key: cord-0256960-rsj21gz8 authors: Kapanga, S.; Mulemena, J. A.; Kamvuma, K.; Phiri, C. N.; Chanda, W. title: Prevalence and correlates of urogenital schistosomiasis in school going children in Maramba compound of Livingstone District, Zambia date: 2022-04-10 journal: nan DOI: 10.1101/2022.04.08.22273629 sha: 7988d63e6734a681a9afec33b820fafabe0b7674 doc_id: 256960 cord_uid: rsj21gz8 Background Schistosomiasis is an acute and chronic parasitic disease that is caused by trematode worms (blood flukes) of the genus Schistosoma. Schistosoma haematobium (S. haematobium) is known to cause urogenital schistosomiasis. The disease is the second most common socio-economically devastating tropical parasitic disease after malaria in Africa. In Zambia, it affects over a million school going children, mostly in rural communities due to unsafe water and inadequate sanitation facilities. This study aimed to determine the presence of S. haematobium in urine specimens of school going children in Maramba compound of Livingstone and establish factors associated with the acquisition and spread of the parasite. Methods A structured questionnaire was administered on all children with signed consent from their guardians/parents and afterward spot urine specimens were collected in sterile containers for macroscopically/microscopically examination by an independent laboratory technologist. Results A total of 173 school going children participated in the study. Parasitic eggs were detected in 6 specimens providing a prevalence of 3.47% (p<0.01) and this had a strong association with presence of microscopic red blood cells (p<0.01), dysuria (p=0.026), washing in a stream (p=0.01), and the perception on bilharzia acquisition (p<0.01). Conclusion The prevalence of urogenital schistosomiasis among school going children in Maramba compound was 3.47%, and the correlates of the infection included washing in a stream, older age and poor knowledge on schistosomiasis. Participants that had schistosomiasis often presented with hematuria and lacked knowledge on disease acquisition, health effects and preventive measures. This calls for more robust sensitization of school going children and periodic screening to curb the disease. Schistosomiasis is an acute and chronic parasitic disease that is caused by trematode children, mostly in rural communities due to unsafe water and inadequate sanitation 78 facilities (15). A meta-analysis study revealed a 32.2% prevalence estimate of S. 79 haematobium across studies for the entire period among school-aged children (15). Despite CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 10, 2022. ; https://doi.org/10.1101/2022.04.08.22273629 doi: medRxiv preprint School registers were used to randomly select participant using a systematic sampling 100 method. From the register, every fourth name was selected for the study and all pupils (6-101 16years old) that visited the out-patient department at Maramba Clinic were also randomly 102 selected for the study. A structured questionnaire was administered on all children with signed consent from 104 their guardians/parents and afterward spot urine specimens were collected in sterile 105 containers for macroscopically/microscopically examination by an independent laboratory 106 technologist. However, school going children whose guardians/parents refused to sign the 107 consent form, or had taken medication for schistosomiasis 2 weeks prior to sample 108 collection were excluded from the study. The outcome study variable was the detection of S. haematobium eggs in urine specimen 110 while the independent variables included age, gender, water source, sanitation levels, 111 proximity to stream, swimming in contaminated water, previous UTI diagnosis, UTI 112 medication history, headache, fever, myalgia, rash, dysuria, and microscopic red blood cells 113 in urine. Data was entered, cleaned and coded in Microsoft Excel 2019 then exported and analyzed 115 using STATA version 15. Descriptive statistics using tables, frequencies, means and 116 medians were utilized to describe the data. A chi-square test was used for categorical 117 variables and logistic regression was used to analyze the logarithmic transformation of the 118 odds of the associated variables. A p-value of ≤5% was considered statistically significant. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 10, 2022. ; https://doi.org/10.1101/2022.04.08.22273629 doi: medRxiv preprint whereas avoiding bathing in contaminated water (41.62%, 72) and handwashing before 141 eating (24.28%, 42) were identified as infection preventive measures (Table 1) . Laboratory findings revealed presence of red blood cells and Schistosoma cysts in 3.47% 143 (6) of the urine specimens analyzed (Table 1) . