Date Published: May 28, 2008
Publisher: Public Library of Science
Author(s): Zilahatou B. Tohon, Halima B. Mainassara, Amadou Garba, Ali E. Mahamane, Elisa Bosqué-Oliva, Maman-Laminou Ibrahim, Jean-Bernard Duchemin, Suzanne Chanteau, Pascal Boisier, Joanne P. Webster
Abstract: BackgroundIn the framework of the monitoring and evaluation of the Nigerien schistosomiasis and soil-transmitted helminth control programme, a follow-up of children took place in eight sentinel sites. The objective of the study was to assess the evolution of Schistosoma haematobium infection and anaemia in schoolchildren after a single administration of praziquantel (PZQ) and albendazole.Methods/Principal FindingsPre-treatment examination and follow-up at one year post-treatment of schoolchildren aged 7, 8, and 11 years, including interview, urine examination, ultrasound examination of the urinary tract, and measurement of haemoglobin. Before treatment, the overall prevalence of S. heamatobium infection was 75.4% of the 1,642 enrolled children, and 21.8% of children excreted more than 50 eggs/10 ml urine. Prevalence increased with age. The overall prevalence of anaemia (haemoglobin <11.5 g/dl) was 61.6%, decreasing significantly with increasing age. The mean haemoglobinemia was 11 g/dl. In bivariate analysis, anaemia was significantly more frequent in children infected with S. haematobium, although it was not correlated to the intensity of infection. Anaemia was also associated with micro-haematuria and to kidney distensions. In a sub-sample of 636 children tested for P. falciparum infection, anaemia was significantly more frequent in malaria-infected children. In multivariate analysis, significant predictors of anaemia were P. falciparum infection, kidney distension, and the village. One year after a single-dose praziquantel treatment (administered using the WHO PZQ dose pole) co-administered with albendazole (400 mg single dose) for de-worming, the prevalence of S. haematobium infection was 38%, while the prevalence of anaemia fell to 50.4%. The mean haemoglobinemia showed a statistically significant increase of 0.39 g/dl to reach 11.4 g/dl. Anaemia was no longer associated with S. haematobium or to P. falciparum infections, or to haematuria or ultrasound abnormalities of the urinary tract.ConclusionsThe high prevalence of anaemia in Nigerien children is clearly a result of many factors and not of schistosomiasis alone. Nevertheless, treatment of schistosomiasis and de-worming were followed by a partial, but significant, reduction of anaemia in schoolchildren, not explainable by any other obvious intervention.
Partial Text: Schistosoma haematobium is endemic in Niger, particularly throughout the Niger River valley and in villages in close proximity to permanent and temporary ponds –. The prevalence of infection is highly variable from one village to another. School-aged children are more often and more heavily infected than adults . Overall, urinary schistosomiasis is an important public health problem in Niger. Thanks to portable ultrasound technology, urinary tract lesions due to S. haematobium infection can be easily identified in large epidemiological surveys –. Nevertheless, the relationship between other frequent pathologies, such as anaemia and S. haematobium infection, are less thoroughly documented . Different studies have found a statistically significant association between urinary schistosomiasis and anaemia ,. However, many other factors, such as malaria, soil-transmitted helminthiasis, nutritional deficiencies and sickle-cell anaemia, are also frequently associated with anaemia – and controversial statements have been made about the real impact of schistosomiasis on haemoglobin status.
According to the WHO guidelines , the aim of the Nigerien National Schistosomiasis Control Programme is to reduce schistosomiasis-associated morbidity by reducing the prevalence of heavy-intensity infections.