BACTERIA IN PRIMARY SCHOOL CHILDREN WITH URINARY SCHISTOSOMIASIS IN RURAL COMMUNITIES IN ENUGU STATE, NIGERIA
BACTERIA IN PRIMARY SCHOOL CHILDREN WITH URINARY SCHISTOSOMIASIS IN RURAL COMMUNITIES IN ENUGU STATE, NIGERIA
No Thumbnail Available
Date
2012-09
Authors
OSSAI, OKECHUKWU PAULINUS
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Urinary schistosomiasis though being second to malaria as the most economically
devastating disease is highly neglected in Nigeria. In fact it was only in 2010 that it
was introduced into the Integrated Disease Surveillance and Response (IDSR). This
has made the control of the disease more challenging despite its known high
endemicity in the country. Several studies have shown that the disease can lead to
some dangerous complications ranging from gross mental retardation in children to
renal complications such as bladder cancer. In Enugu state haematuria is a common
complaint in many communities. However, the only attempt to study and
characterize the disease was in a focal community as far back as in 1989. No attempt
has been made to establish the burden in the state or determine the factors that
predispose to the infection and other associated complications.
We carried out a cross-sectional survey of primary school children between the ages
of 5-15years who were randomly selected through a multi stage sampling method
using WHO guidelines for schistosomiasis surveys. An interviewer administered
questionnaire was used to collect data on demographic and socioeconomic variable,
clinical presentations, risk factors. Urine samples were subjected to parasitological
and bacteriology studies to determine prevalence, intensity as well as associated
bacteria tract infections.
A urinary schistosomiasis pooled prevalence of 34.1% was established in the three
LGAs surveyed. However some schools recorded higher prevalence. Heavy
infections accounted for 62.7% and egg count per10mls of urine ranged from 211138
eggs/10mls urine. While haematuria gave the highest specificity and PPV,
leucocyturia presented the highest sensitivity and NPV. The prevalence of associated
bacteria urinary tract infection was 53.7% and the most implicated organism was
E.coli. Frequent visits to stream OR=6.92(4.74-10.14), closeness of open water body
to household OR=5.7493.59-9.21), main source of water being open water bodies
OR=11.49(7.00-19.03) were identified as risk factors to infection.
In conclusion, we have established that there is moderate prevalence of
schistosomiasis in Enugu state (34.1%) which places it in category 2(20-50%) and
therefore qualifies it for targeted mass drug administration in line with WHO
guidelines. In the study, Haematuria with its high sensitivity and positive predictive
value remains a very good marker for the diagnosis of urinary schistosomiasis
especially at the community level. A high level of significant bacteriuria(53.7%) was
also observed in our study far above the expected normal prevalence of 1-5%. This
might spell doom for the state if positive action is not taken to control the menace..
In view of the above the state should carry out grass root sensitization of the rural
populace especially on these identified risk factors to reduce fresh infections and reinfections.
Identified cases should immediately be treated in line with WHO
guidelines. The high prevalence of associated bacteriuria among cases underscores
the need for concurrent antibiotics administration in order to prevent complications.
Description
A DISSERTATION SUBMITTED
IN PARTIAL FULFILMENT OF REQUIREMENT FOR
THE AWARD OF MASTER OF PUBLIC HEALTH
(MPH) FIELD EPIDEMIOLOGY DEGREE OF
AHMADUBELLO UNIVERSITY, ZARIA
NIGERIA
SEPTEMBER, 2012
Keywords
BACTERIA,, PRIMARY,, SCHOOL,, CHILDREN,, URINARY,, SCHISTOSOMIASIS,, RURAL,, COMMUNITIES,, ENUGU,, STATE,, NIGERIA