The adverse effects of albendazole and praziquantel in mass drug administration by trained schoolteachers

Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) conducted stool examinations for soil transmitted helminthiases (STH) and Schistosoma mansoni, among school children in Mwea Division, Central Kenya where both infections are endemic. Mass drug administrations (MDAs) were then conducted in 2004 and 2005 using schoolteachers trained on how to administer treatment, physically and psychologically prepare the children to take the medication, have them eat before treatment, handle minor and refer serious side effects to local health facilities. Local health workers were on standby to help manage severe side effects. This study examined side effects of the drugs and the teachers’ preparedness to handle the children when such effects occurred. No serious side effects requiring referral to the health centre occurred and the minor ones observed were temporal. In 2005 children in Mwea schools were treated with albendazole 400mg and praziquantel 40mg/kg body weight while those of Ndia, a neighboring division treated with only albendazole 400mg since there was low S.mansoni prevalence. Monitoring of side effects was done in two schools of Ndia and in three of Mwea through a questionnaire distributed to grade three pupils a week after treatment. Of 73 pupils from Mwea, 49.7% reported incidences of stomachache, vomiting/nausea, headache and dizziness whereas 39.2% of 186 from Ndia experienced incidences of cough, stomachache and headache. This shows that more pupils from Mwea, (albendazole and praziquantel) than from Ndia (albendazole alone) experienced minor side effects. These results show that both drugs have temporary, minor side effects, which can be managed by trained schoolteachers by ensuring that the school children do not swallow the drugs on an empty stomach and rest immediately after swallowing the drugs but should be closely monitored by health personnel. In this study, one trained schoolteacher could administer treatment to three hundred children in one day, which makes the approach cost effective and should be adopted nationally.Keywords: albendazole, praziquantel, soil transmitted helminthiasis, schistosomiasi

A fouryear followup of school children after masstreatment for Schistosomiasis and Soil Transmitted Helminths in Mwea, Central Kenya

Poly-parasitism infections are common in school children in tropical regions, especially in Africa. In a school based schistosomiasis and soil-transmitted helminths de-worming model project in Mwea, Kenya, approximately 40,000 school age children from 86 schools were treated annually with a standard dose of praziquantel (40mg/kg body weight) and albendazole (400mg). A cohort of approximately 2,300 children from 5 sentinel schools were followed up at multiple time points each year for four years and examined for intestinal helminths (Schistosoma mansoni, Trichuris trichiura, Hookworm (Necator americanus) and Ascaris lumbricoides). The overall prevalence of infection in the five schools before treatment was 47.4% for S. mansoni, 16.7% for N. americanus, 0.8% for T. trichiura and 1.7% for A. lumbricoides. The mean intensity of infection, as measured by eggs per gram of faeces (epg) was 146.2 for S. mansoni, 36.3 for N. americanus 1.0 for T. trichiura and 35.8 for A. lumbricoides. After 4 rounds of treatment, prevalence of S. mansoni reduced significantly by 88.7% to 5.4% (95%CI=3.6% -7.1%), a 97.1% reduction. The prevalence and intensity of S. mansoni infection varied by school according to its proximity to irrigated area, with those schools closest to the irrigated areas presenting higher infection prevalence and intensity. Re-infection with schistosomiasis following treatment was observed and is likely to reflect continued environmental transmission due to non-treatment of the adult population. Soil-transmitted helminths are less prevalent in the cohort, with corresponding lower intensity. This may allow albendazole treatment to be reduced to every 2 or 3 years. This study has shown that periodic administration of anthelminthic drugs reduces the prevalence and intensity (which is likely to be a close proxy of morbidity) of intestinal parasitic infections in school-age children. Adults in the community could also be targeted where resources allow in order to further increasing the effectiveness of de-worming programmes. Keywords: Soil transmitted helminths, Schistosomiasis, school age, prevalence, Intensity, mass de-worming, school childre

Effect of Praziquantel on Hatching of Schistosoma haematobium Eggs

The hatchability of Schistosoma haematobium eggs excreted by patients treated with praziquantel (PZQ) was examined. The rate of hatching of the eggs excreted by the patients before treatment was 90.1%. The rates of hatching of the eggs excreted by the patients 3 hr, 24 hr and 48 hr after treatment were 25.5%, 19.2% and 29.9% respectively. In vivo PZQ inhibits the hatching of S. haematobium eggs. The result of in vivo experiment was strongly supported by the results of the in vitro experiments. The hatching of the eggs exposed to PZQ at a concentration of 0.1μg/ml for one hour in vitro was inhibited

Epidemiological Studies on Schistosoma haematobium Infection in Coastal Area, Kenya : Cercarial Density at Water Contact Points and Identification of Species of Cercariae

ビルハルツ住血吸虫症の流行地であるケニア国クワレ地区ムワチンガ村において,住民によく利用されている水系から,特に利用頻度の高い2ケ所(Site 6,Site 19)を選び,水中のセルカリア密度を,Prentice(1984)の方法を用いて測定した。さらにセルカリアの種を同定するために,4匹ずつの未感染ハムスターを調査地の水に暴露し,約3カ月後剖検して住血吸虫の感染の有無について調べた.Site 6では,401の水からわずかに1隻のセルカリアが回収されただけで,4匹のハムスターには,いずれも住血吸虫の感染は見られなかった.これに対して,Site 19では81の水から231隻のセルカリアが検出され,また4匹のハムスターからも,合計31個体の住血吸虫成虫(雄20,雌11)が回収された.これらのハムスターの肝臓には多数の住血吸虫卵が見い出され,形態学的特徴からビルハルツ住血吸虫のものと同定された.住血吸虫症流行地のいろいろな水系の水の危険度を測定する際のセルカリオメトリーの有用性について考察した.The cercarial density in natural water was measured at two major water contact points in Mwachinga, Kwale, an endemic area of Schistosoma haematobium infection, by using the filtration technique of Prentice (1984). In addition, the sentinel animals, male golden hamsters, were immersed in water for the identification of species of schistosomes. Only one cercaria was recovered from 40 litters of water sample at one site. Neither adult worm nor egg was recovered from 4 sentinel animals which were immersed there. At the other site, 231 cercariae were detected in 8 liters of water sample. A total of 31 adult worms, 20 males and 11 females, were recovered from 4 sentinel hamsters. The eggs from the livers of hamsters were identified to be S. haematobium based on their morphological features. The practicability of cereariometry in detecting relative risk of infection in different water contact points was discussed

Change in Haematuria and Proteinuria Levels in Urinary Schistosomiasis after Treatment with Praziquantel : Population-based Study in a Kenyan Community

In order to investigate efficacy of praziquantel (biltricide) on morbidity related to Schistosoma haematobium infection, 300 subjects of which 219 had eggs in the urine were examined for urinary eggs, blood and protein before and three months after treatment. Haematuria and proteinuria disappeared in 80.4% and 75.5% of the studied subjects respectively. The disappearance rates were not related to pre-treatment levels of haematuria and proteinuria. The rates both for haematuria and proteinuria were significantly lower in the age group 15 years and over than in the younger age group. Parasitologically, praziquantel cured 85.3% of the egg positives and reduced the mean egg count by 98.2%

Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study.

BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection