An Epidemiology Survey For Schistosomiasis Among Pupils

Medical and Health Science Project and Seminar Material

An Epidemiology Survey For Schistosomiasis Among Pupils


Abstract


Urine and stool samples were collected from 540 students (9-14 years) in at Dakace district in Zaria Local Government Area of Kaduna State. The samples were examined for urinary and intestinal Schistosomiasis infection. Each student was interviewed and data collectors used a structured pre-tested questionnaire that included questions on socioeconomic status of the family and risk factors that may be associated with schistosomiasis infection. A standard filtration technique was used to diagnose and quantify ova of S. haematobium and S. mansoni. Ten millitre (10 ml) of urine was filtered through 13 mm diameter in 12 μm pore size of nylon mesh filter using plastic syringe. Stool samples were tested for the presence of S. mansoni eggs using the standard Kato Katz technique. Two slides from the same stool samples were prepared and examined for infection. Odds ratio and Pearson Chi square test was used to determine the association and relationship between age, school, risk factor and sex with schistosoma infection. An overall prevalence of 120 (22.22%) was recorded with S. haematobium and S. mansoni in all. Schistosoma haematobium recorded the highest prevalence of 14 (28.15%) in urine, while S. mansoni accounted for only 46 (17.04%) in stool samples examined. There were significant difference (p<0.05) in the infection of schistosomiasis among different schools in Dakace district with the highest (34.44%) and lowest (7.78%) infection were obtained. Health education and large-scale chemotherapy for all school children to decrease the prevalence and intensity of infection would be highly suitable.


Table of Content


Chapter One

1.0 Introduction

  • 1.1 Background of the Study
  • 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 Definition of Terms
  • 1.8 Organization of the Study

Chapter Two

2.0 Literature Review

  • 2.1 Background on Schistosomiasis
  • 2.2 Life Cycle of Schistosoma
  • 2.2.1 Life Cycle Stages of Shitosoma
  • 2.2.1.1 Adults
  • 2.2.1.2 Eggs
  • 2.2.1.3 Miracidium Stage
  • 2.2.1.4 Cercaria Stage
  • 2.3 Diagnostic Morphological Features of the Schistosoma Species
  • 2.4 Differential Diagnosis
  • 2.5 Geographical Distribution Of Schistosomiasis
  • 2.6 Pathogenesis
  • 2.7 Treatment and Control
  • 2.8 Vectors of Schistosomiasis

Chapter Three

3.0 Materials and Methods

  • 3.1 Study Area
  • 3.2 Study Design
  • 3.3 Sample Selection
  • 3.4 Data Collection
  • 3.5 Microscopic Diagnosis of Schistosoma Species
  • 3.6 Data Analyses

Chapter Four

4.0 Results and Discussion

  • 4.1 Results
  • 4.2 Discussion

Chapter Five

5.0 Summary, Conclusion and Recommendations

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

Chapter One


1.0 Introduction

1.1 Background of the Study

Schistosomes are important human and animal parasites throughout Africa, Asia and South America, predominantly in rural areas that support agriculture and inland fisheries. The distribution of Schistosomes are linked to that of their snail intermediate hosts (Bulinus and Biomphlaria spp.), which differ in their habitat preferences for slow-flowing or still waters (CDC, 2011). The impact of schistosomiasis has long been underestimated (Bergquist, 2002). It ranks second only to malaria as the most common parasitic disease, killing an estimated 280,000 people each year in the African region alone (CDC, 2011). The prevalence of schistosomiasis, like most parasitic disease is related to poverty and poor living conditions (Engels et al., 2002).

Despite intensive efforts to control the disease, it has been found to affect nearly 240 million people worldwide each year and more than 700 million people live in endemic areas (WHO, 2010). Nonetheless, 85% of the cases reported annually occur in sub-Saharan Africa and over 150,000 deaths are associated with chronic infection caused by S. haematobium in the African region (Hotez and Kamath, 2009; WHO, 2010). Schitosomiasis with soil-transmitted helminthiasis continue to represent more than 40% of the disease burden caused by all tropical diseases, excluding malaria (Hotez and Kamath, 2009). The disease is common in the Niger basin and is found in every country within the West African sub-region (Brown and Wright, 1985; Hegertun et al., 2013).

