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. 2014 Apr 1:7:153.
doi: 10.1186/1756-3305-7-153.

Schistosomiasis in pre-school-age children and their mothers in Chikhwawa district, Malawi with notes on characterization of schistosomes and snails

Helen Poole, Dianne J Terlouw, Andrew Naunje, Kondwani Mzembe, Michelle Stanton, Martha Betson, David G Lalloo, J Russell Stothard  1
Affiliations

Schistosomiasis in pre-school-age children and their mothers in Chikhwawa district, Malawi with notes on characterization of schistosomes and snails

Helen Poole et al. Parasit Vectors. .

Abstract

Background: To complement ongoing schistosomiasis control within national control programmes (NCPs) that administer praziquantel to school-age children, assessing the risk and extent of schistosomiasis in pre-school-age children (PSAC) is important.

Methods: In June 2012, schistosomiasis in Chikhwawa district, Malawi was assessed across 12 villages examining pre-school-age children (PSAC) and their mothers by serological and parasitological diagnosis, as supplemented with urine-antigen and questionnaire-interview methods. Urinary tract morbidity was inferred by haematuria and albuminuria assays.

Results: In total, 49.5% (CI₉₅ 42.6-56.4) of 208 PSAC and 94.5% (CI₉₅ 90.9-98.1) of 165 mothers were seropositive for schistosomiasis, in 2 villages seroprevalence exceeded 75% in PSAC. Egg-patent urogenital and intestinal schistosomiasis was observed; 17.7% (CI₉₅ 12.4-23.2) of PSAC and 45.1% (CI₉₅ 37.4-52.8) of mothers having active schistosomiasis by parasitological and urine-antigen testing combined. PSAC often had extensive daily water contact and many (~25%) had haematuria and albuminuria. As eggs with an atypical morphology of Schistosoma haematobium were observed, a general selection of schistosome eggs was characterized by DNA barcoding, finding Group I S. haematobium and Group IV and V S. mansoni. Malacological surveys encountered several populations of Bulinus globosus but failed to find Biomphalaria.

Conclusions: Both PSAC and their mothers appear to be at significant risk of schistosomiasis and should be considered for treatment within the NCP of Malawi.

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Figures

Figure 1
Figure 1
A sketch map of snail collecting sites around Chikhwawa showing the 12 villages surveyed for schistosomiasis as indicated by SEA-ELISA by pie-charts denoting prevalence in PSAC (black pie segment infected) and in mothers (outer line segment infected).
Figure 2
Figure 2
Observed prevalence of SEA-ELISA positive results in PSAC by age group and by strength of reaction.
Figure 3
Figure 3
Prevalence of schistosomiasis as assessed by different diagnostic methodologies in PSAC and mothers across the 12 villages [CI 95 around the prevalence are indicated].
Figure 4
Figure 4
A & B Frequency of egg-patent urogenital schistosomiasis increases with age of the child (A), microhaematuria is also associated with increasing age (B).
Figure 5
Figure 5
Raised urine albumin levels (> 40 mg/L) in relation to egg-patent infection with S. haematobium reveal underlying urinary tract pathology in young children.
Figure 6
Figure 6
PSAC frequently accompany their mothers into the water when washing upon concrete slabs as shown here at Mpangeni [Inset: an atypical egg (left) alongside a typical egg (right) of S. haematobium. The egg on the left is approximately 190 μm in length and resembles Schistosoma leiperi, a schistosome commonly found in wild antelopes].
See this image and copyright information in PMC

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