A comparative study on the efficacy of praziquantel and albendazole in the treatment of urinary schistosomiasis in Adim, Cross River State, Nigeria.

Background: Praziquantel (PZQ) is the current drug of choice for the treatment of urinary schistosomiasis in endemic areas. It is very efficacious, although the potential for the development of resistance has been reported in some endemic areas among human subjects and in animal studies. Its' limitation include high cost and administration of multiple numbers of tablets. Albendazole (ALB) is used in the treatment of intestinal helminths infection. It is a broad-spectrum single-dose antihelminthic with an excellent cure rate and safety criteria. Currently, it is not routinely used for the treatment of urinary schistosomiasis. Methods: Urine samples collected from 596 pupils aged between 2 and 16 years were processed and examined for the presence of ova of Schistosoma haematobium using a standard filtration technique. A total of 100 infected subjects were treated with a standard dose of PZQ (40 mg/kg body weight), while another group of 96 infected subjects were treated with ALB (400 mg for individuals above 3 years). A post-treatment study was conducted 1 month after treatment to assess their cure rate. Results: The prevalence of S. haematobium infection in the study area was 32.8% (196/596). More males were infected (44.2%) (122/276) than females (23.1%) (74/320). The difference in the prevalence rate of infection by gender was statistically significant (X2=15.7>3.841, p<0.05). The highest prevalence of infection was observed among subjects aged 14-16 years (42.1%) (32/76), while those aged 5-7 years had the least prevalence (23.7%) (38/160). There was no statistically significant difference in the prevalence of urinary schistosomiasis by age of the subjects (X2=5.99<9.5, p>0.05). PZQ gave a higher cure rate of 78.0% (78/100) compared with ALB (68.7%) (66/96). There was no statistically significant difference in the cure rate obtained with both drugs (X2=0.355>0.282, p>0.05). The intensity of egg excretion was greatly reduced in subjects who were not cured by the two drugs. Conclusion: The findings of this study suggest the use of ALB for the treatment of urinary schistosomiasis. We recommend further assessment of the efficacy of the drug in an area with higher morbidity of urinary schistosomiasis than the present study area.

Height as a Surrogate for Bodyweight for Estimating the Dosage of Praziquantel and Artesunate in theTreatment of Urinary Schistosomiasis in School-Age Children

World Health Organization recommends mass treatment of all school children in areas where the prevalence of schistosomiasis is greater than 50. Praziquantel and artesunate are reported to display broad-spectrum antischistosomal activities. Since the susceptibilities of the different stages of schistosomes to the two drugs are distinctively different; it has been established that the use of these two drugs in combination will be beneficial for the treatment of urinary schistosomiasis. Dosage is determined by weight; which can be difficult to determine in field conditions. The use of calibrated height meter with height-based dosage calibration will make the work less cumbersome in field settings. Data on age; weight; and height from 264 school children who were screened and found to be infected with Schistosoma haematobium; diagnosed by the presence of the ova in their urine; were used to predict an alternative to bodyweight and thus the dosage of praziquantel and artesunate required to treat this disease. A very strong positive correlation (r = 0.8) was obtained for the height of treated children measured against weight while a moderately positive correlation coefficient (r = 0.6) was obtained for weight against age measurements; depicting that height can be used in lieu of weight for correct dose determination. A height meter calibrated with the equivalent number of tablets of praziquantel and artesunate could thus be used as a simple measurement to determine the dosage of praziquantel and artesunate needed to treat children in the field. This calibrated height will expedite treating large population of children in mass treatment campaigns in an endemic community

Efficacy of a combination of praziquantel and artesunate in the treatment of urinary schistosomiasis in Nigeria.

