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Efficacy of praziquantel on Schistosoma haematobium and re-infection rates among school-going children in the Ndumo area of uMkhanyakude district, KwaZulu-Natal, South Africa

View Article: PubMed Central - PubMed

ABSTRACT

Background: Despite its low cure rates and possible resistance, praziquantel (PZQ) is the only drug available for schistosomiasis treatment. Hence, monitoring its efficacy is crucial. This study assessed the efficacy of PZQ, determined re-infection and incidence rates of Schistosoma haematobium infection among school-going children in the Ndumo area, KwaZulu-Natal.

Methods: A cohort of 320 school-going children (10 – 15 years) in 10 primary schools was screened for S. haematobium infection using the filtration technique. Infected children were treated at different times and hence were divided into two sub-cohorts; A1 and A2. Non-infected children constituted the sub-cohort B. Children who continued excreting viable eggs 4 weeks post-treatment received a second dose of PZQ. Re-infection rates were determined in sub-cohort A1 and A2 at 28 and 20 weeks post-treatment, respectively. Cure rates (CR) and egg reduction rates (ERR) were calculated. Incidence rate was assessed 28 weeks post baseline survey using children that were negative for schistosome eggs at that survey. Analysis of data was done using the Chi square and the Wilcoxon rank test. A 95% confidence interval with a P-value < 0.05 determined significance.

Results: At baseline, 120 (37.5%) of the 320 study participants were found infected with Schistosoma haematobium. Heavy infections accounted for 36.7%. The calculated cure rates were 88.07% and 82.92% for females and males, respectively. Egg Reduction Rates of 80% and 64% for females and males were observed 4 weeks after the initial treatment. After the second treatment, CR was 100% in females and 50% in males with an ERR of 100% in females and 70% in males. At 20 and 28 weeks post treatment, reinfection rates of 8.03% and 8.00% were observed, respectively, giving an overall rate of 8.1%. An incidence rate of 4.1% was observed 28 weeks after the baseline screening.

Conclusions: The study indicated high CR while the ERR was low suggesting a reduced PZQ efficacy. The efficacy improved among females after the second dose. Re-infection rates at 20 and 28 weeks post-treatment were low. The study also indicated a low incidence rate for the 28 weeks period.

Electronic supplementary material: The online version of this article (doi:10.1186/s40249-017-0293-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Map of Ndumo area and coordinates of surveyed schools, uMkhanyakude district, South Africa, adapted from Manyangadze et al. [28]
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Fig1: Map of Ndumo area and coordinates of surveyed schools, uMkhanyakude district, South Africa, adapted from Manyangadze et al. [28]

Mentions: This study was conducted in Ndumo area located at the northernmost part of uMkhanyakude district in KwaZulu-Natal (KZN) province, South Africa (Fig. 1). The district extends over 12 818 km2 limited to the East by the Indian ocean, to the West by Zululand district, to the North by Mozambique, to the Northwest by Swaziland, and to the South by uThungulu district [27]. uMkhanyakude district is generally arid with a sub-tropical climate characterised by a hot and humid summer (November – February); and a cooler and drier winter (June – August). Its hydrologic network is constituted by rivers (e.g. mainly Ingwavuma and Pongola), streams, dams (e.g. Pongola) and ponds [25]. There is limited access to piped water [28]. Thus, people rely on open sources of water (river and dams) to sustain their daily domestic needs of water [27]. The unemployment rate is high; 46.18% in 2003 [27] and 53.00% in 2010 [25]. Moreover the district, particularly the Ndumo area is considered as the gateway from Mozambique to South Africa [29]. Thus imported cases of schistosomiasis are likely to come in through Mozambique, one of the countries with the highest burden of schistosomiasis worldwide [4]. uMkhanyakude district also has the highest prevalence of HIV infection and schistosomiasis infection in the country [25].Fig. 1


Efficacy of praziquantel on Schistosoma haematobium and re-infection rates among school-going children in the Ndumo area of uMkhanyakude district, KwaZulu-Natal, South Africa
Map of Ndumo area and coordinates of surveyed schools, uMkhanyakude district, South Africa, adapted from Manyangadze et al. [28]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5383960&req=5

Fig1: Map of Ndumo area and coordinates of surveyed schools, uMkhanyakude district, South Africa, adapted from Manyangadze et al. [28]
Mentions: This study was conducted in Ndumo area located at the northernmost part of uMkhanyakude district in KwaZulu-Natal (KZN) province, South Africa (Fig. 1). The district extends over 12 818 km2 limited to the East by the Indian ocean, to the West by Zululand district, to the North by Mozambique, to the Northwest by Swaziland, and to the South by uThungulu district [27]. uMkhanyakude district is generally arid with a sub-tropical climate characterised by a hot and humid summer (November – February); and a cooler and drier winter (June – August). Its hydrologic network is constituted by rivers (e.g. mainly Ingwavuma and Pongola), streams, dams (e.g. Pongola) and ponds [25]. There is limited access to piped water [28]. Thus, people rely on open sources of water (river and dams) to sustain their daily domestic needs of water [27]. The unemployment rate is high; 46.18% in 2003 [27] and 53.00% in 2010 [25]. Moreover the district, particularly the Ndumo area is considered as the gateway from Mozambique to South Africa [29]. Thus imported cases of schistosomiasis are likely to come in through Mozambique, one of the countries with the highest burden of schistosomiasis worldwide [4]. uMkhanyakude district also has the highest prevalence of HIV infection and schistosomiasis infection in the country [25].Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Despite its low cure rates and possible resistance, praziquantel (PZQ) is the only drug available for schistosomiasis treatment. Hence, monitoring its efficacy is crucial. This study assessed the efficacy of PZQ, determined re-infection and incidence rates of Schistosoma haematobium infection among school-going children in the Ndumo area, KwaZulu-Natal.

Methods: A cohort of 320 school-going children (10 – 15 years) in 10 primary schools was screened for S. haematobium infection using the filtration technique. Infected children were treated at different times and hence were divided into two sub-cohorts; A1 and A2. Non-infected children constituted the sub-cohort B. Children who continued excreting viable eggs 4 weeks post-treatment received a second dose of PZQ. Re-infection rates were determined in sub-cohort A1 and A2 at 28 and 20 weeks post-treatment, respectively. Cure rates (CR) and egg reduction rates (ERR) were calculated. Incidence rate was assessed 28 weeks post baseline survey using children that were negative for schistosome eggs at that survey. Analysis of data was done using the Chi square and the Wilcoxon rank test. A 95% confidence interval with a P-value < 0.05 determined significance.

Results: At baseline, 120 (37.5%) of the 320 study participants were found infected with Schistosoma haematobium. Heavy infections accounted for 36.7%. The calculated cure rates were 88.07% and 82.92% for females and males, respectively. Egg Reduction Rates of 80% and 64% for females and males were observed 4 weeks after the initial treatment. After the second treatment, CR was 100% in females and 50% in males with an ERR of 100% in females and 70% in males. At 20 and 28 weeks post treatment, reinfection rates of 8.03% and 8.00% were observed, respectively, giving an overall rate of 8.1%. An incidence rate of 4.1% was observed 28 weeks after the baseline screening.

Conclusions: The study indicated high CR while the ERR was low suggesting a reduced PZQ efficacy. The efficacy improved among females after the second dose. Re-infection rates at 20 and 28 weeks post-treatment were low. The study also indicated a low incidence rate for the 28 weeks period.

Electronic supplementary material: The online version of this article (doi:10.1186/s40249-017-0293-3) contains supplementary material, which is available to authorized users.

No MeSH data available.