Concurrent urinary and intestinal schistosomiasis and intestinal helminthic infections in schoolchildren in Ilobu, South-western Nigeria.

A cross-sectional study was conducted in a schistosome-endemic rural community in Southwestern Nigeria. We assessed prevalence and intensity of soil-transmitted nematodes and the co-occurrence with Schistosoma haematobium and Schistosoma mansoni. Urine and stool samples from 419 schoolchildren were examined, and a questionnaire was administered to obtain socio-demographic characteristics. In total, 78.3% (328/419) were infected with at least one helminth species, with a prevalence (mean egg-count) of 55.1% (3069.2) of Ascaris lumbricoides, 41.1% (127.5) of S. haematobium, 22.7% (98.6) of hookworms, 17.9% (161.3) of Trichuris trichiura, and 10.3% (12.9) of S. mansoni. Multiple infections were significantly more common among children from households with more playmates, absence of toilet facilities and low income level (all p<0.001). Children with heavy hookworm burden were at a significantly higher chance of acquiring S. mansoni (OR=36.35; 95% Cl: 13.22-100.97; p<0.0001). The risk of S. mansoni and A. lumbricoides infections was increased in co-infections with S. haematobium. Logistic regression analysis revealed infections by hookworms and S. mansoni (adjusted odds ratio [aOR]=3.90, 95% Cl: 2.03-7.46; p<0.0001), and by hookworms and T. trichiura (aOR=2.46, 95% Cl: 1.44-4.22; p=0.001) as significant risk factors for multiple infections. Our study shows that polyparasitism is common in the study area. Focused interventions such as mass treatment with anthelminthics and health education are needed to improve the well-being of the affected population.

Bacterial Assessment of Electronic Hardware User Interfaces in Ile-Ife, Nigeria / Bacterial Assessment of Electronic Hardware User Interfaces in Ile-Ife, Nigeria

The study was undertaken to quantify and identify bacterial contaminants associated with private and open access user interfaces in various establishments in the town of Ile-Ife, Nigeria. The study was conducted in selected offices, business centres, banks and cybercafés within Ile-Ife. Swab samples were aseptically collected from each user interface (keyboard, mouse, ATM) and users? hands and cultured on nutrient and MacConkey agar, to determine the total bacterial load and coliform count, respectively, by the pour-plate technique. Bacterial loads present on different types of interface (keyboard, mouse and ATM) were found to be significantly different (p < 0.01). A total of 669 isolates comprising 11 distinct bacterial species were recovered from 313 randomly sampled user interfaces. The frequencies of occurrence of the species were Aerococcus viridans (9.4%), Bacillus spp. (8.4%), Enterobacter aerogenes (4.9%), Gaffkya tetragena (2.1%), Klebsiella pneumoniae (11.1%), Micrococcus luteus (10.9%), Moraxella catarrhalis (1.6%), Proteus spp. (10.6%), Pseudomonas aeruginosa (16.0%), Staphylococcus aureus (16.7%) and Staphylococcus epidermidis (8.2%). All the interfaces examined were contaminated. Contamination on interfaces in educational institutions differed significantly from that found in banks and cybercafés, but was comparable to that in commercial centres. Most isolates were resistant to amoxicillin, augmentin, nitrofurantoin and ceftriaxone, while resistance to ciprofloxacin and ofloxacin was the least frequent. Multiple antibiotic resistance was observed in 89.1% of bacterial isolates, with a total of 68 resistance patterns, resistance to three antibiotics being the most frequent (31.9%). About 74% of multiple antibiotic resistant isolates profiled for plasmid DNA contained either single or multiple plasmids. It was concluded that user interfaces were contaminated with potentially pathogenic bacteria, highly resistant to some commonly used antibiotics. These interfaces are therefore potential vehicles for the transmission of clinically important pathogens.

Epidemiology of intestinal helminth parasites in stray dogs from markets in south-eastern Nigeria.

A survey of gastrointestinal helminth parasites of stray dogs (Canis familiaris) was conducted at Obollo-Afor and Ekwulobia markets, in Enugu and Anambra States, south-eastern Nigeria, respectively, to determine the patterns of infection among dogs in different parts of south-eastern Nigeria. Faecal samples collected, using long forceps, from every dog encountered in the markets between June 2007 and December 2008 were analysed by the Kato-Katz technique. Out of 413 dogs examined in both markets, 217 (52.6%) were infected with at least one of five parasites (Toxocara spp., Dipylidium caninum, Ancylostoma caninum, Taenia spp. and Trichuris vulpis). Overall faecal egg intensity of infection was 49.9 ± 58.7 eggs/g (epg). The prevalence of infection was comparable between the markets and between the male and female dogs, but varied significantly (P < 0.05) by age, decreasing from 78.9% in pups to 36.0% in adult dogs. The mean intensity pattern was similar to that of prevalence, decreasing from 86.7 ± 63.0 epg in pups to 22.1 ± 34.4 in adults. The most important individual parasite infection was Ancylostoma spp. (39.2%; 30.0 ± 41.2 epg) while T. vulpis was the least important (1.9%; 0.7 ± 5.4 epg). Generally, prevalence and intensity patterns of each parasite were also comparable between the markets and between sexes, but significantly (P < 0.05) age-dependent. The implications of these findings to public health in Nigeria and other endemic countries are discussed in relation to options for cost-effective control design and implementation.

