High prevalence of urinary schistosomiasis in a desert population: results from an exploratory study around the Ounianga lakes in Chad

Background Researching a water-borne disease in the middle of the Sahara desert might not seem the most relevant concern. However, nomadic Sahelian pastoralists health concerns regarding their livestock and anecdotal reports about trematode infections of Fasciola spp. and Schistosoma spp. in desert-raised animals justified an exploratory study focusing on the lakes of Ounianga in Northern Chad. The aim was to test whether trematode parasites such as Schistosoma spp. occur in human populations living around the Sahara desert lakes of Ounianga Kebir and Ounianga Serir in northern Chad. Methods The study was carried out in January 2019 and comprised of three components. First, a cross sectional survey based on a random sample drawn from the population to detect infections with S. haematobium and S. mansoni; second, focus group discussions exploring disease priorities, access to health and health seeking behaviour; and third, surveying water contact sites for intermediate host snails. Samples of trematode parasites and snails were confirmed on species level by molecular genetic methods. For parasitological and malacological surveys descriptive statistics were performed. Qualitative data analysis included the full review of all transcripts, followed by a descriptive and explorative thematic analysis. Results Among 258 participants, the overall S. haematobium prevalence using urine filtration was 39.2% [95% confidence interval (CI): 33.5–45.1%], with 51.5% of the infected suffering from heavy infection. The intermediate host snail of S. haematobium (Bulinus truncatus) occurred at water contact sites near both study villages, revealing the potential for local transmission. Although a positive S. mansoni point-of-care circulating cathodic antigen (POC-CCA) test result was obtained from 8.6% (95% CI 5.7–12.8%) of the samples, no intermediate host snails of S. mansoni were found, and the relevance of S. mansoni remains uncertain. Qualitative findings underline the importance of morbidity caused by urinary schistosomiasis, and the lack of access to diagnostics and treatment as a major health concern. Conclusions This research revealed a high prevalence of urinary schistosomiasis in the population living around the lakes of Ounianga in the Sahara, a United Nations Educational, Scientific and Cultural Organization (UNESCO) world heritage site in Chad. Despite the high public health importance of the associated morbidity expressed by the population, there is no access to diagnostics and treatment. Further work is needed to develop and test a context-adapted intervention. Graphical Abstract

Malaria Co – Infection with Urinary Schistosomiasis, Typhoid Fever, Hepatitis B Virus, and Human Immunodeficiency (HIV) Virus among Students in Three Local Government Areas of Ekiti State, South Western Nigeria

Introduction: Malaria, Typhoid fever, urinary schistosomiasis, AIDS and hepatitis B virus disease are major public health problems in the tropical and subtropical countries; they exert a huge burden of morbidity, mortality and economic loss on the populace. Aims: The study investigates the prevalence of co–infection of malaria, typhoid fever, urinary schistosomiasis, hepatitis B virus and HIV virus among 306 students between the ages of 10- 21 years in three local government areas of Ekiti – state Nigeria. Methodology: Blood samples were randomly collected for the examination of malaria parasites, typhoid fever, hepatitis B virus and HIV virus while urine examination was done for urinary schistosomiasis by random sampling and survey for a period one week. Results: The results show that the overall prevalence of malaria, typhoid fever, urinary schistosomiasis and hepatitis B virus were 42.2%, 2.9%, 2.9% and 2.9% respectively. The female students had the highest prevalence of single infection with malaria fever having the highest figure (42.2%). Malaria and Urinary schistosomiasis had the highest prevalence of double infection of 2.3 %, while schistosomiasis and hepatitis B had the lowest prevalence of 0.3%. Also, male students had the highest prevalence of double and triple infections. The co-infection rate of malaria, urinary Schistosomiasis and hepatitis B was 0.3% and this occurred in male between the ages of 19-21 years, none of the students tested positive for HIV virus and therefore no students was found in the quaternaries. Conclusion: Co-infections is prevalent in this study area, therefore there should be integrated control approach directed against these diseases.

Review of Risk Factors Associated with Transmission of Urinary Schistosomiasis amongst Vulnerable Groups: School Pupils and Almajiris and Effect of Treatment with Praziquantel in Maiduguri Metropolis, North-Eastern Nigeria.

