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Schistosomiasis in pre-school-age children and their mothers in Chikhwawa district, Malawi with notes on characterization of schistosomes and snails.

Poole H, Terlouw DJ, Naunje A, Mzembe K, Stanton M, Betson M, Lalloo DG, Stothard JR - Parasit Vectors (2014)

Bottom Line: PSAC often had extensive daily water contact and many (~25%) had haematuria and albuminuria.As eggs with an atypical morphology of Schistosoma haematobium were observed, a general selection of schistosome eggs was characterized by DNA barcoding, finding Group I S. haematobium and Group IV and V S. mansoni.Malacological surveys encountered several populations of Bulinus globosus but failed to find Biomphalaria.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. r.stothard@liv.ac.uk.

ABSTRACT

Background: To complement ongoing schistosomiasis control within national control programmes (NCPs) that administer praziquantel to school-age children, assessing the risk and extent of schistosomiasis in pre-school-age children (PSAC) is important.

Methods: In June 2012, schistosomiasis in Chikhwawa district, Malawi was assessed across 12 villages examining pre-school-age children (PSAC) and their mothers by serological and parasitological diagnosis, as supplemented with urine-antigen and questionnaire-interview methods. Urinary tract morbidity was inferred by haematuria and albuminuria assays.

Results: In total, 49.5% (CI₉₅ 42.6-56.4) of 208 PSAC and 94.5% (CI₉₅ 90.9-98.1) of 165 mothers were seropositive for schistosomiasis, in 2 villages seroprevalence exceeded 75% in PSAC. Egg-patent urogenital and intestinal schistosomiasis was observed; 17.7% (CI₉₅ 12.4-23.2) of PSAC and 45.1% (CI₉₅ 37.4-52.8) of mothers having active schistosomiasis by parasitological and urine-antigen testing combined. PSAC often had extensive daily water contact and many (~25%) had haematuria and albuminuria. As eggs with an atypical morphology of Schistosoma haematobium were observed, a general selection of schistosome eggs was characterized by DNA barcoding, finding Group I S. haematobium and Group IV and V S. mansoni. Malacological surveys encountered several populations of Bulinus globosus but failed to find Biomphalaria.

Conclusions: Both PSAC and their mothers appear to be at significant risk of schistosomiasis and should be considered for treatment within the NCP of Malawi.

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Related in: MedlinePlus

PSAC frequently accompany their mothers into the water when washing upon concrete slabs as shown here at Mpangeni [Inset: an atypical egg (left) alongside a typical egg (right) of S. haematobium. The egg on the left is approximately 190 μm in length and resembles Schistosoma leiperi, a schistosome commonly found in wild antelopes].
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Figure 6: PSAC frequently accompany their mothers into the water when washing upon concrete slabs as shown here at Mpangeni [Inset: an atypical egg (left) alongside a typical egg (right) of S. haematobium. The egg on the left is approximately 190 μm in length and resembles Schistosoma leiperi, a schistosome commonly found in wild antelopes].

Mentions: The situation in mothers is perhaps even more alarming as 94.5% of mothers were positive for schistosomiasis by SEA-ELISA with slightly under half (45.1%) having active infection upon the basis of egg excretion or CCA-dipstick results [22]. It is well-known that parasitological methods are insensitive for intestinal schistosomiasis which has led to the creation of a pocket-prevalence-chart to correct upwardly observed egg-based prevalence values [48] and using this chart would infer a ‘true’ prevalence of 50-60% for intestinal schistosomiasis alone. Taken as a whole with urine-filtration and antigen methods, this location should be considered a high-risk environment for schistosomiasis. However, amongst the mothers, general awareness of schistosomiasis was very low which likely contributes to behaviour that continues to sustain high transmission; more than half of the women daily bathed or washed clothes in environmental water. This also influenced childhood exposure; PSAC accompanied their mothers at the waters’ edge, infant bathing was directly witnessed during snail surveys and 1 in 5 PSAC were reported to be bathed daily in this water (Figure 6). Similar practices have been reported elsewhere [16].


