Urinary schistosomiasis among primary school children at Al‐Takamul area, eastern Khartoum state‐Sudan: An example for urban schistosomiasis

Background: Urinary Schistosomiasis, caused by Schistosoma haematobium, is classically associated with rural areas that provide the hospitable condition for transmission. With the recent massive internal displacement, new communities were settled and created urban extensions to the big cities. These extensions bridged the space between the urban areas and the agricultural schemes around them. The area selected for this study is a good example for these settings. Given that the new population was displaced from known endemic areas, the transmission cycle seems to be completed. Objective: The aim of this study is to identify the frequency of urinary schistosomiasis among school children form Al-Takamul, which is a suburban district located in the Eastern Khartoum State. Materials and Methods: 150 school children were enrolled in this study, all were boys. Half of them were 11 year old or less. 20 ml of fresh voided urine (including terminal urine) were collected from each participant after a short period of exercise. Following physical and chemical examination, 10 ml sample of each specimen was centrifuged and the sediment was then thoroughly examined under the microscope. Results: 22% of study populations were found infected with S. haematobium (sensitivity 96.97%, specificity 100%), 87.9% of them were more than 11 year old (RR 2.23). 27.27% of the infected individuals had a history of past infection. 84.8% of infected population knew about schistosomiasis and its transmission. The results suggested that urban schistosomiasis is prevalent in the study area and it is presented with a distinguished pattern, that is, it is prevalent among children over 11 years old, and it is associated with knowledge but no awareness. Conclusion: The study area may be a potential focal point of urinary schistosomiasis transmission for neighboring areas. Massive survey and preventive chemotherapy is urgent.

Keywords: Schistosomiasis in sudan, schistosoma haematobium, schistosomiasis in Khartoum, urban schistosomiasis, urinary schistosomiasis

A quarter billion people required preventive treatment form Schistosomiasis worldwide. Three major Species of the genus Schistosoma are responsible for causing acute and chronic forms of the disease in about 78 countries; S. mansoni, S. haematobium, and S. jabonnicum.^[1] By its two forms (urinary and intestinal), schistosomiasis kills 11,770 individuals worldwide. It also costs the communities a 3.31 million disability- adjusted life years (DALY) and 2.9 years lived with disability (YLD).^[2]

It was estimated in the year 2000 that there were 70 million people in Sub-Saharan Africa who experienced haematuria caused by S. haematobium. Schistosomiasis remains an important public health problem in sub-Saharan Africa.^[3]

Schistosomiasis was first introduced to the Susan at the beginning of the 20^th century, and it has swarmed everywhere since then. It is endemic in rural areas where there are irrigated agricultural schemes, such as, White Nile State,^[4] Rahad,^[5] Blue Nile State,^[6] River Nile State,^[7] and other places. Schistosomiasis is basically found in rural areas where the sanitation is poor and water sources are polluted.^[8],[9] The treatment with praziquantel is the corner stone of schistosomiasis control.^[10]

The objective of this study is to identify the frequency of urinary schistosomiasis among school children form Al-Takamul district, which is a suburban district located in the Eastern Khartoum State.

This is a cross-sectional study of a qualitative approach, in which 150 school children were surveyed for Schistosomahaematobium infection. The study was conducted at Al-Takamul district, East-Nile Province, Khartoum State.

Study area and population

Al-Takamul district was established in early 1980’s for the settlement of population, which was displaced because of drought and war. It contains mixed population from almost all parts of Sudan and is an urban extension of Khartoum- North (Khartoum Bahry) City. It is neighbouring the southern part of ElSilait irrigated scheme (15 38’56.2″N 32 38’15.7″E) a scheme, which was established in 1974, and is located in the northeast of Khartoum-Bahry, with an objective to produce vegetables and meat for consumption in Khartoum State. The area is fast growing and hyper populated.

150 school children were enrolled in this study. They were selected from Al-Takamul elementary (basic) school for boys. There were eight grades, out of which twenty boys were selected from each grade class.