The combined effects of praziquantel and artesunate in the treatment of urinary schistosomiasis were assessed among 312 randomly selected schoolchildren aged 4-20 years in Adim community, Nigeria. In the preliminary screening, infection was confirmed in 327 (38.5%) of the 850 subjects screened. Infected subjects who reported for treatment were then divided into six treatment groups of 52 subjects each; 44 subjects in each group completed their treatment regimens and submitted their urine for post-treatment assessment. Praziquantel and artesunate were administered orally at 40 mg/kg and 4 mg/kg body weight, respectively. Adverse effects due to drug reactions were assessed 72 h after medication and all perceived episodes of illness were treated. Morbidity indicators were assessed 56 days after the final dose of the drug regimens. All treatment regimens were well tolerated. The cure rates were 72.7% in the praziquantel plus placebo-treated group and 70.5% in the artesunate plus placebo group, while the artesunate plus praziquantel group had the highest cure rate (88.6%). Haematuria and proteinuria were extensively reduced after treatment with the three drug regimens. This study confirmed that the treatment of urinary schistosomiasis with the combination of praziquantel and artesunate is safe and more effective than treatment with either drug alone.

Epidemiology of Paragonimiasis in Oban Community of Cross River State; Nigeria

The epidemiology and perception of Paragonimus infection were investigated in Oban community of Cross River State; Nigeria between January and June; 2006. Sputum samples collected on each of three consecutive days from 311 participants with productive cough were examined using standard parasitological procedures for the detection of ova of Paragonimus Spp. The samples were also processed and stained using the Ziehl-Neelsen technique to exclude Mycobacterium tuberculosis infection. Crabs collected from the village streams were dissected and examined for the presence of metacercariae of Paragonimus Spp. A questionnaire was also administered to test the perception of the disease. Paragonimus uterobilateralis was confirmed as the aetiologic agent of paragonimiasis with a prevalence of 4.2. Peak prevalence of 7.7was found among children aged between 1 to 10 years. More males (4.5) were infected than females (3.9) (P 0.05). The mean egg count was high (222 egs/5ml of sputum). The intensity of infection was found to correlate moderately and strongly with haemoptysis (r = 0.6) and chest pain (r=0.8) respectively. Only 1.6of the subjects had tuberculosis and presented with symptoms which mimic paragonimiasis. Sudanonautes africanus is the suspected vector of the disease in this locality. The disease; its vector and mode of transmission were poorly perceived by the respondents. The study has confirmed the endemicity of paragonimiasis in Oban community as well as provides comprehensive information on the disease and its transmission in this locality. There is urgent need to initiate the control of this disease in this community

Prevalence of Urinary Schistosomiasis among School Children in Ukwelo-Obudu and Abini communities in Cross River State; Nigeria

Background: The prevalence and intensity of Schistosoma haematobium infection were studied in Ukwelo-Obudu; and Abini communities of Cross River State; Nigeria. Aim: To screen for the presence of ova of S. haematobium in the urine of school children in the two communities. Method: Six hundred urine specimens (400 in Abini and 200 in Ukwelo-Obudu community) were collected by random sampling from school children aged 5-17 years from the two communities and screened for ova of Schistosoma haematobium by filtration of urine and counting of filtered carbol fuchsin-stained eggs of Schistosoma haematobium. Retrospective study of Schistosoma haematobium infection was also carried out in Ukwelo-Obudu community. Results: Infection with S. haematobium was not found in Ukwelo-Obudu whereas in Abini community; a prevalence of 4.5was found. The highest prevalence of infection (7.7) occurred in the age group of 11-13 years. There was a strong positive correlation between the presence of infection (ova of S. haematobium) and existence of haematuria (r = 0.81) and proteinuria (r = 0.71) in Abini community. There was a statistically significant difference in the prevalence of proteinuria between male and female subjects examined (P=0.0008). A retrospective study of Schistosoma haematobium infection in Ukwelo-Obudu community showed 2006 as the year with the highest record of infection [11(35.5)] whereas the year 2004 recorded the lowest number of infection. Conclusion: This study has revealed a low prevalence of Schistosoma haematobium infection in Abini and the absence of infection in Ukwelo-Obudu communities respectively

Enterobiasis and its relationship with anal itching and enuresis among school-age children in Calabar, Nigeria.

