Clinical morbidity associated with Schistosoma haematobium infection in pre‐school age children from an endemic district in Zimbabwe

Abstract

Objective To investigate Schistosoma haematobium morbidity in infected pre‐school age children and establish their disease burden. Methodology Pre‐school age children (1–5 years) who were lifelong residents of the study area and had no other infections were included in the study. Participants underwent a physical examination with clinicians blinded to their infection status. Diagnosis of S. haematobium was by urine filtration. Results The prevalence of S. haematobium was 35.1% (146/416). The clinical features observed in patients with Schistosoma haematobium were as follows: wheezes (morbidity attributable factor (AF = 93.9%), haematuria (AF = 92.6%), ascites (AF = 91.5%), atopy (AF = 76.9%), inguinal lymphadenopathy (AF = 68.4%), stunting (AF = 38.2), malnutrition (MUAC)(AF = 20%) and weight for height scales (AF = 5%). Schistosoma. haematobium infected children were at greater odds ratio of presenting with inguinal lymphadenopathy (AOR)=99.2(95% CI 24.2 to 854.5), wheezes in the chest (AOR = 35.4 95% CI 15.3 to 94.2), Distended abdomen with ascites (AOR = 23.9 95% CI 11.4 to 54), haematuria (AOR = 12.6 95% CI 11.6 to 14.1), atopy history (AOR = 5.6 95% CI 1.85 to 20.2), malnutrition (AOR = 2.3 95% CI 1.4 to 3.2) and stunting (AOR = 1.9 95% CI 1.1 to2.7). Conclusion The study is novel as it demonstrates for the first time clinical morbidity markers associated with S. haematobium infection in pre‐school age children. Furthermore the study adds scientific evidence to the call for inclusion of pre‐school age children in schistosomiasis control programmes. These morbidity markers highlight the need for early diagnosis and screening for S. haematobium in pre‐school age children.

Association of Schistosoma haematobium infection morbidity and severity on co-infections in pre-school age children living in a rural endemic area in Zimbabwe

“…The coinfections were selected from top causes of morbidity in Zimbabwean children under-5 years of age [ 15 ]. Information was extracted from the Zimbabwe demographic health survey, and Zimbabwe provincial and district census statistics [ 12 , 14 – 21 ]. The data captured on under-5 mortality was then compared with the prevalence of the top mortality conditions in children which included HIV, malaria, diarrhoea and schistosomiasis [ 22 – 25 ].…”

“…Shamva recorded the highest prevalence of schistosomiasis in Zimbabwe at 62.3%, during schistosomiasis and soil transmitted helminths (STH) national mapping exercise [13]. The district lies 945 m above sea level, has a warm climate and average temperature of 20.2°C and an annual rainfall of 887 mm [14]. Shamva district has high farming activity due to presence of fertile soil.…”

“…Participants recruited into the study were lifelong residents of the Shamva district. The PSAC were aged between 1 to 5 years and had a previously reported inclusion criteria [14]. In addition participants had to have a Mantoux test reaction < 5 mm and a normal nutrition status (based on clinical examination, which included mid upper arm circumference measurement and weight-for-age as well as height-for-age measurements).…”

“…Haematuria check and parasitology was done as previously described [14]. The parasitology team recorded the results independently of the clinical team.…”

“…Trends showing schistosomiasis prevalence in comparison to child and under 5 mortality per 1000 live births from Zimbabwe provinces. The data was extracted from the national demographic and health survey, Zimbabwe and Zimbabwe provincial and district census statistics[12,[14][15][16][17][18][19][20][21] …”