Epidemiological and clinical aspects of urogenital schistosomiasis in women, in Burkina Faso, West Africa

Abstract

BackgroundBecause infections with Schistosoma Haematobium usually peak in childhood, the majority of studies on schistosomiasis have focused on school-aged children. This study aimed to assess the epidemiological and clinical aspects of urogenital schistosomiasis in women in Burkina Faso, West Africa.MethodsA cross-sectional study was conducted in a mesoendemic region (Kombissiri) and a hyperendemic region (Dori) for schistosomiasis in Burkina Faso. A total of 287 females aged 5 to 50 years were included in the study. S. haematobium infection was assessed using the urine filtration method and dipsticks were used for the detection of hematuria. Interviews were conducted to identify clinical aspects and risk factors related to urogenital schistosomiasis.ResultsThe overall prevalence of S. haematobium infection in Dori was 21.3 %, where as Kombissiri was less affected with a prevalence of 4.6 %. The most affected age group was the 10- to 14-year-olds (41.2 %), followed by the 15- to 19-year-olds (26.3 %). Risk factors significantly associated with schistosomiasis (P <0.05) were place of residence, age, contact with open water in the past year, and distance of home to open water. The percentage of participants who had contact with open water was significantly higher among the women living in Dori compared to Kombissiri. Females over 15 years of age showed a significant higher rate of water contact compared to the 5- to 15-year-olds. A significant correlation between schistosomiasis and hematuria was established. Microhematuria showed a sensitivity of 80.6 %, a specificity of 92.7 %, and a positive predictive value of 61.7 %, whereas macrohematuria had a sensitivity of 47.2 %, a specificity of 99.2 %, and a positive predictive value of 89.5 %. The mass distribution of praziquantel in Burkina Faso is well established. However, over half of the participants with schistosomiasis in this study said they took praziquantel in the past 6 months, which indicates a high reinfection rate. This may be associated with a lack of knowledge about the transmission of schistosomiasis. Only 6 % of the participants in Kombissiri and 1.5 % in Dori knew about the correct mode of transmission.ConclusionsThe results of our study indicate that distribution campaigns should be extended from school-aged children to young women. Our data also demonstrate the necessity of combining already established mass distribution campaigns with information campaigns, so that long-term elimination, or at least reduction, of schistosomiasis can be achieved.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0174-1) contains supplementary material, which is available to authorized users.

Determinants of Urogenital Schistosomiasis Among Pregnant Women and its Association With Pregnancy Outcomes, Neonatal Deaths, and Child Growth

“…Hematuria was included in our definition of urogenital schistosomiasis to reflect the single urine sample available per participant, the low sensitivity of urine microscopy for low-intensity infections, which were predominant in our cohort, and female genital schistosomiasis pathology due to encystment of eggs in tissues [ 11 ]. Both eggs and hematuria have established validity for detection of urogenital schistosomiasis in endemic areas [ 2 , 3 , 5 ], although hematuria can result from alternative causes [ 27 , 28 ]. The association between hematuria and urogenital schistosomiasis is supported in our cohort by the geographical overlap between egg-positive and hematuria-positive prevalence, and higher infection intensities among women with more severe hematuria.…”

“…A convex age-prevalence and age-infection intensity relationship is typical in schistosome-endemic communities, with infections accumulated in early life, peaking in childhood, and declining with age thereafter [ 33 ]. The age-related decline in infection could be driven by development of immune-mediated resistance [ 33 , 34 ], increasing years of education [ 29 ], and/or changes in physiology [ 35 , 36 ] and water contact behavior [ 2 , 37–39 ]. For example, younger women tend to have more water contacts than older women [ 38 ] and a higher percentage of older women are aware of schistosomiasis [ 29 ].…”

“…Ongoing egg deposition drives chronic tissue damage, which can progress to renal and urogenital dysfunction if untreated [ 1 ]. Microscopic detection of S. haematobium eggs in urine is diagnostic of urogenital schistosomiasis, which can also be identified indirectly via hematuria [ 2–5 ]. Adult worms can be cleared by the antihelminthic drug praziquantel; however, treatment does not clear immature parasites nor prevent reinfection [ 1 ].…”

Seasonal Pattern and Occurrence of Schistosoma haematobium Egg Excretion among Pregnant Women in Munyenge, South West Region, Cameroon

“…About one in four women was positive for worm during pregnancy suggesting that the disease is an important public health concern in Munyenge. It is wellknown that the transmission of schistosomiasis is common among rural African women who obtain water for domestic and other uses from springs and streams [46][47][48][49]. The high dependency on stream as water source in this setting is partly influenced by inadequate access to pipe-borne water despite scale up of communal piped water sources [33,37].…”

Tools for Detection of Schistosomiasis in Resource Limited Settings

“…This inability to carry out repeated testing will result in an underestimation of the true burden of infection, necessitating a more sensitive diagnostic and cost effective tool in such settings [ 11 , 26 ]. In schistosomiasis screening campaigns, hematuria has been found to be significantly associated with S. haematobium infection [ 27 ]. Macro- or micro-hematuria can be assessed using dipstick [ 28 ].…”