Prevalence and Predictors Associated to Schistosoma mansoni Infection among Patients Attending the Saint Jean de Malte Hospital, Njombe, Littoral Region, Cameroon.

Background: Schistosomiasis remains a major public health concern in sub-Saharan Africa. It has been associated to morbidity and mortality in developing countries including Cameroon, and Njombe-Penja health district is an endemic area. This study is aimed at determining the prevalence and risk factors of Schistosoma mansoni infection among patients attending the Saint Jean de Malte Hospital, Njombe. Methods: A cross-sectional study design was employed, with the enrolment of 300 participants using convenience sampling technique. Data were collected using a structured questionnaire. Stool specimens were collected and examined using direct microscopy, Kato-Katz's method, and formol ether concentration technique. Data were analyzed using SPSS, and chi-square test was used to assess the association. Risk factors for S. mansoni infection were assessed using multivariable logistic regression, and a p < 0.05 was considered significant. Results: The overall prevalence of Schistosoma mansoni infection was 13%. Schistosoma mansoni infection was mostly frequent among patients < 20 years and males. Stream usage (AOR = 2.15, 95% CI. 1.32-3.50), always visiting the stream (AOR = 11.35, 95% CI 2.33-55.33), always swimming and washing clothes in the stream (AOR = 7 : 10, 95% CI 2.31-21.80), age group < 20 years (AOR = 3.7, 95% CI 1.1-12.2), and age group 20-29 years (AOR = 2.58, 95% CI 1.14-18.42) were significantly associated with increased risk of S. mansoni infection. Conclusion: These findings suggest that Schistosoma mansoni infection is of public health concern in Njombe and its environs. Age of <20 years and between 20 and 29 years, stream usage, always visiting the stream, and always swimming and washing clothes in the stream were the main risk factors of S. mansoni infection. Thus, mass drug administration and health education are required.

Confounding influences of malnutrition and Plasmodium falciparum and Schistosoma haematobium infections on haematological parameters in school children in Muyuka, Cameroon.

BACKGROUND: School-aged children (SAC) are a high-risk demographic group for infectious diseases and malnutrition. The objective of this study was to assess the burden and the effect of Plasmodium falciparum and Schistosoma haematobium infections on the haematological indices in SAC and the confounding influence of malnutrition on the outcomes. METHODS: This cross-sectional study was conducted in SAC 4-14 years old living in Ikata, Bafia and Mile 14-Likoko in Muyuka, Cameroon. Anthropometric measures of malnutrition were obtained and blood samples collected were used for detection of malaria parasites by Giemsa-stained blood films using light microscopy and complete blood count analysis using an automated haematology analyser. Urine samples collected were used to detect micro haematuria with the aid of reagent strips and the eggs of S. haematobium by urine filtration technique. Multiple linear regression model was used to examine influence of independent variables on haematological parameters. RESULTS: Out of the 606 SAC examined, the prevalence of single infections with Plasmodium or S. haematobium and co-infection with both parasites was 16.2, 16.3 and 8.3%, respectively. Overall, malaria parasite (MP), urogenital schistosomiasis, malnutrition, anaemia, haematuria, microcytosis and thrombocytopenia was prevalent in 24.4, 24.6, 25.9, 74.4, 12.2, 45.4 and 11.1% of SAC, respectively. A significant linear decline (P = 0.023) in prevalence of P. falciparum infection with the severity of stunting was observed. Factors that significantly influenced haematological parameters included haemoglobin: age, stunting and MP; haematocrit: age and MP; white blood cell count: age; red blood cell count; age and MP; lymphocyte counts: stunting; mean cell volume: age; mean cell haemoglobin: age and stunting; mean cell haemoglobin concentration: sex, stunting and red cell distribution width-coefficient of variation: sex, age and stunting. CONCLUSIONS: Malnutrition, Plasmodium and S. haematobium infections are common while anaemia is a severe public health problem in Muyuka, Cameroon. The interaction between haematological parameters with malaria parasites as well as linear growth index was negative and other interactions indicate systemic inflammation. While findings provide contextual intervention targets to ensure the judicious use of the limited resources, there is need for regular monitoring and proper treatment to improve the health of the underserved population.

Polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths in school-aged children in Muyuka-Cameroon following implementation of control measures: a cross sectional study.

