The effect of improved water and sanitation on the prevalence of schistosomiasis and soil transmitted helminths (STH) amongst female primary school aged children in Ugu District of KwaZulu-Natal, South Africa.

Master of Medical Science in Public Health Medicine.Background: Inadequate water supply and sanitation adversely affect the health and socio-economic development of communities and place them at risk of contracting S. haematobium and soil transmitted helminths (STH). AIM. The aim of the study was to determine if improved water and sanitation infrastructure has had an impact on the prevalence and intensity of schistosomiasis and soil transmitted helminths in female pupils aged 10-12 years attending primary schools in Ugu district, KwaZulu-Natal. METHODS. A descriptive cross-sectional study was conducted in Ugu district amongst primary school pupils from 18 randomly selected. Kato-Katz and urine centrifugation techniques were used to analyze stool and urine samples respectively. A structured questionnaire was used to collect water contact information, and one stool sample and three consecutive day’s urine samples, were collected from each participant. Information on sanitation and water infractructure in communities was obtained through interviews with community ward councillors. Same analysis were done on the data from 1998 Parasite Control Programme (PCP) and findings used to compare with current study’s findings. Results. Amongst the 1057 pupils interviewed, prevalence of Ascaris lumbricoides and Trichuris trichiura was 25% and 26% respectively, and corresponding mean intensities of infections were 21 and 26 eggs per gram. The prevalence of Schistosoma haematobium was 32.2% and the mean intensity of infection was 60 eggs/10ml. When asked whether pupils knew about schistosomiasis, whether they had had red urine in the past week and if they had ever had dysuria, 60%, 9% and 22% respectively, answered in the affirmative. The 15 Ugu ward councillors reported improved access to safe water and sanitation. CONCLUSION. Improved service delivery is likely to have contributed to reduced prevalence of STHs. However, a third of the study samples and a quarter of the study sample was infected with S. haematobium and STHs respectively

Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract

BACKGROUND: Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. METHODS: Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). RESULTS: FGS was associated with a higher frequency of CD14 + cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4 + cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14 + cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). CONCLUSIONS: The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this

Mapping Schistosoma haematobium for Novel Interventions against Female Genital Schistosomiasis and Associated HIV Risk in KwaZulu-Natal, South Africa

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Effect of Female Genital Schistosomiasis and Anti-Schistosomal Treatment on Monocytes, CD4+ T-Cells and CCR5 Expression in the Female Genital Tract

Background Schistosoma haematobium is a waterborne parasite that may cause female genital schistosomiasis (FGS), characterized by genital mucosal lesions. There is clinical and epidemiological evidence for a relationship between FGS and HIV. We investigated the impact of FGS on HIV target cell density and expression of the HIV co-receptor CCR5 in blood and cervical cytobrush samples. Furthermore we evaluated the effect of anti-schistosomal treatment on these cell populations. Design The study followed a case-control design with post treatment follow-up, nested in an on-going field study on FGS. Methods Blood and cervical cytobrush samples were collected from FGS negative and positive women for flow cytometry analyses. Urine samples were investigated for schistosome ova by microscopy and polymerase chain reaction (PCR). Results FGS was associated with a higher frequency of CD14+ cells (monocytes) in blood (11.5% in FGS+ vs. 2.2% in FGS-, p = 0.042). Frequencies of CD4+ cells expressing CCR5 were higher in blood samples from FGS+ than from FGS- women (4.7% vs. 1.5%, p = 0.018). The CD14+ cell population decreased significantly in both compartments after anti-schistosomal treatment (p = 0.043). Although the frequency of CD4+ cells did not change after treatment, frequencies of CCR5 expression by CD4+ cells decreased significantly in both compartments (from 3.4% to 0.5% in blood, p = 0.036; and from 42.4% to 5.6% in genital samples, p = 0.025). Conclusions The results support the hypothesis that FGS may increase the risk of HIV acquisition, not only through damage of the mucosal epithelial barrier, but also by affecting HIV target cell populations, and that anti-schistosomal treatment can modify this

Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between Schistosoma haematobium and the soil-transmitted helminths (STHs) Ascaris lumbricoides and Trichuris trichiura in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if S. haematobium can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for S. haematobium and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between S. haematobium and STHs at a school level (Spearman’s correlation coefficient =0.93; p<0.001). The prevalences were found to be 36.9% and 38.8% for S. haematobium and STHs, respectively. A significant association was found between S. haematobium and STHs (odds ratio =2.05; confidence interval =1.58–2.93; p<0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with A. lumbricoides and T. trichiura infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and A. lumbricoides and T. trichiura. We cautiously suggest that all S. haematobium endemic areas should be treated for STH infections. Significance:  • The prevalences of urogenital schistosomiasis and soil-transmitted helminth infections were highly significantly correlated. • More than half (60%) of the investigated schools are in need of annual treatment for S. haematobium infection. • Almost half of the infected schoolgirls had a heavy intensity of S. haematobium infection. • Nearly all the schools investigated require treatment for soil-transmitted helminthiasis once or even twice per year. • This study can contribute to the epidemiological planning process of the deworming programme

Reproductive health problems in rural South African young women: risk behaviour and risk factors

