Infection status and risk factors associated with urinary schistosomiasis among school-going children in the Ndumo area of uMkhanyakude District in KwaZulu-Natal, South Africa two years post-treatment

Objectives: To assess the efficacy of praziquantel in children infected with Schistosoma haematobium over a 2-year period in the Ndumo area of uMkhanyakude District, South Africa. Methods: This cohort study enrolled 173 school-going children in September 2017 who had participated in a baseline survey conducted in 2015 in the Ndumo area. Questionnaire interviews were conducted to collect information on the risk factors related to the transmission of schistosomiasis. The filtration technique was performed to detect Schistosoma haematobium eggs in urine. Infection intensity was classified as light or heavy. The Chi-square test was used to assess the associations between variables at the 95% confidence level, and p = 0.05 was considered significant. Results: Of the 173 participants screened 2 years post-treatment, 10 were infected. Six of these were new infection cases, while four were cases of re-infection. The intensity of infection had decreased significantly (p = 0.001) at the time of the follow-up survey compared to the baseline survey. However, no significant difference was found among the risk factors for schistosomiasis 2 years later. Conclusions: The prevalence of S. haematobium had decreased significantly in the cohort at 2 years post praziquantel treatment, during a period of persistent drought in the area. Risk factors that were significantly associated with schistosomiasis at baseline were no longer significantly associated at 2 years following treatment

Efficacy of praziquantel treatment regimens in pre-school and school aged children infected with schistosomiasis in sub-Saharan Africa: a systematic review

Abstract Background Schistosomiasis is a serious public health burden in sub-Saharan Africa. Praziquantel is the only drug recommended by the World Health Organization to treat both urogenital and intestinal schistosomiasis. The reliance on a single drug to treat a disease with such a huge burden has raised concerns of possible drug resistance mainly in endemic areas. This systematic review was conducted to identify gaps and recent progress on the efficacy of different regimens of praziquantel in treating schistosomiasis among children in sub-Saharan Africa where Schistosoma mansoni and S. haematobium are endemic. Main text A literature search of peer-reviewed journals was done on Google Scholar, MEDLINE (under EBSCOhost) and PubMed databases using pre-defined search terms and Boolean operators. The search included studies published from 2008 to 2017 (August) with emphasis on the efficacy of praziquantel on S. haematobium and S. mansoni infections among preschool and school children. Nineteen publications satisfied the inclusion criteria for the review. The studies reviewed were from 10 sub-Saharan African countries and 7/19 of the studies (37%) were conducted in Uganda. Seven studies (37%) focused on Schistosoma mansoni, 6/19 (31.5%) on S. haematobium and another 6 on mixed infection. A single standard dose of 40 mg/kg body weight was the most used regimen (9) followed by the repeated single standard dose assessed for efficacy at 3–4 weeks post-treatment. Conclusions A repeated standard dose of 40 mg/kg achieved satisfactory efficacy compared to a single dose against both parasite species. However, findings on efficacy of repeated doses in co-infection of S. mansoni and S. haematobium were not conclusive. Praziquantel administrated at 60 mg/kg was slightly more efficacious than the 40 mg/kg standard dose. Minor and transitory side-effects were reported for both regimens. The review indicates that further investigations are necessary to conclusively determine efficacy of praziquantel on coinfection of S. haematobium and S. mansoni to formulate concrete guidelines on the use of repeated doses at 40 or 60 mg/kg for treating schistosomiasis. We recommend the use of the egg reduction rate (ERR) formula recommended by the WHO for assessing praziquantel efficacy in order for the results to be comparable for different regions

Edutainment and infographics for schistosomiasis health education in Ndumo area, Kwazulu-Natal, South Africa

Educational interventions targeting communities which are at risk of contracting schistosomiasis infection may empower them to develop capacity to minimize the spread of the disease. We compared the effectiveness of health education interventions for schistosomiasis knowledge uptake among school-going children in Ndumo area, KwaZulu-Natal using a quasi-experimental trial. An assessment of health education interventions (edutainment and infographics) in the community’s own language and socio-cultural context was done among primary school-aged children in two primary schools in Ndumo, a schistosomiasis endemic area (37%). The study involved 37 students from Munywana primary where the intervention was on infographics and 44 from Maphindela where the intervention was on edutainment. The students wrote a schistosomiasis knowledge test, 1 month before the knowledge uptake interventions were implemented. The same test was given to the two groups after the interventions. Baseline and post-intervention scores were used to test whether the interventions improved schistosomiasis knowledge levels. Paired t-test and independent t-tests were conducted to test the change in knowledge assimilation at the 5% significance level. Our findings show that health education interventions significantly improved knowledge on schistosomiasis among school children (P < 0.001). At post-intervention, the mean score of the whole sample increased to 15,6/35, from a baseline score of 6,5/35. However, there was no significant difference in the post-intervention mean scores of infographics and edutainment interventions. In order to improve schistosomiasis research uptake among school-aged children, health education interventions such as edutainment and infographics can be effective in making the children assimilate schistosomiasis research findings as it has been shown elsewhere. The number of participants in the intervention and high attrition rate were notable limitations of the study. Future studies may need to invest more resources and use digital-based interventions incorporating both infographics and edutainment on one platform such as a digital device

Additional file 2: of Efficacy of praziquantel treatment regimens in pre-school and school aged children infected with schistosomiasis in sub-Saharan Africa: a systematic review

Table S1. Summary of findings on the use of praziquantel against Schistosoma mansoni between 2008–2017 in sub-Saharan Africa. (DOCX 25 kb

Additional file 4: of Efficacy of praziquantel treatment regimens in pre-school and school aged children infected with schistosomiasis in sub-Saharan Africa: a systematic review

Table S3. Summary of review of findings on the use of praziquantel on co-infection with Schistosoma haematobium and S. mansoni between 2008–2017 in sub-Saharan Africa. (DOCX 22 kb

Additional file 1: of Efficacy of praziquantel treatment regimens in pre-school and school aged children infected with schistosomiasis in sub-Saharan Africa: a systematic review

Multilingual abstracts in the six official working languages of the United Nations. (PDF 417 kb

Efficacy of praziquantel on Schistosoma haematobium and re-infection rates among school-going children in the Ndumo area of uMkhanyakude district, KwaZulu-Natal, South Africa

Abstract Background Despite its low cure rates and possible resistance, praziquantel (PZQ) is the only drug available for schistosomiasis treatment. Hence, monitoring its efficacy is crucial. This study assessed the efficacy of PZQ, determined re-infection and incidence rates of Schistosoma haematobium infection among school-going children in the Ndumo area, KwaZulu-Natal. Methods A cohort of 320 school-going children (10 – 15 years) in 10 primary schools was screened for S. haematobium infection using the filtration technique. Infected children were treated at different times and hence were divided into two sub-cohorts; A1 and A2. Non-infected children constituted the sub-cohort B. Children who continued excreting viable eggs 4 weeks post-treatment received a second dose of PZQ. Re-infection rates were determined in sub-cohort A1 and A2 at 28 and 20 weeks post-treatment, respectively. Cure rates (CR) and egg reduction rates (ERR) were calculated. Incidence rate was assessed 28 weeks post baseline survey using children that were negative for schistosome eggs at that survey. Analysis of data was done using the Chi square and the Wilcoxon rank test. A 95% confidence interval with a P-value < 0.05 determined significance. Results At baseline, 120 (37.5%) of the 320 study participants were found infected with Schistosoma haematobium. Heavy infections accounted for 36.7%. The calculated cure rates were 88.07% and 82.92% for females and males, respectively. Egg Reduction Rates of 80% and 64% for females and males were observed 4 weeks after the initial treatment. After the second treatment, CR was 100% in females and 50% in males with an ERR of 100% in females and 70% in males. At 20 and 28 weeks post treatment, reinfection rates of 8.03% and 8.00% were observed, respectively, giving an overall rate of 8.1%. An incidence rate of 4.1% was observed 28 weeks after the baseline screening. Conclusions The study indicated high CR while the ERR was low suggesting a reduced PZQ efficacy. The efficacy improved among females after the second dose. Re-infection rates at 20 and 28 weeks post-treatment were low. The study also indicated a low incidence rate for the 28 weeks period

Additional file 3: of Efficacy of praziquantel treatment regimens in pre-school and school aged children infected with schistosomiasis in sub-Saharan Africa: a systematic review

Table S2. Summary of findings on the use of praziquantel against Schistosoma haematobium between 2008–2017 in sub-Saharan Africa. (DOCX 22 kb