BACKGROUND: Despite the ubiquity of polyparasitism, its health impacts have been inadequately studied. The aim of this study was to determine the prevalence and determinants of polyparasitism with Schistosoma haematobium, Plasmodium and soil-transmitted helminths (STH) following sustained control measures, as well as evaluate the outcomes and clinical correlates of infection in school-aged children (SAC) living in the schistosomiasis endemic focus of Muyuka-Cameroon. METHODS: In a cross-sectional study, urine, blood and stool samples were each collected from SAC (4-14 years) selected at random between March and June 2015. Microhaematuria in urine was detected using reagent strip and S. haematobium ova by filtration/microscopy methods. Plasmodium was detected using Giemsa-stained blood films and complete blood count was obtained using an auto-haematology analyser. STH in stool was detected by the Kato-Katz method. Categorical and continuous variables were compared as required, Kappa value estimated and the adjusted odds ratio (aOR) in the multivariate analysis was used to evaluate association of the risk factors with infection. RESULTS: Out of the 638 SAC examined, single infection was prevalent in 33.4% while polyparasitism was 19.9%. Prevalence of S. haematobium + Plasmodium was 7.8%; S. haematobium + STH was 0.8%; Plasmodium + STH was 0.8%; while S. haematobium + Plasmodium + STH was 0.9%. Higher preponderance of S. haematobium + Plasmodium infection occurred in females, those from Likoko, did not use potable water, practiced bathing in stream and carried out open defecation than their equivalents. However, being female (aOR = 2.38, P = 0.009) was the only significant risk factor identified. Anaemia was a common morbidity (74.3%) with a slight agreement with microscopy in predicting S. haematobium and Plasmodium infections. The sensitivity and specificity of haematuria (13.0%) in predicting S. haematobium infection was 46.5% and 100% with a moderate agreement with microscopy. Co-infection with S. haematobium and malaria parasite was significantly associated with threefold odds of history of fever in the last three days. CONCLUSIONS: Polyparasitism is a public health problem in Muyuka with females most at risk. Anaemia prevalence is exacerbated in co- and triple-infections and together with a history of fever are of value in predicting polyparasitism.

Efficacy and safety of praziquantel against Schistosoma haematobium in the Ikata-Likoko area of southwest Cameroon.

BACKGROUND: Schistosomiasis remains a parasitic infection of public health importance especially in Africa south of the Sahara including Cameroon. Chemotherapy using praziquantel has been the most effective and widespread control measure used. However, there are reports of reduced efficacy of the drug. The aim of this study was to assess the efficacy and safety of praziquantel against Schistosoma haematobium among infected individuals in the Ikata-Likoko area of southwest Cameroon. Following a baseline study, S. haematobium egg load was determined using the urine filtration technique and microscopy. Participants were treated with a unique dose of praziquantel of 40 mg/Kg body weight. A control test was carried out on the 42nd day post-treatment to determine the proportion of positive participants with viable eggs (cure rate) and the egg loads. The egg loads obtained during the control and at baseline were used to calculate the egg reduction rate (ERR) used as the main indicator of praziquantel efficacy according to the WHO, 2013 protocol. RESULTS: At baseline, the prevalence of S. haematobium was 34.3% (177/516). Out of these a total of 174 participants aged between 4 and 76 years were recruited into the study. A total of 130 participants came for follow up on day 42. Among them, 22.3% (29) were positive for eggs of S. haematobium but none of the eggs were viable giving a cure rate of 100%. The overall mean egg load per 10 mL (MEL/10 mL) of urine reduced from 31 (1-400) at baseline to 6.0 (1-35) on day 42. The overall ERR was reduced (80.3%). However, the efficacy was satisfactory (ERR ≥ 90%) in females, children ˂ 5 years, and some localities and for individuals with heavy infection intensity. Fifteen (8.6%) of the participants presented minor adverse events including abdominal disorders, headache and vomiting but did not last for more than 24 h. CONCLUSIONS: Treatment with praziquantel was efficacious and safe showing reduction in prevalence as well as mean egg load in some individuals with few adverse events recorded. The distribution of praziquantel in the area should be extended to other age groups and not just school-age children. A study with multiple drug doses and longer period of evaluation could reveal more information on praziquantel efficacy in the area.