Background South African young women continue to be vulnerable, with high prevalence of teenage pregnancy, HIV, sexually transmitted infections (STIs) and female genital schistosomiasis (FGS). This study seeks to examine the underlying factors that may be associated with these four adverse reproductive health outcomes. Methods In a cross-sectional study of 1413 sexually active of young women, we explored these four adverse reproductive health outcomes by considering socio-demographic factors, socio-economic factors, sexual risk behaviour, substance abuse and knowledge about reproductive health by using a questionnaire. Consenting participants were asked about previous pregnancies and were tested for HIV, STIs and FGS. Multivariable regression analyses were used to explore the factors associated with these four reproductive health outcomes. Results 1. Early pregnancy: Among the young women, 44.4% had already been pregnant at least once. Associated factors were hormonal contraceptives, (adjusted odds ratio (AOR): 17.94, 95% confidence interval (CI): 12.73–25.29), and sexual debut < 16 years (AOR: 3.83, 95% CI: 2.68–5.47). Living with both parents (AOR 0.37, 95% CI: 0.25–0.57) and having a steady partner (AOR: 0.43, 95% CI: 0.24–0.76) were identified as protective factors against pregnancy. 2. HIV: HIV prevalence was 17.1%. The odds of having HIV were higher in intergenerational (AOR: 2.06, 95% CI: 1.05–4.06) and intragenerational relationships (AOR: 1.51 95% CI: 1.06–2.15), compared to age-homogenous relationships. Other associated factors were: condom use (AOR: 1.60, 95% CI: 1.16–2.20), number of times treated for an STI (AOR: 1.32, 95% CI: 1.02–1.71), and total number of partners (AOR: 1.14, 95% CI: 1.03–1.28). 3. STIs: Participants who had at least one STI (40.5%) were associated with total partner number (AOR 1.17, 95% CI: 1.06–1.30), and testing HIV positive (AOR: 1.88, 95% CI 1.41–2.50). 4. FGS: FGS prevalence (19.7%) was associated with previous anti-schistosomal treatment (AOR: 2.18, 95% CI: 1.57–3.05). Conclusion There is a high prevalence of pregnancy, HIV, STIs and FGS among sexually active young women in rural KwaZulu-Natal. Multidisciplinary approaches are urgently needed for educational and health literacy programs prior to sexual debut, and health care facilities, which should be made accessible for young women

Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between&nbsp;Schistosoma haematobium&nbsp;and the soil-transmitted helminths (STHs)&nbsp;Ascaris lumbricoides&nbsp;and&nbsp;Trichuris trichiura&nbsp;in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if&nbsp;S. haematobium&nbsp;can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for&nbsp;S. haematobium&nbsp;and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between&nbsp;S. haematobium&nbsp;and STHs at a school level (Spearman’s correlation coefficient =0.93;&nbsp;p&lt;0.001). The prevalences were found to be 36.9% and 38.8% for&nbsp;S. haematobium&nbsp;and STHs, respectively. A significant association was found between&nbsp;S. haematobium&nbsp;and STHs (odds ratio =2.05; confidence interval =1.58–2.93;&nbsp;p&lt;0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with&nbsp;A. lumbricoides&nbsp;and&nbsp;T. trichiura&nbsp;infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and&nbsp;A. lumbricoides&nbsp;and&nbsp;T. trichiura. We cautiously suggest that all&nbsp;S. haematobium&nbsp;endemic areas should be treated for STH infections. Significance:&nbsp; The prevalences of urogenital schistosomiasis and soil-transmitted helminth infections were highly significantly correlated. More than half (60%) of the investigated schools are in need of annual treatment for&nbsp;S. haematobium&nbsp;infection. Almost half of the infected schoolgirls had a heavy intensity of&nbsp;S. haematobium&nbsp;infection. Nearly all the schools investigated require treatment for soil-transmitted helminthiasis once or even twice per year. This study can contribute to the epidemiological planning process of the deworming programme.&nbsp

Seasonal variations in schistosoma haematobium egg excretion in school-age girls in rural Kwazulu-Natal province, South Africa

Background. A predominant feature of Schistosoma haematobium infection is urinary egg excretion, and microscopic egg detection remains the accepted standard field diagnostic tool. Praziquantel is the drug of choice for schistosomiasis, and the World Health Organization recommends that it should be administered to all children >4 years of age living in schistosomiasis-endemic areas. The frequency of mass drug administration depends on the prevalence rate in the community. Urinary schistosome egg output has a day-to-day and hour-to-hour intrasubject variation. Therefore, it is important to assess possible seasonal variations in egg excretion to improve the planning of drug treatment. Objectives. To assess the influence of seasonality on urinary schistosome egg excretion in South Africa (SA). Methods. We performed a prospective cohort study, exploring seasonal variations of S. haematobium egg excretion in 184 girls aged 10 - 12 years from randomly selected schools in a rural area of KwaZulu-Natal Province, SA. The area has a subtropical climate characterised by a cool dry season and a hot humid season. For children, water contact is higher in the latter season. At baseline, 108 girls were examined in the hot season, and 76 in the cold season. In the next year’s cold season the untreated patients were re-investigated before treatment. Results. There was a decrease in infection in the group initially tested in the hot season compared with the group tested in the cold season at both time points when adjusted for age and water contact (adjusted odds ratio 3.61 (95% confidence interval 1.14 - 11.44); p=0.03). Conclusions. This unique study shows that schistosomiasis prevalence determined by microscopy exhibits seasonal variation, with a higher prevalence in the hot rainy season. Precise community prevalence estimations are key in decisions to treat communities. There was significantly lower egg output in the cold season, and sampling in that season may therefore underestimate the prevalence of urinary schistosomiasis. The study indicates that sampling in SA should be done in the hot season