An extensive burden of giardiasis associated with intestinal schistosomiasis and anaemia in school children on the shoreline of Lake Albert, Uganda

Abstract

Background: Water-borne parasitic diseases associated with poverty still blight the lives of African school children. In Uganda, intestinal schistosomiasis is still common along the shoreline of Lake Albert, despite ongoing control, and co-infection with giardiasis and malaria is poorly described. To shed light on putative interactions between diseases, a prospective cross-sectional parasitological survey was undertaken in five primary schools.

Methods: Stool samples from 254 school children, aged 5-10 years, were examined by microscopy and rapid diagnostic tests (RDTs), with additional real-time PCR assays for detection of Giardia DNA. A finger-prick blood sample was also taken from each child and tested for malaria, and haemoblobin levels measured. Assocations between diseases and anaemia were assessed.

Results: Intestinal schistosomiasis (46.5%), giardiasis (41.6%) and malaria (56.2%) were common, and a quarter of children were anaemic (<115 g/L). Up to 87.0% of children were excreting Giardia DNA and the prevalence of heavy infection by real-time PCR (Ct≤19) was 19.5%, being positively associated with light, moderate and heavy egg-patent schistosomiasis, as well as with anaemia.

Conclusions: In this setting, an extensive burden of giardiasis was revealed with heavy intensity infections associated with egg-patent intestinal schistosomiasis and anaemia. To improve child health, greater attention on giardiasis is needed along with exploring joined-up actions across diseases that promote better water hygiene and sanitation measures.

Keywords: Co-infection; Control; Epidemiology; Giardia; Plasmodium; Schistosoma.