The prevalence of enterobiasis and its relationship with anal itching and enuresis were investigated among 799, randomly selected children aged 5-14 years, who lived, either in an area of high population density or one with a much lower population density, in Calabar, Nigeria. The eggs of Enterobius vermicularis were found in anal swabs (collected with transparent adhesive tape) from 60 (7.5%) of the subjects tested, with the prevalence of infection appearing markedly higher in the 403 children from the area with a high population density than in the 396 from the less densely populated area (11.7% v. 3.3%; P < 0.05). Questionnaire-based interviews were used to determine which of the children suffered from anal itching, enuresis or both. Compared with the egg-negative subjects, the 60 children who were egg-positive for Enterobius were found to be much more likely to be suffering from anal itching (78.3% v. 28.3%; P < 0.05) or enuresis (53.3% v. 36.4%; P < 0.05). Enterobiasis is therefore not a problem that is restricted to the temperate regions of the world, and may be a cause of enuresis or at least a contributory factor in the development of this complaint.

Efficacy of artesunate in the treatment of urinary schistosomiasis, in an endemic community in Nigeria.

The efficacy and tolerability of oral artesunate for the treatment of urinary schistosomiasis was assessed among schoolchildren aged 5-18 years in Adim community, Nigeria. Overall, 500 children, randomly selected from those attending the Presbyterian primary school, were each invited to provide two consecutive urine samples. Using standard parasitological procedures, Schistosoma haematobium ova were found in the samples from 145 (29.0%) of the subjects. Most (87) of the infected subjects were then treated orally with artesunate, using two doses, each of 6 mg/kg, given 2 weeks apart. When the treated children were re-examined 4 weeks after the second dose of artesunate, 61 (70.1%) appeared egg-negative and were therefore considered cured. Post-treatment, the geometric mean egg count (GMEC) for the treated subjects who were not cured was significantly lower than the pre-treatment GMEC for all the treated subjects, with log10[(eggs/10 ml urine) + 1] values of 0.9 v. 1.75 (t = 4.45; P < 0.05). The cure 'rate' for the subjects aged > or = 10 years was slightly higher than that among the younger subjects. It was lowest for the heavier subjects (70% for those weighing 41-50 kg) and highest (79%) for the subjects who weighed 31-40 kg. The artesunate was well tolerated. This observation of a therapeutic effect of artesunate against S. haematobium in Nigeria confirms recent observations from Senegal. In the Adim community at least, it would be more cost-effective to treat urinary schistosomiasis with artesunate than with praziquantel. The wide-spread use of artesunate against schistosomiasis has to be considered carefully, however, if it is not to compromise the efficacy of the drug as an antimalarial, by increasing the risk of resistance developing in local Plasmodium.

Modification of behaviour and attitude in the control of schistosomiasis. 1. Observations on water-contact patterns and perception of infection.

Observations on the water-contact patterns of 2136 residents of Admin community in Nigeria were conducted at four streams between February 1993 and January 1994. Urine samples collected from those observed were used to estimate the prevalence and intensity of Schistosoma haematobium infection. A questionnaire was also completed for each of the subjects, to test their perception of urinary schistosomiasis and its transmission. Infection was detected in 1076 (50.4%) of the subjects, with peak prevalence among those aged 10-14 years. Intensity of infection was more closely correlated with the number of water contacts (r = 0.97) than with the total duration of the exposure (r = 0.77), emphasising the importance of specific/multiple activities, and of the surface area of the body submerged, in transmission. One stream (Culvet) was identified as the main transmission point, with bathing/swimming and fishing as the main activities predisposing people to infection. The awareness of urinary schistosomiasis and its symptom (blood in urine) were high but specific knowledge about the parasite, its vector and the interaction between the parasite and vector in the parasite's life-cycle were extremely low. Activities that require behaviour and attitude modification have been identified and encouraged as components in the control of schistosome-attributable morbidity (in the absence of pipe-borne water).

School-based schistosomiasis control programmes: a comparative study on the prevalence and intensity of urinary schistosomiasis among Nigerian school-age children in and out of school.