Factors associated with urinary schistosomiasis in two peri-urban communities in south-western Nigeria.

In Nigeria, there is only very limited epidemiological information on which the control of human urinary schistosomiasis could be based. In a cross-sectional study, therefore, the prevalences and intensities of, and risk factors for, human infection with Schistosoma haematobium infection were explored in two endemic peri-urban villages in the south-western state of Osun. The villagers' knowledge about the infection and demographic, socio-economic and environmental variables were recorded using a structured questionnaire. Of the 1023 individuals who were investigated, 634 (62.0%) were found infected, with a mean (S.D.) overall intensity of 114.2 (327.7) eggs/10 ml urine. The subjects aged 10-14 years had both the highest prevalence (83.6%) and the highest mean (S.D.) intensity of infection [196.67 (411.7) eggs/10 ml urine]. Most (70.0%) of the subjects appeared to have no knowledge of the transmission of S. haematobium. The results of multivariate regression analysis indicated that infection and moderate-heavy infection (i.e. >50 eggs/10 ml urine) were both associated with: a low family income, of

Socio-environmental factors and ascariasis infection among school-aged children in Ilobu, Osun State, Nigeria.

The risk factors predisposing children to ascariasis transmission in a rural community of Osun State, Nigeria were investigated from November 2005 to April 2006. Children below 16 years of age were examined at the household level after information on biodata, access to water supply and sanitation, socio-economic status of their parents and degree of cohabitation with their parents was collected using a questionnaire. Of 440 children examined, overall prevalence was 60% and median intensity was 1548 eggs per gram (epg) (min. 48 epg; max. 55464 epg). Infection patterns were gender comparable and age dependent, with peak prevalence (67.8%) occurring in children aged 5-9 years and peak median intensity (4368 epg) in children aged >or=15 years. Logistic regression analysis revealed that prevalence was influenced by patterns of water supply and sanitation, parents' educational background, number of biological parents living with a child and number of playmates a child has. These findings suggest that socio-environmental risk factors which play a role in disease transmission need to be taken into account when formulating sustainable control strategies for ascariasis and other intestinal parasites in Nigeria and elsewhere.

Diagnostic accuracy of different urine dipsticks to detect urinary schistosomiasis: a comparative study in five endemic communities in Osun and Ogun States, Nigeria.

The diagnostic accuracy of urine dipsticks was investigated using two different brands in five endemic communities of south-western Nigeria. The BM-5L test was used in 1992 to screen 566 subjects in two communities in Ogun State, while 1457 subjects in three other communities in Osun State were screened with the Combur-9 test in 2006. Haematuria gave a higher prevalence of infection than proteinuria irrespective of which strip brand was used (e.g. BM-5L test: 58.3 and 36.2%; Combur-9 test: 46.5 and 41.9%, respectively). Compared with egg microscopy (gold standard), haematuria identified over 90% of egg-positive samples using either the BM-5L test in 1992 or the Combur-9 test in 2006. The corresponding values for proteinuria were 58% using the BM-5L test and 82% using the Combur-9 test. Sensitivity of haematuria to infection was higher using the BM-5L test (92.4-93.5%) than Combur-9 (58.6-73.3%), while sensitivity of proteinuria to infection was higher using Combur-9 (55.5-80.4%) than BM-5L test (26.0-58.3%). However, both strip brands have comparable specificity for haematuria (BM-5L test, 88.3-99.5%; Combur-9, 88.9-100%) and proteinuria (BM-5L test, 94.4-100%; Combur-9, 98.7-100%) to infection. Based on these results we conclude that neither brand nor manufacturer has a significance effect on the performance of chemical reagent strips. However, the diagnostic value of both haematuria and proteinuria varied according to the positivity level adopted, intensity of infection and age, but was not affected by sex and village of residence.

Multiple infection diagnosis of intestinal helminthiasis in the assessment of health and environmental effect of development projects in Nigeria.