From each study subject; 20 ml of fresh voided urine (including terminal urine) was collected following a short period of exercise. The specimens were subjected to physical and chemical examination. 10 ml sample of each specimen was centrifuged and the sediment was thoroughly examined under the microscope.

Clinical and biographic data were collected and the participants were interviewed via structured study Performa for their knowledge about schistosomiasis.

The obtained data was tabulated and analyzed using IBM® Statistical Package for Social Sciences (SPSS v 19).

Ethical statement

This study received the ethical approval from Ethical Committee of the Faculty Board Council, Faculty of Medical Laboratory Sciences, Al-Neelain University. A written informed consent was obtained from the guardian of each participating child.

150 school children were enrolled in this study; allboys, 50% of them were 11-year old or less. The frequency of urinary schistosomiasis among study population was 22% (sensitivity 96.97%, specificity 100%). The infection was significantly prevalent among students whose age was more than 11 years (87.9% of the infections, with relative risk 2.23 and P. value 0.00).

Haematuria was significantly associated with infection (96.97%), and it is more prevalent among subjects with egg count more than 50 egg/ml (61% among haematuria). All students with proteinuria were found infected with S. haematobium. Proteinuria was found increased proportionally with an increase in egg count. However, proteinuria was not detected in 7 of the infected individuals (egg count less than 50/ml). 12 (8%) of the study population presented with history of treated infection. 9 of them were with “new infection”. 27.27% of the infected individuals had a history of past infection.

76 (50.7%) of the students knew about schistosomiasis and its transmission, 64 (84.2%) of them were over 11 year old. 28 (84.8%) of them were found infected. [Table 1] illustrates the results of this study.

Since its discovery, schistosomiasis has been associated with rural areas where the sanitary system is poor or does not exist.^[11]

During the last three decades of the 20^th century, there had been massive waves of internal displacement from rural to the urban areas. This is attributed to many socio-economic factors, including wars and environmental conditions. This status creates new extensions to the urban areas and is often associated with poor infrastructures including shortage or even absence of sanitary services.

In our case, the study area constitutes a perfect model for urbanization following the above mentioned paradigm. As it is settled now, urbanization creates new challenges for the epidemiology of infectious disease.^[12] The absence of sanitary services paves the way for Schistosoma transmission and renders the community eligible for epidemics.^[13]

The area was selected for this study because of the urgent reports, which came from the local health care facilities regarding the increasing number of urinary schistosomiasis cases.

The transmission cycle is completed in the study area. It is neighboring an irrigated scheme, and some of the populations were displaced from known endemic areas. The snail vector usually finds its place in the circle. However, the community seems not to be aware of this.

Form the results; it appears that the infection is prevalent among students above 11 years old. They go to the potentially infested canals for swimming and playing at leisure. We don’t observe any occupational activities over there. Also, it was observed that the only source of knowledge about schistosomiasis and its transmission is from the school curriculum. It is taught to students at the 5th grade. This explains why students less than 11 year old do not know about schistosomiasis. Nevertheless, the knowledge does not reflect on the attitude and practice of the students towards the diseases prevention. This may be due to the fact that they don’t recognize the problem as a local concern.

Urban schistosomiasis has been reported by several researches, from Nigeria,^[14] Zambia,^[9] Niger,^[15] Mali,^[8] Tanzania (Zanzibar),^[16] Brazil^[17] and china.^[18] It seems that urban schistosomiasis has got a distinguished footprint. It affects boys rather thangirls, and it is more prevalent among children more than 11 year old. Furthermore, it might be associated with the knowledge but without awareness.

The results of this study suggested that, urban schistosomiasis is prevalent in the study area and it is presented with a distinguished pattern, that is, it is prevalent among children over 11 years old, and it is associated with knowledge but no awareness. The study area may be a potential focal point of urinary schistosomiasis transmission for neighboring areas. Massive survey and preventive chemotherapy is urgent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.208720

[Table 1]