Schistosoma mansoni infection and its association with nutrition and health outcomes: a household survey in school-aged children living in Kasansa, Democratic Republic of the Congo.

INTRODUCTION: Schistosomiasis (SCH) is an important public health problem in developing countries and school-aged children are the most affected. This study explored health and nutritional status and their correlation with SCH in children attending primary school (3rd to 6th class) living in the area of Kasansa in the Democratic Republic of Congo. METHODS: Across-sectional household survey was carried out in Kasansa health area in February 2011. Children whose parents reported to attend primary school (3rd to 6th class) were included. Socio-demographic characteristics, information on morbidity history and risk factor were collected using a semi-structured questionnaire. S. mansoni and malaria infection were assessed using the Kato-katz technique and rapid diagnostic test, respectively. Haemoglobin concentration was also performed using a portable HemoControl device. Bivariate and multiple logistic regressions were used to assess risk factors for S. mansoni. RESULTS: A total of 197 school aged children participated in the study with a median age of 12 years and 53.8% of them were boys. The overall health status of the children was poor with very high prevalences of S. mansoni infection (89.3%), malaria infection (65.1%), anaemia (61.4%) and stunting (61.0%). Regular contact with river water was the most important risk factor (OR: 11.7; p<0.001) related to SCH infection. A low haemoglobin concentration was significantly associated with a SCH infection (OR: 12.3; p=0.003) and egg load was associated with stunting (OR: 12.4; p=0.04). Children from farmers were more at risk for low school performance (OR: 5.3; p=0.03). CONCLUSION: High prevalence of Schistosoma mansoni and malaria infection was observed in the study population living in Kasansa area. Moreover, they presented a high burden of anaemia, chronic malnutrition and low school performance. An integrated disease control and management of these diseases and their consequences, endorsed by surveillance, is needed.

Initiating NTD programs targeting schistosomiasis and soil-transmitted helminthiasis in two provinces of the Democratic Republic of the Congo: Establishment of baseline prevalence for mass drug administration.

BACKGROUND: Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). METHODS: Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9-15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. RESULTS: Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00-65.00%). The prevalence of hookworm, roundworm and whipworm were 51.62% (32.40%-71.50%), 15.77% (0.50%-39.60%) and 13.46 (0.50%-33.20%), respectively. CONCLUSION: This study provided the evidence base for implementing programs targeting SCH and STH in these Health Zones. Observations also reinforce the operational value and feasibility of the POC-CCA test to detect S. mansoni and, for the first time, S. intercalatum infections in a routine NTD program setting.

The road towards sustainable control of schistosomiasis in the Democratic Republic of Congo: Pre-assessment of staff performance and material resources in endemic regions

Objective:To improve knowledge and practice of health staff as well as the availability of material resources for diagnosis and management of schistosomiasis in two endemic provinces of DRC (Kinshasa and Bas-Congo).Methods:Structured interviews were performed using questionnaires with staff from 35 healthcare facilities in 9 health zones (HZ) of Kinshasa and 2 HZ in Bas-Congo.Results:Schistosomiasis was reported to be present in all the included HZ.Health staff knew the most important symptoms of schistosomiasis,but advanced symptoms were more accurately reported in Bas-Congo.Knowledge of symptoms related to schistosomiasis such as anemia (P =0.0115) and pollakiuria (P =0.0260) was statistically different in both two provinces.Kato-Katz technique and urine filtration were unavailable in both provinces.Parasitological diagnosis was mostly performed using the direct smear method.PZQ was available in 70％ of the health facilities,all situated in Bas-Congo.Diagnosis and treatment mostly relied on symptoms and cost more in urban area than in rural.Conclusions:Though knowledge on schistosomiasis among health staff appears sufficient,substantial efforts still must be made to improve the availability of diagnostic tools and treatment in the health facilities in DRC.

High prevalence of Schistosoma mansoni in six health areas of - Kasansa health zone, Democratic Republic of the Congo: short report.

School-aged children suffer the most from schistosomiasis infection in sub Saharan Africa due to poverty and limited sanitary conditions. Mapping of disease burden is recommended and there is a need of updating prevalence data which is as old as 20 years in the Democratic Republic of Congo. An epidemiological and parasitological study was carried out in 2011 in the health zone of Kasansa. Six health areas (HA) were included in the study. In each health area, one primary school was selected. School-aged children were screened for S. mansoni infection using parallel Kato-Katz and direct microscopy techniques. A total of 335 school-aged children were screened. The average prevalence was 82.7% and ranged between 59.5-94.9%. Four of the six HAs had a prevalence level over 91%. Of all infected children, about half 112 (43.2%) had light parasite density. These results demonstrate that Schistosoma mansoni infection is a bigger problem than anticipated and there is an urgent need to implement effective control measures.