Patterns of intestinal helminth infections among school-aged children have been assessed in Eko-ende and Ore, as part of an overall assessment of the public health impact of Erinle Dam Reservoir in Osun State, Nigeria. The investigation was carried out between January and May 2005 using the Kato Katz thick smear technique and simple questionnaire for information on the bio-data, knowledge, attitude and practice of individuals towards disease transmission and control. Ascaris lumbricoides, hookworm, Trichuris trichiura, Taenia spp., Strongyloides stercoralis and Schistosoma mansoni were recovered at an overall prevalence of 78.3% among 309 children examined. Ascaris lumbricoides, hookworm, T. trichiura and S. mansoni were the most common infections while S. stercoralis and Taenia spp. were found only among a few children. Infection patterns of the common diseases were age-specific with peaks in the 11-15 age bracket. Children not attending school were significantly (P < 0.05) more at risk of infection than those attending school. Multiple infections were pronounced with over 54% double infections and 6% four parasites or more infections. The need for urgent intervention to arrest the obviously serious public health situation attributable to Erinle Dam is emphasized.

Unabated schistosomiasis transmission in Erinle River Dam, Osun State, Nigeria: evidence of neglect of environmental effects of development projects.

The status of Schistosoma haematobium infection around Erinle Dam in Osun State, Nigeria, was investigated 10 years after the disease was first reported in the area. School children in two rural communities (Ilie and Oba-Ile) were examined for infection and the lake surveyed for snail intermediate host species between March 2000 and February 2001. Overall infection rate among 320 children examined in both communities was 46.6% (52.3% in Ilie and 43.0% in Oba-Ile). Mean intensity of infection ranged between 144.2 +/- 389 and 156.5 +/- 378 eggs per 10 ml urine in Ilie and Oba-Ile respectively (overall: 148.8 +/- 378 eggs per 10 ml urine). Prevalence and intensity were comparable in both communities and between boys and girls, but varied significantly (P < 0.05) with age. Bulinus globosus identified by a previous study as the local intermediate host species was found to be abundant in the lake and occurred throughout the year, in contrast to seasonal occurrence reported previously. Both prevalence and intensity of infection also increased significantly over the levels reported 10 years earlier. These results are clear indications that transmission has remained unabated in the lake during the period. The need for urgent and effective national control programme to reduce the public health importance of schistosomiasis in Erinle and other dams in Nigeria was discussed.

The effect of Oja-titun market effluent on the chemical quality of receiving OPA reservoir in Ile-Ife, Nigeria.

The effect of market effluent from the Oja-titun market in Ile-Ife, Nigeria on the chemical quality of the Opa Reservoir located 3.5 km downstream was investigated between February and November 2000. Water samples were collected in February, May, August and November from 16 sites, four along each of the market drainage channels (MDC), market stream, tributary stream and the Opa River and Reservoir. The peak level of each variable-biochemical oxygen demand, temperature, total alkalinity, Na(+), K(+), Ca(2+), Mg(2+), PO(4)(3+), SO(4)(2+), Cl(-), NO(3)(-), Pb and Zn-occurred at the MDC, and decreased significantly downstream, except pH, conductivity and dissolved oxygen, which increased. Seasonal fluctuation in most variables was pronounced. Generally, there were high values in the early dry and dry seasons and low values in the rainy and early rainy seasons. Comparison of the reservoir water with international limitation standards for drinking water supply showed that the quality of the reservoir water was very low and that treatment required to achieve minimum limitation standards for drinking water would be both intensive and expensive. The study concluded that the stream borne effluent from the market impacts significantly on the chemical quality of the reservoir water although other tributaries within the Reservoir's catchment are other possible sources of pollutants in the reservoir.

The role of health education and sanitation in the control of helminth infections.

Health education and sanitation are two important components of primary health care system introduced by the World Health Organization (WHO) as a basis for the prevention and control of communicable diseases. However, the roles of health education and sanitation in disease control have been controversial, especially in the wake of recent advances in safe and effective oral drugs. This article has reviewed the various health education and sanitation interventions around the world to determine what roles they have played in the past relative to other intervention strategies and the role they have to play in future control efforts. It appears clear-cut from the review, that while chemotherapy has been and will remain the best option for morbidity control, sanitation has an important role to play not only to sustain the benefits of chemotherapy but also to protect the uninfected. Health education that is effective, simple and low-cost remains the only tool for creating the enabling environment for both chemotherapy and sanitation to thrive.

Effect of water supply and sanitation on the prevalence and intensity of Ascaris lumbricoides among pre-school-age children in Ajebandele and Ifewara, Osun State, Nigeria.