In Nigeria, one of the most severely affected countries in Africa, it is estimated that 101.28 million people are at risk of infection while 25.83 million are infected with Schistosoma haematobium, Schistosoma mansoni and Schistosoma intercalatum (Chitsulo et al., 2000). The risk and reemergence of urinary schistosomiasis is attributed to the range of snail habitats promoted by water development schemes such as dam construction (WHO, 2010). Furthermore, school age children who have frequent water contact are more vulnerable to schistosomiasis, and hence this age group that are often associated more frequently with schistosomiasis problems (Deribe et al., 2011; Bala et al., 2012).

Urogenital or urinary schistosomiasis is caused by Schistosoma haematobium while intestinal schistosomiasis is caused by S. guineensis, S. intercalatum, S. mansoni, S. japonicum, and S. mekongi (Hotez and Kamath, 2009). Other Schistosomes of veterinary importance reported in man include Schistosoma bovis, Schistosoma mathei, Schistosoma hippopotami, Schistosoma sprinadalis and Schistosoma rohhaini (Noble and Glem, 1982; Taylor and Naidu, 2013).

The intermediate snail host of S. mansoni is Biomphalaria spp. Bulinus snails are intermediate host for S. haematobium and Oncomelania snail for S. japoniacum (Ukoli, 1984). The parasitic larvae of Schistosoma species live in fresh water. It has the ability to penetrate host skin, predisposing people to the risk of infection due to everyday activities such as washing laundry or fetching water. Human contact with water is thus necessary for infection by schistosomes. Animals such as dogs, cats, rodents, pigs, horses and goats serve as reservoirs for Schistosoma spp.

Various socio-epidemiological factors are responsible for transmission of the disease and level of infection; some of which include distance from transmission site, migration and emergence of new foci, urbanization, socio-economic status, sanitation, water supply patterns and level of faecal contamination of water source (Sammy et al., 2011).

The provision of civilized swimming pools which is for recreational activities could serve as a good control measure for the spread of the disease (Gracio et al., 1992). Wearing of footwear to protect the legs could also be a good protective measure against active penetration by the cerceriae of the Schistosoma (Sammy et al., 2011). The geographical distribution of schistosomiasis in any locality depends on the distribution of the snail hosts and opportunities for infection of both the snail and human (Luka et al., 2005; Pillay et al., 2014).

School aged children are mostly infected with this silent destructive disease because it is easily contracted while bathing or swimming in water contaminated with the parasite that is shed by snails (Kabatereine et al., 2004; Kanwai et al., 2011). It has been estimated that every year, a child‟s risk of infection increases, peaking between the ages of 10 and 20 (Kabatereine et al., 2004). However, the intensity of their infection, as measured by quantitative egg counts of faeces or urine, shows the heaviest burden in the youngest age group. The morbidity associated with childhood infection can result in cognitive and growth stunting that is irreversible (Nokes et al., 1999).

Clinical manifestations of schistosomiasis are associated with the species-specific oviposition sites and the burden of infection (WHO, 2006). This parasitic infection imposes significant economic burdens on individuals, communities and nations (Blas et al., 2006). Urinary schistosomiasis is a chronic disease usually characterised by haematuria, dysuria, urinary frequency but in highly endemic areas, more than 50% of children show moderate to severe urinary pathology (van der Werf, 2003). A survey in the year 2000 of the disease-specific mortality, reported that 70 million individuals, out of 682 million, had experienced haematuria and 32 million, dysuria associated with S. haematobium infection (van der Werf, 2003; Pillay et al., 2014). It is associated with bladder and uretral fibrosis, sandy patches in the bladder mucosa and hydronephrosis that are commonly seen in chronic cases while bladder cancer is possible at late stage complication (Gryseels, 2006). The WHO estimates that out of these infected individual 18 million suffered cancers of the bladder and 10 million hydronephrosis (King et al., 2005).

On the other hand, intestinal clinical manifestations include abdominal pain, diarrhoea, and blood in the stool. In advanced cases, hepatosplenomegaly is common and is repeatedly associated with ascites and other signs of portal hypertension (Mostafa, 1999). Genital disease is present in approximately one third of infected women (Poggensee et al., 2001), resulting in a variety of vulvar and perineal disease, including ulcerative, fistulous, or wart-like lesions. Vulvar schistosomiasis may also facilitate the transmission of HIV (Stephenson et al., 1989; Feldmeier et al., 1995).