A cross-sectional study was conducted in February 1998 on the prevalence and intensity of urinary schistosomiasis among school-age children in and out of school at Adim village in Nigeria to test the objective of delivering a control programme through the school system. School enrollment figures and non-attendance rate were collated from questionnaires that were self-administered by heads of families. Prevalence and intensity of infection were determined following filtration of urine and counting of carbol fuchsin-stained eggs of Schistosoma haematobium. The rates of regular school attendance, irregular attendance and non-attendance were 69.1%, 5.1%, and 25.8%, respectively. These indices were not significantly associated with the age of the schoolchildren (P > 0.05). Boys (76.6%) were more associated with regular attendance than girls (61.4%) (P < 0.0001) while girls had a higher rate of non-attendance (32.7%) than males (19.1%) (P < 0.0001). Although more out-of-school children were infected (90.7%) than those in school (86.8%), the difference was not statistically significant (P > 0.05). The same association was established in the variation of mean egg count between the 2 study populations though intensity was higher among out-of-school children. The principal reasons proffered for the high rate of non-attendance listed in their order of importance were: economic, sickness, poor performance, refusal, farming and fishing. A dual method of control that would in incorporate the integration of recognized local authorities is suggested in areas with moderate school attendance rate like Adim, as lack of treatment of infected out-of-school children ensures continuous contamination and re-infection.

Risk of contamination from air vents during intravenous fluid administration.

The microbial effect of creating air-inlet during intravenous fluid administration in different wards of the University of Calabar Teaching Hospital was studied between May and July, 1997. A total of 123 in-use (test) and 80 unused (control) infusion fluids were studied. Subjects that developed septicaemia following infusion were screened for microbial aetiology. Settle plate cultures were made in all the wards used in the study. Thirty two of in-use infusion fluids (26%) were contaminated, while contamination was not detected among the unused ones. There is a statistically significant relationship in the contamination rate of in-use bags and controls (p < 0.001). Bags with air-vents were more contaminated 27(49.1%) than those with none, five (7.4%). The difference in prevalence of contamination rate by air-vent status was statistically significant (p < 0.001). Gram positive organisms constituted the majority of agents 26(74.3%). Out of seven subjects that received contaminated fluid, four (57.1%) developed septicaemia. It is concluded that creating air-vent for introduction of additives during intravenous fluid administration provides routes of entry for micro-organisms.

Frequency of foetal haemoglobin and haemoglobin values in various haemoglobin genotypes in Calabar, Nigeria.

The frequency of foetal haemoglobin (HbF) and haemoglobin (Hb) levels were determined among 108 subjects with different haemoglobin genotypes in Calabar, between March and October, 1996. Hb-genotype was determined using the cellulose acetate method, while HbF and Hb were estimated using the modified Betke alkaline denaturation method and cyanmethaemoglobin techniques respectively. Haemoglobin genotype SS individuals had the highest mean HbF concentration of (3.05 +/- 1.61) as compared to AA and AS subjects with means of 0.195 +/- 0.25 and 1.072 +/- 0.98 respectively. This relationship was statistically significant (P < 0.02). On the other hand, AA subjects had the highest mean haemoglobin concentration (12.79 +/- 1.19) while SS subjects had the lowest (10.65 +/- 2.06). This study has indicated the persistence of HbF into adult life in this locality. Since HbF is associated with natural anti-sickling properties, its role as a monitoring factor in the management of sickle cell anaemia is examined in detail.

The status and consequences of Mansonella perstans infection in Calabar, Nigeria.

Two aetiological studies on filariasis were conducted from January to June, 1993. In the first study, 690 blood samples clinically diagnosed of filariasis were examined. In the other, 150 blood samples and 150 skin snips collected from the same group of eye clinic Patients clinically diagnosed of filariasis were investigated. Of the 690 subjects, 108 (15.64%) had filariasis with M. perstans and Loa loa accounting for 98.15 and 1.85% of positive cases respectively. Among the eye clinic patients, 16% had M. perstans while O. volvulus was seen in 4% of patients. There was no concurrent infection with these two agents. A statistically significant association existed in the frequency of M. perstans in the different ages treated (p > 0.01) while non existed by sex (p > 0.01). The possible involvement of M. perstans in ocular filariasis and its treatment are discussed.