Urinary schistosomiasis among schoolchildren in Yemen: prevalence, risk factors, and the effect of a chemotherapeutic intervention.

BACKGROUND: Schistosomiasis is one of the most important public health problems in Yemen. The prevalence of urinary schistosomiasis varies considerably across different parts of Yemen and was estimated to be 10% among schoolchildren in Sana'a. Praziquantel (PZQ) is highly effective against all five major human species of schistosomes. OBJECTIVES: The aim of the present work was to estimate the prevalence of urinary schistosomiasis, describe the risk factors associated with its endemicity, and implement and assess a chemotherapeutic intervention using PZQ in a village in Yemen. PATIENTS AND METHODS: The sample included 696 schoolchildren from a village in Abyan Governorate. During the baseline school survey, personal, sociodemographic, and environmental data, and data on practices in relation to water contact were collected from each study participant using a predesigned structured questionnaire. Urine samples from each participant were examined for macrohematuria and the presence of Schistosoma haematobium eggs. The chemotherapeutic intervention was assessed 3 and 6 months after the treatment and certain indicators were calculated. RESULTS: The prevalence of S. haematobium was 18.1%. The main significant risk factors were male sex; proximity of houses to water ponds; and using pond water for swimming, agricultural activities, and for bathing in houses. PZQ treatment reduced the prevalence of infection and decreased the prevalence of high-intensity infection. Survival analysis showed that the probability of residual infection also dropped after the treatment intervention. CONCLUSION AND RECOMMENDATIONS: Male sex and using pond water for various activities were the main significant risk factors associated with urinary schistosomiasis. PZQ is still a cornerstone drug in reducing or eliminating morbidity associated with schistosomiasis infection. Health education programs tailored for the community are required for the control and prevention of urinary schistosomiasis. To address schoolchildren, school curricula should include lessons about urinary schistosomiasis.

Socioeconomic and environmental factors affecting malaria infection in Fayoum Governorate, Egypt.

Malaria as a disease has been identified in Egypt since ancient times. Remnant residual foci are still localized in two districts; Sinnuris and Faiyoum, Faiyoum Governorate. The work focused on socioeconomic and environmental factors affecting malaria infection. The results showed that malaria infection increase with the decrease of socioeconomic level of families, educational level of examined individuals and among unemployed or students. The infection increase among those lived in muddy or bad constructed house near the breeding places. The infection decreased significantly among who owned animal sheds and had large number of animals. The indoors use of 5% mala-thion did not affect the malaria infection.

Malariometric parasitological survey in El-Fayoum Governorate, Egypt.

Egypt represents the only focus in the Mediterranean region where Plasmodium falciparum transmission still occurs. A total number of 9065 individuals of different ages of both sexes were examined. 7236 (79.82%) individuals examined during (MBE) i.e. house-to-house visit; 1184 (13.06%) individuals examined by (PCD) i.e passive case detection; and 645 (7.12%) individuals represented (NOD). The total number of positive cases was 52. Out of them, two only were P. vivax. But, the rest were P. falciparum, 32 cases (61.54%) were detected by MBE, 12 cases (23.08%) by PCD and 8 cases (15.38%) by NOD. The mean age of the total positive cases was 20.54 +/- 14.93 years. It was found that malaria infection didn't get affected by sex. The parasite rate (PR) among was 0.57%, parasite formula was 96.15% for P. falciparum and 3.85% for P. vivax, species infection rate (SIR) was 0.55% for P. falciparum and 0.02% for P. vivax. Gametocytaemia was 74% of the total positive malaria cases. High parasite density (PD) was encountered among the younger age groups less than five years.

Development of schistosomal school-based health education model for Yemeni schoolchildren.

In this study, 152 students (90 males & 62 females) of primary (5th & 6th grades, 52 males & 30 females) and preparatory (1st & 2nd grades, 38 males & 32 females) schoolchildren of different age and sex group inhabited in two endemic villages with Schistosoma mansoni in Taiz Govenorate were examination. The highest prevalence and intensity of S. mansoni were-among males at the age group from 10 - < 12 years. A significant relationship was recorded between prevalence and intensity of infection and those who using pond water for human usage. The prevalence was significantly higher among children who received previous praziquantel treatment as well as those who didn't have TV, Radio and/or Video. The results were discussed on the light of certain variables.

Malaria status in Al-Hodeidah Governorate, Republic of Yemen. Part II: Human factors causing the persistence of chloroquine resistant P. falciparum local strain.

Two hundred and nine Yemeni with P. falciparum local strain satisfing all criteria of WHO for monitoring chloroquine sensitivity by in vivo and in vitro tests in urban and rural population of Al-Hodiedah G. were interviewed to study the human factors causing the persistence of chloroquine resistant. A pre-designed questionnaire sheet was used for every case, which included data concerning assessment of chloroquine resistant problem. The results revealed that, 54.7% of the studied group had used chloroquine for malaria treatment. About 75.0% were used antimalarial drugs by over the counter (OTC) i.e. self medication which was more common in rural (76.9%) than urban areas (63.6%). Chloroquine resistant was increased with the decrease of education level; decrease income/capita/month; among younger age-group (<15 years); and sleeping in open air in courts (56.3%, 57.8%, 56.6% and 66.7% respectively). The highest percentage of chloroquine resistant (71.0%) was recorded among cases with high parasite density (>1000 asexual parasite/microL); in presence of gametocytes (82.6%); among cases who did not complete antimalarial course (89.7%); those who gave a history of receiving antimalarial drugs without laboratory diagnosis (75.0%); those keeping leftover drugs after usage (63.8%) and reading expiry date and pamphlet of malaria drugs (26.9%). The results suggested the need for increasing of public awareness on emergence and spread of chloroquine-resistant and to outline potential risk factors useful for health workers in Yemen, especially in remote areas to identify high risk P. falciparum patients for chloroquine resistance before treatment.

Malaria status in Al-Hodeidah Governorate, Yemen: malariometric parasitic survey & chloroquine resistance P. falciparum local strain.

Malaria continues to be a major public health problem in Al-Hodeidah G. A cross-sectional malariometic parasitic survey including 4000 Yemenis of various age /sex groups were enrolled in this study from 43 villages/or Harah in five selected districts representing Al-Hodeidah G. Duplicate thin and thick blood smears were stained with Giemsa's stain and examined. Out of 4000 examined slides, 646 (16.2%) were found to be malaria positive, 508 (78.6%) of them were detected through ACD, while 138 (21.4%) cases were detected by PCD. The overall parasite rate was 16.2%, a situation of prevalently mesoendemic condition. P. falciparum was the predominant species recorded (96.7%), followed by P. vivax (1.7%), the least prevalent was P. malariae (0.3%). Yemen has been considered free of ovale malaria. The recorded an indigenous case of P. ovale for the first time in Yemen should be taken into consideration for the existence of this particular Plasmodium species when surveying for malaria in the future. The present study was the first document in Yemen to compare simultaneously the in vivo and in vitro response to chloroquine among 209 of P. falciparum field isolate patients that were satisfied all criteria of WHO for the implementation of the in vivo and in vitro tests and were obtained by PCD and ACD methods. Chloroquine resistance of local strain of P. falciparum was recorded in all studied districts (Zabid, Bajil, Azohrah, Azaidiah and Al-Hodeidah city). RIII (high level of resistance) was recorded for the first time in Yemen and should be taken into consideration in the treatment of infected malaria patients. This calls for urgent revision of the current malaria treatment policy in Yemen where chloroquine is the first-line treatment of uncomplicated P. falciparum malaria.