Evaluating The Status Of Schistosomiasis

Project and Seminar Material for Public Health

Abstract

The study evaluated the prevalence of urinary and intestinal Schistosomiasis among Primary School Pupils in Lavun Local Government Area, Niger state, Nigeria in relation with associated risk factors. Three hundred and eight consenting pupils from 10 primary schools between ages 5 and 14years were screened for the study. Urine and stool samples of each pupil was collected and examined for Schistosoma haematobium responsible for urogenital schistosomiasis and Schistosoma mansoni responsible for intestinal schistosomiasis. The urine samples were examined both macroscopically and microscopically using standard Sedimentation methods while the stool samples were examined using Kato-Katz and formol-ether concentration technique. A well-structured pre-tested questionnaire was administered on 308 pupils to obtain socio-demographic data such as age, sex, educational status of parents and risk factors.The overall prevalence for both forms of schistosomiasis in the study area was 7.5%. The prevalence of urinary schistosomiasis was 5.5% while intestinal schistosomiasis was 0.7% and 1.3% using kato-katz and formol-ether methods respectively. There was no statistically significant difference (p>0.05) for all forms of schistosomiasis and the primary schools. There was also no statistically significant relationship (p>0.05) between the prevalence of urinary schistosomiasis and the different schools. However, there was significant difference (p<0.05) between the prevalence of intestinal schistosomiasis and the different schools by Kato-Katz method. There was no significant difference between the infections and age. However gender significantly influenced S. haematobium infection but there was no significant association between gender and S. mansoni infection by both the Kato-katz and formol-ether Method. Odds ratio showed association between the infection and pipe borne water (OR=1.1), borehole (OR=3.3), river/stream (OR=5.3), defecating in the bush (OR=8.8), having ponds around houses (OR=3.5), fishing (OR=8.0), do wash clothes (OR=7.8), swimming (OR=8.2) and playing (OR=9.4). There was no significant difference between formol-ether concentration method and Kato-Katz technique used in detecting Schistosoma mansoni. The study therefore concluded that the overall prevalence for both forms of schistosomiasis in the study area was 7.5% having 5.5% urinary schistosomiasis and 0.7%, 1.3% intestinal schistosomiasis by Kato-Katz and Formol-ether concentration methods respectively. It was therefore recommended that the teaching of Health Science as a subject in in primary schools should be intensified and the pupils should be taught more on personal hygiene, preventive measures and control of certain

Chapter One

Introduction

1.1 Background to the Study

Schistosomiasis, also known as bilharziasis or snail fever, is primarily a tropical parasitic disease caused by eggs of adult stages of the blood fluke known as Schistosoma. The name bilharziasis was coined from the name of Theodor Bilharz, a German pathologist, who first identified the worms in 1851 (Nawal, 2010; WHO, 2010a). It is a chronic and debilitating water-borne parasitic infection that leads to a significant ill health and economic burden.

Schistosomiasis is a disease caused by Schistosoma spp and is a prevalent tropical disease, ranking second to malaria and posing a great public health and socio-economic threat in sub-Saharan Africa (Moleneux, 2004; Hotez et al., 2007). More than 200 million people in 76 countries have schistosomiasis of which 85 percent live in sub-Saharan Africa (WHO, 2008). A recent World Health Organisation (WHO, 2010b) report estimated that more than 600 million people are at risk for schistosomiasis. Human schistosomiasis is a chronic disease caused by the blood flukes belonging to the genus Schistosoma. The main disease causing schistosome species are Schistosoma haematobium, S. mansoni, S. japonicum, S. mekongi and S. intercalatum (Gryseel et al., 2006). Schistosomiasis is estimated to affect 249 million people worldwide, of which at least 224 million people that are affected live in sub-Saharan Africa (WHO, 2015a).An estimated 280,000 people each year in the African region alone are killed as a result of the disease (CDC, 2011). Schistosoma haematobium is the aetiologic agent of urinary schistosomiasis and it is most prevalent in Africa (NATHNAC, 2008). In sub-Sahara Africa, S. haematobium infection is estimated to cause 70, 32, 18 and 10 million cases of heamatutria, dysuria, bladder-wall pathology and major hydronephrosis, respectively (vander-Werf et al., 2003). The infection is also responsible for nutritional deficiencies and growth retardation (Stephenson, 1993), adverse effects on cognitive development (WHO, 2002), as well as for decreasing physical activity, school performance, and work capacity and productivity (Stephenson, 1993).

