Change in children's school behavior after mass administration of praziquantel for Schistosoma mansoni infection in endemic areas of western Kenya: A pilot study using the Behavioral Assessment System for Children (BASC-2)

Abstract

Background: Schistosomiasis is a parasite-related chronic inflammatory condition that can cause anemia, decreased growth, liver abnormalities, and deficits in cognitive functioning among children.

Methodology/principal findings: This study used the Behavior Assessment System for Children (BASC-2) to collect data on thirty-six 9-12 year old school-attending children's behavioral profiles in an Schistosoma mansoni-endemic area of western Kenya, before and after treatment with praziquantel for S. mansoni infection. BASC-2 T scores were significantly reduced post-treatment (p < 0.05) for each of the 'negative' behavior categories including externalizing problems (hyperactivity, aggression, and conduct problems that are disruptive in nature), internalizing problems (anxiety, depression, somatization, atypicality, and withdrawal), school problems (academic difficulties, included attention problems and learning problems), and the composite behavioral symptoms index (BSI), signifying improved behavior. While the observed improvement in the 'positive' behavior category of adaptive skills (adaptability, functional communication, social skills, leadership, and study skills) was not statistically significant, there were significant improvements in two adaptive skills subcategories: social skills and study skills.

Conclusion/significance: Results of this study suggest that children have better school-related behaviors without heavy S. mansoni infection, and that infected children's behaviors, especially disruptive problem behaviors, improve significantly after praziquantel treatment.

Fig 1

Mean BASC-2 T scores for S. mansoni egg-positive (Panel A) and egg-negative (Panel B) students before and after treatment with praziquantel. The results of the BASC-2 survey were transformed into standardized T scores for each of 5 composite behavior categories. The mean T scores for each group of students were then determined; the numerical values and standard deviations are listed in S1 Table. A lower score indicates fewer problematic behaviors for externalizing problems, internalizing problems, school problems, and the Behavioral Symptoms Index. A higher score indicates more favorable behaviors for Adaptive Skills. dark blue = before treatment; light blue = after treatment.

Fig 2. Percent of students with average, at-risk, or clinically significant BASC-2 T scores.

Percentages were calculated for S. mansoni egg-positive and egg-negative students both before and after treatment. Color intensity represents the category: dark blue = clinically significant; medium blue = at-risk; light blue = average.