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. Living near a stream . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. Defecating/urinating in latrines 22 12.72 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. History of hematuria . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. The presence of Schistosoma cysts in urine denoted urogenital schistosomiasis infection. The cysts were detected in 6 specimens providing a prevalence of 3.47% (p<0.01) and this Table 2 . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. ; https://doi.org/10.1101/2022.04.08.22273629 doi: medRxiv preprint During multivariable analysis only age was found to be statistically significant (p=0.011). It 178 was observed that an increase in age was associated with an increased odds of acquiring 179 schistosomiasis (OR 2.86; 95%CI: 1.27-6.44; p= 0.011), this was supported by a linear 180 regression analysis (R 2 : 0.063, p=0.001). is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. A study by Gbalégba et al. (28) found males to be nearly two times more likely to be 226 infected with S. haematobium than females (adjusted OR, (aOR) 1.75, 95% CI: 1.11-2.77), 227 and children at primary school were nearly two times more likely to be infected than those 228 who did not go to school (aOR 1.79, 95% CI: 1.07-2.99). Our study involved children at 229 primary school and the male gender was not strongly associated with contracting S. 230 haematobium after confounding factors were excluded. In establishing correlates of schistosome infections, variables such as human contact with 232 water and socio-demographics create a high risk of exposure (29). Our study found that 233 not living near a stream, not washing in a stream and avoiding swimming in a stream 234 reduced chances of putting children at risk of contracting schistosome infection by 22%, 235 67% and 47%, respectively. This was in line with a study done in Mauritania which found 236 swimming/bathing as the main activity, followed by washing clothes and dishes (28). The 237 variability of ambient temperature and humidity in sub-Saharan Africa forces children to 238 have swimming activities and general interaction with water. Therefore, mollusk control . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. ; https://doi.org/10.1101/2022.04.08.22273629 doi: medRxiv preprint programs might prevent disease spread since contact with water may not be avoided by 240 children. Furthermore, we discovered that an increase in age was associated with an increased odds 242 of acquiring S. haematobium (aOR 2.86; 95% CI: 1.27-6.44, p=0.011) and this was similarly 243 seen in a study in Yemen where the prevalence of S. haematobium infection was found 244 significantly higher in children aged over 10 years and lower in younger ones (30). This 245 observation could probably be because this age group is often involved in water-contact 246 activities such as swimming, washing, watering or fishing. Despites clinical manifestations such as headache, fever, skin rash and dysuria having an Therefore, it is cardinal to sensitize the risk community about the disease. Primary school . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted April 10, 2022. The prevalence of urogenital schistosomiasis among school going children in Maramba 275 compound was 3.47% and the correlates of acquiring S haematobium included washing in a 276 stream, age and poor knowledge on schistosomiasis. Participants that had schistosomiasis 277 often presented with dysuria and hematuria. Therefore, we recommend that an integrated 278 program that involves sensitizing the community about schistosomiasis and its 279 complications as well as hygiene and behavioral change program could be implemented for 280 easy risk factor modification. The clinic with the help of community health assistants may 281 work hand-in-hand with the community to periodically screening school going children to . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted April 10, 2022. ; https://doi.org/10.1101/2022.04.08.22273629 doi: medRxiv preprint capture and treat the asymptomatic individuals. Finally, use of molluscicides on Maramba 283 stream to control vector infestation could subsequently control urogenital schistosomiasis. Acknowledgements 286 We would like to graciously acknowledge all parents, guardians and teachers of Maramba 287 school for their unwavering support during data collection, and all the study participants 288 for their cooperation during specimens and data collection. We would like to further 289 acknowledge the contribution of the laboratory technologists and staff members of 290 Maramba clinic for their assistance. 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