Human schistosomiasis is the most prevalent tropical disease in the world after malaria. Most of the countries in Sub Saharan Africa including Nigeria have not achieved the Millennium Development Goals for accessing safe drinking water and halting or reversing major disease incidences. School aged children and young Almajiri were selected for the cross-sectional study. Awareness lectures were given at every study site before collection of samples. Urine filtration technique was used for the diagnosis of urinary schistosomiasis. Infected subjects were given 60mg Praziquantel and followed up after 28 days and the effect was assessed by calculating the cure rate. A total of 308 subjects were enrolled comprising of 200 school children and 108 Almajiri respectively with a mean age of 13 years old. Female-to-male ratio is 9.6. Out of the 308 participants, 149 had urinary schistosomiasis (48.4%) with 5 among the females (17.2%) and 144 among the males (51.6%) respectively (p>0.005). A significant 26.3% of the respondents had haematuria and 77.8% were infected. Only one respondent admitted having knowledge of the disease. A total 136 of those infected received the treatment of 60mg Praziquantel and 43 (31.6%) showed eggs in their urine 28 days after taking PZQ. Highest (84.6%) cure rate was observed among the youngest age group of 5-9 years and lowest (60.3%) was observed among the oldest age group 15-19 years (p=0.005). An overall prevalence of 48.4% among these vulnerable group of the society calls for a great concern because these group of the population serve as means of maintaining the infection cycle. Dearth of knowledge about schistosomiasis, extreme weather condition, lack of potable water supply and poverty remains the reason behind the continued endemicity of schistosomiasis in the study area.

High Prevalence of Urinary Schistosomiasis in a Desert Population: Results from an Exploratory Study Around the Ounianga Lakes in Chad

Background: Researching a water-borne disease in the middle of the Sahara desert might not seem the most relevant concern. However, nomadic Sahelian pastoralist’s health concerns regarding their livestock and anecdotal reports about trematode infections of Fasciola spp and Schistosoma spp in desert-raised animals justified an exploratory study focusing on the lakes of Ounianga in Northern Chad. The aim was to test whether trematode parasites such as Schistosoma spp occur in human populations living around the Sahara desert lakes of Ounianga Kebir and Ounianga Saker in northern Chad. Methods: The study comprised of three components. First, a cross sectional survey based on a random sample drawn from the population to detect infections with S. haematobium and S. mansoni ; second, focus group discussions exploring disease priorities, access to health and health seeking behaviour; and third, searching water contact sites for intermediate host snails. Samples of trematode parasites and snails were confirmed on species level by molecular genetics methods. Results: Among 258 participants, the overall S. haematobium prevalence using urine filtration was 39.1% (95% CI 33.2% – 45.1%), with 51.5% of the infected suffering from heavy infection. The intermediate host snail of S. haematobium ( Bulinus truncatus ) occurred at water sites near both study villages, revealing the potential for local transmission. Although a positive S. mansoni POC-CCA test result was obtained from 15.2% (10.6%-19.7%) of the samples no intermediate host snails of S. mansoni were found, and the relevance of S. mansoni remains uncertain. Qualitative findings underline the importance of morbidity caused by urinary schistosomiasis, and the lack of access to diagnostics and treatment as a major health concern. Conclusion: This research revealed a high prevalence of urinary schistosomiasis in the population living around the lakes of Ounianga in the Sahara, a UNESCO world heritage site in Chad. Despite the high public health importance of the associated morbidity expressed by the population there is no access to diagnostics and treatment. Further research is needed to develop and test a context adapted intervention.

Urinary Schistosomiasis and Primary Evidence of Female Genital Schistosomiasis among Pupils in Nsugbe Community, Anambra State, Nigeria

Urinary schistosomiasis is considered a major public health parasitic disease in African communities. Prior to this study, Nsugbe community was not considered endemic for the disease and as such was not involved in Praziquantel-Preventive Chemotherapy (PC). Longitudinal study of 281 consented pupils aged 5-16 years was carried out with aim of determining the status of urinary schistosomiasis. Urinalysis laboratory test strip, urine filtration technique and syndromic diagnosis were used for the confirmation of the presence of haematuria in urine samples, identification of Schistosoma haematobium ova and the confirmation of female genital schistosomiasis (FGS), respectively. Risk factors for urinary schistosomiasis infection were determined using pre-tested structured questionnaire. Data were analyzed using Minitab 17 software and intensity of infection categorized following World Health Organization (WHO) recommendations. Of the 281 pupils, 117 (42%) were males and 164 (58%) were females with mean age of 9 years. At baseline, an overall prevalence of 0.4% (1/281) which was of light intensity was established. At follow-up, an overall prevalence of 2.1% (6/281) which was of both light (16.7%) and heavy infection (83.3%) was established. The result of the clinical examination showed eggs of S. haematobium in and around the vaginal area indicating FGS of a female pupil aged 12 years. This was treated. Identified risk factors for S. haematobium infection in the community include water-contact activities, ignorance, source of water supply among others. The study revealed the need for an all inclusive mass administration of Praziquantel-PC in the study community for effective control and possible elimination.