Schistosomiasis in pre-school-age children and their mothers in Chikhwawa district, Malawi with notes on characterization of schistosomes and snails.

Poole H, Terlouw DJ, Naunje A, Mzembe K, Stanton M, Betson M, Lalloo DG, Stothard JR - Parasit Vectors (2014)

PSAC frequently accompany their mothers into the water when washing upon concrete slabs as shown here at Mpangeni [Inset: an atypical egg (left) alongside a typical egg (right) of S. haematobium. The egg on the left is approximately 190 μm in length and resembles Schistosoma leiperi, a schistosome commonly found in wild antelopes].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230191&req=5

Figure 6: PSAC frequently accompany their mothers into the water when washing upon concrete slabs as shown here at Mpangeni [Inset: an atypical egg (left) alongside a typical egg (right) of S. haematobium. The egg on the left is approximately 190 μm in length and resembles Schistosoma leiperi, a schistosome commonly found in wild antelopes].
Mentions: The situation in mothers is perhaps even more alarming as 94.5% of mothers were positive for schistosomiasis by SEA-ELISA with slightly under half (45.1%) having active infection upon the basis of egg excretion or CCA-dipstick results [22]. It is well-known that parasitological methods are insensitive for intestinal schistosomiasis which has led to the creation of a pocket-prevalence-chart to correct upwardly observed egg-based prevalence values [48] and using this chart would infer a ‘true’ prevalence of 50-60% for intestinal schistosomiasis alone. Taken as a whole with urine-filtration and antigen methods, this location should be considered a high-risk environment for schistosomiasis. However, amongst the mothers, general awareness of schistosomiasis was very low which likely contributes to behaviour that continues to sustain high transmission; more than half of the women daily bathed or washed clothes in environmental water. This also influenced childhood exposure; PSAC accompanied their mothers at the waters’ edge, infant bathing was directly witnessed during snail surveys and 1 in 5 PSAC were reported to be bathed daily in this water (Figure 6). Similar practices have been reported elsewhere [16].

Bottom Line: PSAC often had extensive daily water contact and many (~25%) had haematuria and albuminuria.As eggs with an atypical morphology of Schistosoma haematobium were observed, a general selection of schistosome eggs was characterized by DNA barcoding, finding Group I S. haematobium and Group IV and V S. mansoni.Malacological surveys encountered several populations of Bulinus globosus but failed to find Biomphalaria.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. r.stothard@liv.ac.uk.

ABSTRACT

Background: To complement ongoing schistosomiasis control within national control programmes (NCPs) that administer praziquantel to school-age children, assessing the risk and extent of schistosomiasis in pre-school-age children (PSAC) is important.

Methods: In June 2012, schistosomiasis in Chikhwawa district, Malawi was assessed across 12 villages examining pre-school-age children (PSAC) and their mothers by serological and parasitological diagnosis, as supplemented with urine-antigen and questionnaire-interview methods. Urinary tract morbidity was inferred by haematuria and albuminuria assays.

Results: In total, 49.5% (CI₉₅ 42.6-56.4) of 208 PSAC and 94.5% (CI₉₅ 90.9-98.1) of 165 mothers were seropositive for schistosomiasis, in 2 villages seroprevalence exceeded 75% in PSAC. Egg-patent urogenital and intestinal schistosomiasis was observed; 17.7% (CI₉₅ 12.4-23.2) of PSAC and 45.1% (CI₉₅ 37.4-52.8) of mothers having active schistosomiasis by parasitological and urine-antigen testing combined. PSAC often had extensive daily water contact and many (~25%) had haematuria and albuminuria. As eggs with an atypical morphology of Schistosoma haematobium were observed, a general selection of schistosome eggs was characterized by DNA barcoding, finding Group I S. haematobium and Group IV and V S. mansoni. Malacological surveys encountered several populations of Bulinus globosus but failed to find Biomphalaria.

Conclusions: Both PSAC and their mothers appear to be at significant risk of schistosomiasis and should be considered for treatment within the NCP of Malawi.

Show MeSH
Related in: MedlinePlus