Transmission of urinary schistosomiasis is dependent on availability of specific snail hosts and human activities with water contacts (WHO, 2010b). Therefore, the risk and reemergence of urinary schistosomiasis is attributed to the range of snail habitats promoted by water development schemes such as dam construction (Jamison et al., 2006). On the other hand, school age children have frequent water contact that make them more vulnerable to schistosomiasis, and therefore this age group is associated more frequently with schistosomiasis (Deribe et al., 2011; Bala et al., 2012).

Globally, report from Global Burden of Disease (GBD) has it that; schistosomiasis caused the loss of 1.7 million disability- adjustment life years (DALYS) worldwide in 2001, out of which 82% Africa (1.4 million DALYs) were lost in sub-Saharan (SSA) alone. Worldwide, more than 700 million people are at risk of infection and more than 207 million people are infected (WHO, 2016).

In Africa, it has been estimated that 85% of the world‟s cases of schistosomiasis are in Africa, where prevalence can exceed 50% in local populations with Schistosoma mansoni and S. haematobium being distributed throughout Africa; report from Ethiopia showed that both S. haematobium and S. mansoni are endemic, with an estimated 4 million people infected and 30–35 million being at risk of infection (Kassa et al., 2005). Mbah and Useh (2008) studied a relationship between the transmission of urinary schistosomiasis and prevailing socio-economic factors in some villages in Lagdo District of the Republic of Cameroon and Schistosoma haematobium was confirmed amongst 39.2% of the study population. Mixed infections of S. mansoni and S. haematobium occurred in only 4.5% of the pupils. In 2009 report from sub-Sahara Africa revealed that 192 million people are estimated to be infected with the two forms of schistosomiasis (intestinal and urinary), with Nigeria recording the largest number of infection with about 29 million cases (Hotez and Kamath, 2009). Schistosomiasis has a long history in Egypt, and the government has been over sixty years of schistosomiasis control efforts. It is well documented that Schistosoma haematobium was endemic in Ancient Egypt. Infection was diagnosed in mummies 3000, 4000 and 5000 years old (Barakat, 2013). Scott was the first to describe the pattern of schistosomiasis infection in Egypt. Schistosoma haematobium was highly prevalent (60%) both in the Nile Delta and Nile Valley South of Cairo in districts of perennial irrigation while it was low (6%) in districts of basin irrigation. Schistosoma mansoni infected 60% of the population in the Northern and Eastern parts of the Nile Delta and only 6% in the Southern part. Neither S. mansoni cases nor its snail intermediate host were found in the Nile Valley South of Cairo (Barakat, 2013). Also, El-Khoby et al. (2013) reported a 4.8%, 13.7%, 7.8% prevalence of S. haematobium in 4 governorates in Upper Egypt.

In Nigeria, diverse prevalence of schistosomiasis has been reported in various part of the country. These includes; the 28.8% reported by Agere et al. (2010) in Jalingo and Ardokola Local Government Areas of Taraba State, 4.6% recorded in Jos (Goselle et al., 2010), 82% recorded in Ogun State (Sowole and Adegbite, 2012), 9.8% recorded in Afikpo North Local Government Area of Ebonyi State (Nworie et al., 2012), 41.5% reported in Benue State (Houmsou et al., 2012), 6.0% reported in Potiskum Yobe State (Bigwan et al., 2012), 48.2% recorded in southwestern Nigeria (Babatunde et al., 2013), 44.3% reported in North Central Nigeria (Okwori et al., 2014) And the 17.5% reported in Ezza-North Local Government Area of Ebonyi State (Nwosu et al., 2015).

1.2 Statement of the Research Problem

Despite more than a century of control efforts and the introduction of highly effective anti-schistosomal drugs such as niridazole, metrifonate, oxamniquine, and praziquantel, the eradication of the disease is still far from actualization. The prevalence and risk factors of schistosomiasis in Lavun LGA have not, to our knowledge, been investigated thus the disease status is largely unknown.