Evaluation of a novel Nano diagnostic assay for Assessing the Prevalence of Schistosoma haematobium Infection in Areas at Risk in Upper Egypt

Background Urogenital schistosomiasis caused by Schistosoma heamatobium is one of the major public health problems worldwide. It is thought that despite extensive efforts and integrated control programs implicated over the last few decades, the global disease burden of schistosomiasis remains unacceptably high. This persistence of the disease may be due to in part the lack of accurate diagnostic tools for case detection and community screening in endemic areas. Aim of the work The present work aims to develop a novel nano-diagnostic assay using gold nanoparticles (nanomagnetic beads based- ELISA) which can utilize larger surface area, achieving a higher sensitivity for detection of urinary schistosomal egg antigen (SEA) in urine of human schistosomiasis haematobium and comparing it with the traditional sandwich ELISA and direct microscopic examination of urine sediments together with indirect screening by chemical reagent strips for microhaematiria and proteinuria for assessing prevalence of urinary schistosomiasis in some villages in Beni-Suef governorate. Subjects and methods A cross sectional study was conducted on 290 students (192 male and 98 female) selected randomly from Primary and Preparatory schools in four villages in Beni-Suef governorate; The participating children were aged 8–15 years old. A simple questionnaire was designed based on the key indicators of urinary schistosomiasis then, terminal urine samples were collected between 10 am and 2 pm in clean container from each participant to be screened by chemical reagent strips (Combi 10) and examined by urine microscopy and sandwich ELISA techniques (traditional and IMB) for S. haematobium detection. Soluble egg antigen (SEA) was used to produce specific polyclonal antibodies (pAbs) which were then used as a primary capture in the sandwich ELISA techniques. The anti-SEA pAbs were labeled with horse-radish peroxidase (HRP) and used as a secondary capture. Results Out of the 290 participants, 39 children (13.4%) were positive by UM, 53 were positive by traditional sandwich ELISA, with diagnostic sensitivity (87.2%) and specificity (92.4%) and 50 were positive by IMB-sandwich ELISA with diagnostic sensitivity (94.9%) and specificity (95.2%)based on UM results. Micro-haematuria and proteinuria were assessed by chemical reagent strips which gave sensitivity of 29.5%, specificity of 90.8% for micro-haematuria alone, sensitivity of 18.4%, specificity of 92.4% for proteinuria alone, while sensitivity of 35.9%, specificity of 94.9% for combined micro-haematuria and proteinuria which indicated a highly significant association with S. haematobium infection (p value<0.001). Conclusion Combination of both clinical and epidemiological data in addition to sensitive diagnostic tools is essential for diagnosis. The present study as with other studies revealed that, IMB-ELISA based on gold nanoparticles provides more rapid and sensitive detection for SEA in urine samples of patient with active schistosomiasis. Simplicity and fast detection (10 min) are its main advantages. Moreover, its high sensitivity and specificity ensure its application with greater precision and rapid detection. Also, in addition, the prevalence of urinary schistosomiasis in these regions is considered relatively high requiring rapid implementation of control programs to decrease the prevalence and improve the community's health status.

Prevalence and intensity of urinary schistosomiasis among selected people in Tulus area, South Darfur State, Sudan

Background: Urinary schistosomiasis is a major public health issue in Sudan. The disease is endemic in many rural communities across the country.Methods: This is a cross-sectional study conducted to determine the prevalence and intensity of urinary schistosomiasis among selected individual in the city of Tulus, South Darfur state, Sudan. One hundred terminal urine samples were collected and examined for Schistosoma haematobium eggs using standard filtration technique.Results: A total of 100 individual were enrolled in the study with a mean (±SD) age of 17.7±0.73 years. Out of them, 62 (62%) were found to be infected with Schistosoma haematobium. The statistical analysis showed significant association with gender (p=0.043) with higher prevalence 70.9 % (39/55) in female than males 51.1 % (23/45). Majority of the S. haematobium infections were classified as intense infection (82%, 51/62) with egg count ≥50 eggs/10 ml urine, while gross haematuria was observed in 10% of urine samples.Conclusions: In conclusion, the prevalence of S. haematobium infection in the study participants was remarkably high. However, further studies, including large sample size will be essential to assess the burden of the disease in the study area.