BACTERIA IN PRIMARY SCHOOL CHILDREN WITH URINARY SCHISTOSOMIASIS IN RURAL COMMUNITIES

(A CASE STUDY OF ENUGU STATE, NIGERIA)

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Author

Presented To

Department of Medicine

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.