1.3 Justification

The research has provided baseline information on the status of Schistosoma infection among primary school pupils in Lavun LGA, from which the disease burden and risks of transmission will be assessed towards adequate intervention so as to save the lives of primary school pupils, thereby reducing the rate of transmission.

1.4 Aim

To evaluate the prevalence of schistosomiasis among pupils of some primary schools in Lavun Local Government Area, Niger state.

1.5 Objectives

The objectives of this study are to determine;

The prevalence of urinary and intestinal schistosomiasis infections among primary school pupils in Lavun LGA, Niger state.
The association between urinary and intestinal schistosomiasis with age and gender.
The association between urinary and intestinal schistosomiasis and risk factors.
To compare the Kato Katz and Formol Ether concentration methods used in testing intestinal schistosomiasis.

1.6 Hypotheses

Urinary and intestinal schistosomiasis are not prevalent among primary school pupils in Lavun Local Government Area, Niger state
There is no significant association between urinary and intestinal schistosomiasis with age and gender.
Risk factors are not significantly associated with schistosomiasis.
There is no significant different of intestinal schitosomiasis between Kato Katz and Formol Ether concentration methods.

Chapter Six

6.0 Summary, Conclusions and Recommendations

6.1 Summary

This study was carried out to determine the prevalence of urinary and intestinal Schistosomiasis among primary school pupils in Lavun Local Government Area, Niger state, Nigeria. Ten primary schools were selected for the study which included: Model Primary School, Yakawada, LGEA Unguwar Pah, Yakawada, LGEA Kuringa, Dan Mahawayi, LGEA Hayin Madara, Lavun, Model Primary School, Kidandan, LGEA Sabon Layi, Kidandan, Model Primary School, Shika, Katsinawa Primary School, Shika, LGEA, Lavun and Model Primary School, Dan Mahawayi. Out of the 308 primary school pupils recruited for the study 22(7.5%) were positive. The overall prevalence for both forms of schistosomiasis amongst the schools varied significantly from 20% to 0%. Infection varied significantly among males (11.3%) and females (2.9%). However there was no significant difference observed among the age groups with the highest prevalence recorded in the >14years group followed by 11-12years group, 13-14years and 9-10years while the 5-6 and 7-8years age groups were not infected at all. All the risk factors were associated with the spread of the infection in the study area except for well water and pit latrine. There was no significant difference between Kato-Katz and formol-ether concentration methods used in detecting Schistosoma mansoni

6.2 Conclusions

This study reveals an overall prevalence of 7.5% for both forms of schistosomiasis with 5.5% urinary schistosomiasis and 0.7%, 1.3% intestinal schistosomiasis by Kato- Katz and Formol-ether concentration methods respectively with formol-ether concentration being more sensitive. It can therefore be deduced that both S. haematobium and S. mansoni infections are low among primary school pupils in Lavun Local Government Area, Niger state, Nigeria.
iThere was no statistically significantly difference between the infections and age. However gender significantly influenced S. haematobium infection but there was no significant association between gender and S. mansoni infection by both the Kato- katz and formol-ether Method.
Association was recorded between the infection and the following risks factors; pipe borne water (OR=1.1), borehole (OR=3.3), river/stream (OR=5.3), defecating in the bush (OR=8.8), having ponds around houses (OR=3.5), fishing (OR=8.0), wash clothes in water bodies (OR=7.8) and swimming (OR=8.2). All these showed association with the infections.
There was no statistically significantly difference (P>0.05) between the prevalence of S. mansoni using both techniques and age groups.

6.2 Recommendations

The recommendations are based on the result from this study, though schistosomiasis had low endemicity in the study area, it is therefore recommended that efforts be made by avoiding further spread of the infections in the area.

This can be done through the following measures;

Pupils or individuals in Lavun Local Government Area who are already infected should be identified and giving prompt treatment in other to avoid further spread of the disease in the Local Government Area.
There should be snail surveys at time intervals so as to check for the snail- intermediate host towards destroying them to avoid harboring infective stages.
There is need to provide safe water, for drinking and domestic use by Federal and State governments so as to reduce the rate of exposure to infested water bodies.
The teaching of Health Education as a subject in primary schools should be intensified and the pupils should be taught more on personal hygiene, preventive measures and control of certain parasites.

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