planorbidae serve as intermediate hosts of Schistosoma mansoni and Schistosoma haematobium. Schistosoma mansoni is transmitted by snails of the genus Biomphalaria and S. haematobium by Bulinus species (Chandiwana, 1986; King et al., 1988).

Salinity, temperature, velocity of the water and presence of aquatic vegetation support the snail colonies of the various genera. Snail population in any water reservoir starts to build up at the onset of the rainy season around May, they become abundant between October and December (Shurrock, 2001; Nmorsi et al., 2005).


1.2 Statement of Problem

Schistosomiasis currently infects 200 million people in 74 endemic countries (WHO, 2010a). It affects primarily women and school – aged children. Infections occur when a person comes into contact with freshwater that is infested with schistosome cercariae and containing snail intermediate hosts. The infection can lead to stunted growth and development and in severe cases of bladder cancer and kidney, liver and spleen malfunctions (Kabatereine et al., 2004). Schistosomiasis is prevalent in tropical and sub-tropical areas, especially in poor communities without access to safe drinking water and adequate sanitation. It is estimated that at least 90% of those requiring treatment for Schistosomiasis live in Africa (Habib et al., 2000).

Schistosomiasis infection is associated with rural agricultural and other human activities around the freshwater bodies such as swimming, fishing, washing and bathing in ponds, rivers and dams, where the snail intermediate hosts breed. Construction of earthered dams to facilitate the breeding/ ground for snails. Children are more prone to
Schistosomiasis infection due to their exposure to water bodies, through fishing, swimming, washing and fetching water for household chores. These activities expose these children to the infective stage of the parasite from the intermediate hosts in these water bodies. Personal hygiene, attitude and play habits make children especially vulnerable to infection (John et al., 2008). Women doing domestic chores, such as washing of clothes in infested water, are also at risk. Urogenital Schistosomiasis is also considered to be a risk factor for HIV infection, especially in women. Approximately 10 million women in Africa have Schistosomiasis during pregnancy (Mohammed et al., 2007; John et al., 2008).

The economic and health effects of Schistosomiasis are considerable. In children, schistosomiaisis can cause anaemia, stunting and a reduced ability to learn, although the effects are usually reversible with treatment. Chronic Schistosomiasis may affect people’s ability to work and in some cases can result in death. In sub-Saharan Africa, more than 200,000 deaths per year are due to Schistosomiasis (WHO, 2010a). Hence the need for this study to determine the an epidemiology survey for schistosomiasis among adults.


1.3 Research Objectives

The purpose of this study is to carry out an epidemiology survey for schistosomiasis among adults in Birnin Gwari Local Government Area of Kaduna State. Specifically, the objectives include:

  1. To determine the prevalence and epidemiology of Schistosomiasis among adults in Birnin Gwari Local Government Area, Kaduna State.
  2. To determine the age and sex specific prevalence of Schistosomiasis infection in Birnin Gwari Local Government Area, Kaduna State.
  3. To determine the risk factors associated with the transmission of Schistosomiasis to adults in Birnin Gwari Local Government Area, Kaduna State.

1.4 Research Questions

This project is designed to tackle the following reach questions;

  1. What is the prevalence and epidemiology of Schistosomiasis among adults in Birnin Gwari Local Government Area, Kaduna State?
  2. What is the age and sex specific prevalence of Schistosomiasis infection in Birnin Gwari Local Government Area, Kaduna State?
  3. What are the risk factors associated with the transmission of Schistosomiasis to adults in Birnin Gwari Local Government Area, Kaduna State?

1.5 Research Hypothesis

The following null hypotheses were formulated to guide the study the hypothesis is to be tested at 0.5 alpha levels.

  • HO1: Schistosomiasis is not prevalent among adults in Birnin Gwari Local Government Area, Kaduna state.
  • HO2: The age and sex of adults are not associated with the prevalence of Schistosomiasis in Birnin Gwari Local Government Area, Kaduna state.
  • HO3: There is no specific risk factor associated with the transmission of Schistosomiasis to adults in Birnin Gwari Local Government Area, Kaduna State.

1.6 Significance of the Study

Schistosomiasis is one of the most prevalent of the waterborne diseases and constitutes a serious health risk in rural areas of developing countries (Van der Werf, 2003; Pillay et al., 2014). Both children and adults are reported to be highly susceptible to the scourge of this disease. Schistosomiasis as a public health problem and has not been properly researched and documented in Birnin Gwari Local Government Area, Kaduna State. The information obtained may therefore serve as a guide to the schistosomiasis Control Programme of the State Ministry of Health in Kaduna State Nigeria and applying treatment plans for schistosomiasis in the study area.


1.7 Scope of Study

The study is limited to adults in Birnin Gwari Local Government Area, Kaduna State. The study is restricted to carry out an epidemiology survey for schistosomiasis among adults in Birnin Gwari Local Government Area of Kaduna State.


1.8 Limitation of the Study

In the course of this study, the researcher encountered some limitations. This includes: the geographical spread of the areas of study was a big limitation because the researcher could not move around the whole of Birnin Gwari Local Government Area, Kaduna State in order to access the respondents, however the study used trained assistant in collection of the questionnaire.


1.9 Definition of Terms

Schistosomiasis:

Also known as bilharzia, is a disease caused by parasitic worms. Although the worms that cause schistosomiasis are not found in the United States, people are infected worldwide. In terms of impact this disease is second only to malaria as the most devastating parasitic disease.

Epidemiology:

Epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighborhood, school, city, state, country, global).

Adult:

A person who is fully grown or developed, usually above 18 years of age in Nigeria


1.10 Organization of the Study

This study is divided into five chapters. The first chapter is the introduction which contains the background, research problems and objectives. The second chapter is the literature review and the third chapter is the methodology. In the fourth chapter, the researcher analyses the data and discusses the results. The fifth chapter is the last chapter which presents the summary, conclusion and recommendations.


Chapter Five


5.0 Summary, Conclusion and Recommendation

5.1 Summary

An overall prevalence of Schistosoma haematobium was 36.0% out of 300 adults examined. The prevalence of the disease by age among the males showed that the highest prevalence was recorded in the age group of 36 – 40 years, followed by age group of 26-30 years. While among the females, the highest prevalence was recorded in the 21 – 25 age group followed by in the age group 36 – 40 years. The prevalence of S. mansoni was 20.3% varied from one community to another. The intensity of and it infection was light with the intensity ranging from 1 to 18 eggs per gram of faeces.

With regards to the responses of the adults to the questionnaires, relating the associations between various epidemiological variables and the disease, Odds ratio value greater than 1 indicated associations between fishing, use of pond water, stream water with the disease prevalence.


5.2 Conclusion

In conclusion, the study had provided an idea on the prevalence of Schistosomiasis infection among adults in Birnin Gwari Local Government Area. The prevalence of Schistosomiasis among adults examined showed that Schistosomiasis is a serious public health problem, The prevalence rate is higher in males than in females.


5.3 Recommendation

Therefore to reduce the morbidity of Schistosomiasis in these areas, target or selective chemotherapy should be carried out using praziquantel. A community health eradication campaign and adequate health education should be promoted on the control of the disease. The community should be educated on the mode of transmission of the disease and the pathology of the disease and therefore encourage them to adopt control measures. Portable water should be provided in the community with other basic amenities to promote the level of good living in the rural communities, thereby avoiding the use of pond, river and stream water.


An Epidemiology Survey For Schistosomiasis Among Adults


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