The combined effects of praziquantel and artesunate in the treatment of urinary schistosomiasis were assessed among 312 randomly selected schoolchildren aged 4-20 years in Adim community, Nigeria. In the preliminary screening, infection was confirmed in 327 (38.5%) of the 850 subjects screened. Infected subjects who reported for treatment were then divided into six treatment groups of 52 subjects each; 44 subjects in each group completed their treatment regimens and submitted their urine for post-treatment assessment. Praziquantel and artesunate were administered orally at 40 mg/kg and 4 mg/kg body weight, respectively. Adverse effects due to drug reactions were assessed 72 h after medication and all perceived episodes of illness were treated. Morbidity indicators were assessed 56 days after the final dose of the drug regimens. All treatment regimens were well tolerated. The cure rates were 72.7% in the praziquantel plus placebo-treated group and 70.5% in the artesunate plus placebo group, while the artesunate plus praziquantel group had the highest cure rate (88.6%). Haematuria and proteinuria were extensively reduced after treatment with the three drug regimens. This study confirmed that the treatment of urinary schistosomiasis with the combination of praziquantel and artesunate is safe and more effective than treatment with either drug alone.

The efficacy and tolerability of oral artesunate for the treatment of urinary schistosomiasis was assessed among schoolchildren aged 5-18 years in Adim community, Nigeria. Overall, 500 children, randomly selected from those attending the Presbyterian primary school, were each invited to provide two consecutive urine samples. Using standard parasitological procedures, Schistosoma haematobium ova were found in the samples from 145 (29.0%) of the subjects. Most (87) of the infected subjects were then treated orally with artesunate, using two doses, each of 6 mg/kg, given 2 weeks apart. When the treated children were re-examined 4 weeks after the second dose of artesunate, 61 (70.1%) appeared egg-negative and were therefore considered cured. Post-treatment, the geometric mean egg count (GMEC) for the treated subjects who were not cured was significantly lower than the pre-treatment GMEC for all the treated subjects, with log10[(eggs/10 ml urine) + 1] values of 0.9 v. 1.75 (t = 4.45; P < 0.05). The cure 'rate' for the subjects aged > or = 10 years was slightly higher than that among the younger subjects. It was lowest for the heavier subjects (70% for those weighing 41-50 kg) and highest (79%) for the subjects who weighed 31-40 kg. The artesunate was well tolerated. This observation of a therapeutic effect of artesunate against S. haematobium in Nigeria confirms recent observations from Senegal. In the Adim community at least, it would be more cost-effective to treat urinary schistosomiasis with artesunate than with praziquantel. The wide-spread use of artesunate against schistosomiasis has to be considered carefully, however, if it is not to compromise the efficacy of the drug as an antimalarial, by increasing the risk of resistance developing in local Plasmodium.

A cross-sectional study was conducted in February 1998 on the prevalence and intensity of urinary schistosomiasis among school-age children in and out of school at Adim village in Nigeria to test the objective of delivering a control programme through the school system. School enrollment figures and non-attendance rate were collated from questionnaires that were self-administered by heads of families. Prevalence and intensity of infection were determined following filtration of urine and counting of carbol fuchsin-stained eggs of Schistosoma haematobium. The rates of regular school attendance, irregular attendance and non-attendance were 69.1%, 5.1%, and 25.8%, respectively. These indices were not significantly associated with the age of the schoolchildren (P > 0.05). Boys (76.6%) were more associated with regular attendance than girls (61.4%) (P < 0.0001) while girls had a higher rate of non-attendance (32.7%) than males (19.1%) (P < 0.0001). Although more out-of-school children were infected (90.7%) than those in school (86.8%), the difference was not statistically significant (P > 0.05). The same association was established in the variation of mean egg count between the 2 study populations though intensity was higher among out-of-school children. The principal reasons proffered for the high rate of non-attendance listed in their order of importance were: economic, sickness, poor performance, refusal, farming and fishing. A dual method of control that would in incorporate the integration of recognized local authorities is suggested in areas with moderate school attendance rate like Adim, as lack of treatment of infected out-of-school children ensures continuous contamination and re-infection.

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This study is suggestive of the involvement of E. vermicularis in the aetiology of enuresis in Calabar. Children presenting with, especially, uncomplicated enuresis should be screened for enterobiasis.