A parasitological survey, in rural Zanzibar, of pre-school children and their mothers for urinary schistosomiasis, soil-transmitted helminthiases and malaria, with observations on the prevalence of anaemia

Abstract

'Kick-out-Kichocho' is an integrated helminth-control initiative that is aimed at reducing the burden of urinary schistosomiasis and soil-transmitted helminthiases (STH) on Zanzibar Island (Unguja), in Tanzania. Like other initiatives based on preventive chemotherapy, the programme is mainly school-based and, consequently, pre-school children (aged < or =6 years) are not targeted specifically. To assess the importance of urinary schistosomiasis, STH and malaria, as well as the occurrence of anaemia and growth retardation among these younger children, an epidemiological survey has been undertaken, in a rural area of Unguja, among 152 pre-school children and their 113 mothers. In the pre-school children investigated, urinary schistosomiasis was rare because of the children's lack of contact with environmental water. Malaria was also rare in the children, probably as a consequence of the study season, the widespread use of insecticide-treated bednets and the good access to first-line antimalarial drugs. In contrast, the prevalences of infection with at least one soil-transmitted helminth and of anaemia were alarmingly high among the pre-school children, at 50.0% [95% confidence interval (CI)=40.4%-59.6%) and 73.4% (CI=?65.2%-80.5%), respectively; the corresponding values in the children's mothers were 35.2% (CI=25.4%-45.9%) and 25.9% (CI=18.0%-35.3%). In the rural study area, Kandwi was identified as a hamlet with particularly high levels of transmission of soil-transmitted helminths, and household aggregations of STH were common. To reduce the present health inequities, the future integration of pre-school children within ongoing anthelmintic-control programmes in schools is strongly recommended.

Epidemiology of Schistosomiasis in Two High-Risk Communities of South Côte d'Ivoire with Particular Emphasis on Pre-School–Aged Children

“…18 Previous studies have highlighted such early Schistosoma infection in areas of high endemicity. 25,28,33,34 The negative health impact of such early infections has been emphasized. 31,32,35,36 Our observation of CCA detected in the urine of a child as young as 3 months in the absence of S. mansoni eggs in fecal samples is in line with recent observations from a study in Uganda using different approaches for detecting Schistosoma infections in pre-school-aged children.…”

“…[12][13][14]28,29 It has also been discussed whether preventive chemotherapy should be extended from schoolaged to pre-school-aged children. 27,[30][31][32] However, there are a number of issues that must be addressed before policy recommendations can be made regarding the inclusion of preschoolers in preventive chemotherapy.…”

Community Co-Designed Schistosomiasis Control Interventions for School-Aged Children in Zanzibar

“…Since then, the prevalence of S. haematobium infection has fallen to below 10%. However, transmission hotspots remain (Stothard et al, 2009;Knopp et al, 2013a, b), and visible haematuria, microhaematuria and urinary tract pathology associated with urogenital schistosomiasis are still common (Savioli et al, 1990;Sousa-Figueiredo et al, 2008;Stothard et al, 2009). Successes in the reduction of infection prevalence and intensity have been mainly attributed to the regular administration of preventive chemotherapy on the islands, but a considerable improvement in socioeconomic living standards, including access to safe water and household latrines, also need to be considered (Stothard et al, 2009;Guidi et al, 2010;Knopp et al, 2013b).…”

Changing Policy and Practice in the Control of Pediatric Schistosomiasis

“…Other researchers have also demonstrated that young children in several African countries (including Nigeria, Cote d'Ivoire, Kenya, Mali, Uganda, and Zimbabwe) are infected with schistosomes. 2,17,[30][31][32][33] In addition, in some areas, their infection levels are as high as those in their caregivers; these caregivers, however, were eligible for treatment, while the infected children remain untreated for several years (as reviewed by Stothard et al 28 ). Furthermore, the limited investigations describing and quantifying morbidity in this age group have shown that these infections in young children are clinically significant.…”