Rate of reinfection with S. mansoni following treatment in two newly reclaimed areas of Egypt.

This paper reports an on-going study in two newly reclaimed areas in Ismailia Governorate, El-Manayef, 10 km south-west of the city of Ismailia (area 1) and the other in Siani Peninsula, just east of the Bitter Lakes (area 2). In he baseline survey, the prevalence of infection of 49.9% and 40.1% and high intensity infection of 21.8% and 15.7% were found for S. mansoni in areas 1 and 2 respectively. Geometric mean egg counts for those found positive were 101.2 and 75.9. In a subsequent survey, a year after treatment of positives, the overall prevalence was 30.2% and 30.5% and the prevalence of high intensity infection was 8.6% and 10.5% in the two areas. The prevalence among those found positive and then treated during the first round (reinfection rate) was 31.7% and 19.2%. Geometric mean egg counts had declined from 141.3 to 63.1 and from 133.6 to 59 among those who were reinfected. The occurrence of reinfection was strongly associated with younger age in both areas. Rates of reinfection showed a strong but not significant association with male sex in area 2 (p = 0.087), but no association in area 1. These high rates of reinfection demonstrate the importance of promotion of hygiene behaviors as well as ensuring access to chemotherapy.

Factors affecting knowledge of the symptoms of schistosomiasis in two rural areas near Ismailia, Egypt.

The primary method of control of schistosomiasis in Egypt is through passive chemotherapy, in which people who suspect they have the disease are encouraged to go to their local health unit to be tested and treated. If people are unable to recognize the symptoms of schistosomiasis, this strategy may fail. This paper presents data on local knowledge of the symptoms of schistosomiasis from two areas recently reclaimed from the desert near Ismailia. Using data from free-listing and triadic comparisons, it is shown that schistosomiasis is primarily seen as a urinary disease. Factor analysis performed on a series of 12 questions on the symptoms of schistosomiasis included in a survey demonstrated that responses group into three patterns, the first stressing constitutional symptoms such as weakness, the second stressing abdominal symptoms and the third blood in the urine, burning on urination and blood in the stool. The paper discusses the implications of these findings for efforts to promote regular treatment with praziquantel of people living in or near the Nile Delta who are at risk for intestinal schistosomiasis.

Minoxidil selectively improves peritoneal ultrafiltration.

This cross-over randomized clinical trial was carried out to evaluate the effects of intraperitoneal (i.p.) administration of minoxidil on fluid removal and solute clearance during peritoneal dialysis. Twenty-one patients with endstage renal disease, awaiting enrollment in chronic hemodialysis therapy, were randomly allocated to receive i.p. minoxidil either in the first or the last nine cycles of a 24-cycle peritoneal dialysis session. Cycle-to-cycle data on fluid balance, blood pressure, and adverse effects of the drug were obtained. The dialysis fluid recovered in cycles 3, 6, 9, 18, 21, and 24 was analyzed, together with plasma, for creatinine, urea nitrogen, and protein content. The mean excess fluid volume collected in minoxidil cycles was 1123.8 +/- 1119 mL versus 145.2 +/- 743.6 mL in the minoxidil-free cycles (p = 0.004). The mean creatinine clearance, urea nitrogen clearance, and protein losses were comparable in minoxidil cycles and the minoxidil-free cycles. Six patients developed hypotension during the minoxidil cycles, corrected by normal saline, but no other important side effects were noted. It is concluded that i.p. minoxidil selectively increases ultrafiltration without influencing solute clearance in peritoneal dialysis.

Prevalence and epidemiology of Schistosoma mansoni and S. haematobium infection in two areas of Egypt recently reclaimed from the desert.

Projects are being carried out in many regions of Egypt to reclaim land from the desert for agriculture. This paper presents findings from a baseline epidemiologic study conducted in 1992 in two newly reclaimed areas near Ismailia, Egypt. In the first area, just east of the Suez Canal, 40.0% of the residents tested positive for Schistosoma mansoni and 1.7% tested positive for S. haematobium, while in the second area, 15 km southwest of Ismailia, 49.3% tested positive for S. mansoni and 3.3% tested positive for S. haematobium. The intensities of S. mansoni infection were moderately high, with a geometric mean egg count of 76 eggs/gram of feces among positive individuals in the first area, and 100 eggs/gram of feces in the second area. When compared with a previous study conducted in 1985, the prevalence of S. mansoni infection in the first area has increased from 21.7% to 42.1% among settlers in the last seven years, while that of S. haematobium has decreased from 7.8% to 1.7%. These trends may result from changes in irrigation practices or other alterations in the local environment. There is a risk of schistosomiasis becoming a major public health problem in reclaimed areas if adequate control measures are not taken.

Social and economic conditions in two newly reclaimed areas in Egypt: implications for schistosomiasis control strategies.

Reclamation of land from the desert is currently taking place in all parts of Egypt. A side-effect of many of these projects has been the introduction of schistosome parasites and their snail intermediate hosts, sometimes among Bedouin population with no previous exposure to the disease. The purpose of the present study was to describe social, environmental and economic conditions which can affect the transmission and control of schistosomiasis in reclaimed areas, and to investigate how residents of these areas view local conditions. Two areas were found to have high rates of internal and external migration, many different social groups with widely divergent priorities and minimal contact with each other, and inadequate infrastructure in terms of roads, transport, water and sanitation and health services. As a result of these conditions, control strategies which are effective for the population living in the Nile Valley will have to be modified considerably if schistosomiasis is to be brought under control in reclaimed areas.