The relationship between Ascaris lumbricoides infection and provisions for safe water supply and excreta disposal was investigated in Ajebandele and Ifewara, 2 peri-urban communities near Ile-Ife, Osun State, Nigeria, from September 1998 to December 1999. Although there were more facilities for safe water supply (pipe-borne and shallow wells) and sanitation (flush toilets and pit latrines) in Ajebandele than in Ifewara, they were not evenly distributed and only a few families, mainly in Ajebandele, were well provided for. Our results indicated that the prevalence of A. lumbricoides was significantly higher in Ifewara (21.2%) than in Ajebandele (13.1%), and within villages was much lower in houses with tap water and flush toilets. However, the mean intensity of infection was unexpectedly higher in Ajebandele (166.5 +/- 692.0) than in Ifewara (153.1 +/- 485.8) suggesting that the present level of investment in Ajebandele is probably not sufficient to reduce morbidity. These findings confirm suggestions that there is a threshold level of investment below which interventions on water supply and sanitation may not significantly improve human health. Sustainable ascariasis control in the study communities will require significant improvements to existing water supplies and sanitation facilities and any future interventions should incorporate a programme of health education to ensure that the facilities provided are properly used and hygienically maintained.

Patterns of infection with Schistosoma haematobium in lakeside resettlement communities at the Oyan Reservoir in Ogun State, south-western Nigeria.

Patterns of infection with Schistosoma haematobium were studied in 1991 and 1992 in two, lakeside, resettlement communities at the newly established Oyan Reservoir in Ogun State, Nigeria. Prevalence and intensity of S. haematobium infection and frequency of haematuria and proteinuria all increased markedly from 1991 to 1992, indicating intensive transmission. This was confirmed in an incidence study. In both years, infection patterns were highly age-dependent, with peaks in those aged 10-14 years. These patterns deviate from those seen during a survey carried out in the same communities in 1988, providing strong evidence that infection had changed from an epidemic to an endemic stage. Although sex, tribe, religion, occupation, and village of residence had little if any effect on infection pattern, the patterns in settled and migrant groups differed considerably. The study provided a thorough elucidation of the complexity and instability of transmission of S. haematobium in a resettlement community characterized by social instability and extensive population movements. Although haematuria was very common, the subjects knew little about its cause.

Water level regulation and control of schistosomiasis transmission: a case study in Oyan Reservoir, Ogun State, Nigeria.

The effect of different water discharge patterns from the artificial Oyan Reservoir in Ogun State, Nigeria, on water level fluctuations and on schistosomiasis transmission was investigated between August 1990 and March 1993 to determine the impact of water level regulation on schistosomiasis transmission and control. The results show that transmission was greatly influenced by the pattern of water discharge during the hot dry season (January-April). A high discharge during this period of no rainfall, high temperatures, and intense sunshine stimulated rapid water level fluctuations and lake draw-down, which led to significant reductions in all indices of schistosomiasis transmission, i.e. snail density, snail infection rates, human water contact patterns, and incidence of infection. Although these results support continuous water discharges from the reservoir during the hot dry season, this may run counter to current water management policies. Further investigation is therefore required to harmonize the potential benefits in this type of discharge pattern with the objectives of efficient water management in artificial reservoirs.

A study of an outbreak of schistosomiasis in two resettlement villages near Abeokuta, Ogun State, Nigeria.

Frequent reports of haematuria among resettlers at Ibaro and Abule-titun located close to a newly constructed reservoir, 20 km north-west of Abeokuta, Ogun State, Nigeria, prompted a pre-control survey to assess age and sex distribution of urinary schistosomiasis in the communities. 210 persons were examined at Ibaro and 145 at Abule-titun between April 1988 and February 1989. Overall prevalence was about 80% in both villages, and all age and sex groups examined were affected. The pattern of infection in both villages was similar, prevalence being high in all age and sex groups, and, unlike most endemic communities, the rate of infection was not significantly higher among the 5-14 year age groups. Intensity of infection was also high in all age and sex groups with mean range egg output of between 73 +/- 73 and 2016 +/- 3875 ova/10ml urine at Ibaro and between 231 +/- 122 and 1340 +/- 1786 ova/10ml urine at Abule-titun. This is attributed to an occupation-related high rate of human water contact in both villages.

The prevalence and endemicity of dracunculiasis in Akowide village, Oyo State, Nigeria.

An epidemiological assessment of the prevalence and endemicity of guinea-worm infection at Akowide village in Oyo State, Nigeria was carried out between September 1986 and August 1987. A total of 325 people were interviewed and examined during the period. The data obtained were analysed to show the relationship between the prevalence of the disease and the population structure in the affected community. Overall, about 15% of persons in the village were infected. The rate of infection was significantly lower (P less than 0.05) in children (less than 20 years of age) than in adults (20 years of age and above). Among men, it was highest (29%) within the age groups of 20-24 and 45-49 years, while the highest rate among females (30%) was among the age group of 10-14 years of age. In the 0-14 and 30-44 years age groups the average rate of infection was higher in females (21.1 +/- 8.1%) than in males (13.9 +/- 6.1%), while in the age groups of 15-29 and 45 years and above the average rate of infection was significantly higher (P less than 0.05) in males (23.4 +/- 4.7%) than in females (14.8 +/- 2.9%). The severity and duration of incapacitation was high (63%) among the affected persons, and the disease was found to have serious detrimental effects on the socio-economic life of this village.