High Prevalence of Urinary Schistosomiasis in a Desert Population: Results from an Exploratory Study Around the Ounianga Lakes in Chad

Abstract

Background: Researching a water-borne disease in the middle of the Sahara desert might not seem the most relevant concern. However, nomadic Sahelian pastoralist’s health concerns regarding their livestock and anecdotal reports about trematode infections of Fasciola spp and Schistosoma spp in desert-raised animals justified an exploratory study focusing on the lakes of Ounianga in Northern Chad. The aim was to test whether trematode parasites such as Schistosoma spp occur in human populations living around the Sahara desert lakes of Ounianga Kebir and Ounianga Saker in northern Chad. Methods: The study comprised of three components. First, a cross sectional survey based on a random sample drawn from the population to detect infections with S. haematobium and S. mansoni ; second, focus group discussions exploring disease priorities, access to health and health seeking behaviour; and third, searching water contact sites for intermediate host snails. Samples of trematode parasites and snails were confirmed on species level by molecular genetics methods. Results: Among 258 participants, the overall S. haematobium prevalence using urine filtration was 39.1% (95% CI 33.2% – 45.1%), with 51.5% of the infected suffering from heavy infection. The intermediate host snail of S. haematobium ( Bulinus truncatus ) occurred at water sites near both study villages, revealing the potential for local transmission. Although a positive S. mansoni POC-CCA test result was obtained from 15.2% (10.6%-19.7%) of the samples no intermediate host snails of S. mansoni were found, and the relevance of S. mansoni remains uncertain. Qualitative findings underline the importance of morbidity caused by urinary schistosomiasis, and the lack of access to diagnostics and treatment as a major health concern. Conclusion: This research revealed a high prevalence of urinary schistosomiasis in the population living around the lakes of Ounianga in the Sahara, a UNESCO world heritage site in Chad. Despite the high public health importance of the associated morbidity expressed by the population there is no access to diagnostics and treatment. Further research is needed to develop and test a context adapted intervention.

Pediatric schistosomiasis in hard-to-reach areas and populations: a scoping review

“…The studies mainly focused on S. mansoni, and were primarily conducted in island shing communities, including only limited data from other hard-to-reach areas and populations. Although we identi ed two studies on nomad populations [38,39], these were not included in this review, as the authors did not stratify prevalence results into appropriate age groups. Of note, articles from populations living on the shores of the Great Lakes (as opposed to islands) were also not included as we felt they did not meet the 'hard-to-reach' criterion.…”