1.2 Statement of Problem

The global burden of schistosomiasis has been estimated at 1.7–4.5 million disability-adjusted life years lost per annum (Molyneux et al., 2005), but new research suggests that this estimate is a considerable underestimation of the true burden of schistosomiasis (Jia et al., 2007). Children born in Nigerian villages are highly exposed to parasitic infection almost throughout their lifetime. According to the National Schistosomiasis Control Programme, the lack of adequate studies on schistosomiasis prevalence in some developing countries such as Nigeria and under developed countries has stalled the implementation of a treatment strategy. Schistosomiasis disease burden needs to be identified as a health problem in Zaria Local Government Area of Kaduna State, particularly among school children.


1.3 Research Objectives

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

  1. To determine the prevalence of Schistosoma mansoni among primary school pupils in six selected primary schools in Dakace district of Zaria Local Government Area.
  2. To determine the prevalence of Schistosoma haematobium in primary school pupils of six selected primary schools in Dakace district of Zaria Local Government Area
  3. To determine the risk factors associated with schistosomiasis among primary school pupils in Dakace district.

1.4 Research Questions

This project is designed to tackle the following reach questions;

  1. What is the prevalence of Schistosoma mansoni among primary school pupils in six selected primary schools in Dakace district of Zaria Local Government Area?
  2. What is the prevalence of Schistosoma haematobium in primary school pupils of six selected primary schools in Dakace district of Zaria Local Government Area?
  3. What are the risk factors associated with schistosomiasis among primary school pupils in Dakace district?

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: There is no significant difference in the prevalence of Schistosoma mansoni in primary school pupils of six selected primary schools in Dakace district of Zaria Local Government Area HO2: Schistosoma haematobium is not prevalent among primary school pupils in Dakace district of Zaria Local Government Area.
  • HO3: There are no risk factors associated with schistosomiasis infections among primary school pupils in Dakace district of Zaria Local Government Area.

1.6 Significance of the Study

Schistosomiasis is 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). Children under 18 years of age are reported to be highly susceptible to the scouge of this disease. Schistosomiasis as a public health problem and has not been properly researched and documented in Dakace district of Zaria 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 Dakace district.


1.7 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).


1.8 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 Recommendations

5.1 Summary

A total of five hundred and forty (540) samples of urine (270) and stool (270) were collected from schoolchildren in six schools in Dakace, Zaria, Kaduna State. The prevalence of 22.22% was established in the selected schools sampled in Dakace District, Zaria for the two infections. Prevalence of S. haematobium was higher (13.70%) than that of S. mansoni (8.52%). The risk factors such as source of water supply well OR = 1.52); tap (OR = 2.053); and stream (OR = 2.125); and faecal disposal (pit latrine; OR =1.117; water system; OR = 1.992) were associated with both S. haematobium and S. mansoni. Males (28.15%) were more exposed to infection than females (16.30%). In conclusion, S. haematobium and S. mansoni infection were recorded in all the schools sampled.


5.2 Conclusion

The results obtained show that the Dakace district area is endemic for urinary and intestinal schistosomiasis infection.

  1. The prevalence of Schistosoma haematobium was found to be 13.70% in this study.
  2. Schistosoma mansoni prevalence in this study was established to be 8.52%.
  3. There was relationship between risk factors (source of water supply and faecal disposal) and the Schistosoma infection among primary school students attending some selected schools in Dakace. There was significant association (p<0.05) between schistosomiasis infection and age groups that attended the selected schools in Dakace.

The study also revealed that schistosomiasis infection was highly prevalent in male (28.15%) than their female (16.30%) counterpart.


5.3 Recommendations

Based on the result of this study, the following recommendations are made:

  1. Villages and rural areas need access to pipe borne water to reduce contact with infested waters.
  2. Further intervention studies to determine the best and cost-effective strategies to provide treatment to children and communities in the affected areas are required.
  3. Epidemiology and prevalence of schistosomiasis in adult need to be evaluated as this study did not cover them.
  4. Ecological studies are also needed to identify transmission foci to facilitate implementation of ecologically targeted control measures.

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