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Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe
  1. Derick Nii Mensah Osakunor1,
  2. Takafira Mduluza2,3,
  3. Nicholas Midzi4,
  4. Margo Chase-Topping5,
  5. Masceline Jenipher Mutsaka-Makuvaza4,6,
  6. Theresa Chimponda2,
  7. Enwono Eyoh1,
  8. Tariro Mduluza2,
  9. Lorraine Tsitsi Pfavayi2,
  10. Welcome Mkululi Wami1,
  11. Seth Appiah Amanfo5,
  12. Janice Murray1,
  13. Clement Tshuma7,
  14. Mark Edward John Woolhouse5,8,
  15. Francisca Mutapi1,8
  1. 1Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
  2. 2Department of Biochemistry, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  3. 3School of Laboratory Medicine and Medical Sciences, University of KwaZulu Natal, Durban, South Africa
  4. 4Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
  5. 5Centre for Immunity, Infection and Evolution, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  6. 6National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
  7. 7Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe
  8. 8NIHR Global Health Research Unit Tackling Infections to Benefit Africa (TIBA), University of Edinburgh, Edinburgh, UK
  1. Correspondence to Derick Nii Mensah Osakunor; d.osakunor{at}ed.ac.uk

Abstract

Background Recent research has shown that in schistosome-endemic areas preschool-aged children (PSAC), that is, ≤5 years, are at risk of infection. However, there exists a knowledge gap on the dynamics of infection and morbidity in this age group. In this study, we determined the incidence and dynamics of the first urogenital schistosome infections, morbidity and treatment in PSAC.

Methods Children (6 months to 5 years) were recruited and followed up for 12 months. Baseline demographics, anthropometric and parasitology data were collected from 1502 children. Urinary morbidity was assessed by haematuria and growth-related morbidity was assessed using standard WHO anthropometric indices. Children negative for Schistosoma haematobium infection were followed up quarterly to determine infection and morbidity incidence.

Results At baseline, the prevalence of S haematobium infection and microhaematuria was 8.5% and 8.6%, respectively. Based on different anthropometric indices, 2.2%–8.2% of children were malnourished, 10.1% underweight and 18.0% stunted. The fraction of morbidity attributable to schistosome infection was 92% for microhaematuria, 38% for stunting and malnutrition at 9%–34%, depending on indices used. S haematobium-positive children were at greater odds of presenting with microhaematuria (adjusted OR (AOR)=25.6; 95% CI 14.5 to 45.1) and stunting (AOR=1.7; 95% CI 1.1 to 2.7). Annual incidence of S haematobium infection and microhaematuria was 17.4% and 20.4%, respectively. Microhaematuria occurred within 3 months of first infection and resolved in a significant number of children, 12 weeks post-praziquantel treatment, from 42.3% to 10.3%; P<0.001.

Conclusion We demonstrated for the first time the incidence of schistosome infection in PSAC, along with microhaematuria, which appears within 3 months of first infection and resolves after praziquantel treatment. A proportion of stunting and malnutrition is attributable to S haematobium infection. The study adds scientific evidence to the calls for inclusion of PSAC in schistosome control programmes.

  • dynamics
  • incidence
  • morbidity
  • paediatric
  • praziquantel efficacy
  • prevalence
  • preschool
  • schistosomiasis
  • Zimbabwe

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2017-000661

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    Footnotes

    • Handling editor Alberto L Garcia-Basteiro

    • Contributors DNMO, TM, NM, MEJW and FM were involved in conceptualisation. MEJW and FM designed the study. TM, NM, MEJW and FM were involved in project supervision DNMO, TM, NM, MJM-M, TC, EE, TM, LTP, WMW, SAA, JM, CT and FM conducted the field work. DNMO, TC, EE, LTP and WMW curated the data. DNMO, MCT, WMW, MEJW and FM analysed the data. DNMO and FM prepared the draft manuscript, and all authors were involved in review and editing of the manuscript. All authors read and approved the final manuscript.

    • Funding Our paediatric schistosomiasis project is funded by the Thrasher Research Fund 12440 and the Wellcome Trust 108061/Z/15/Z. This research is also commissioned by the National Institute of Health Research, using Official Development Assistance (ODA) funding 16/136/33.

    • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute of Health Research or the Department of Health. The funders had no role in the conception, study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests DNMO is supported by the Darwin Trust of Edinburgh and MCT is supported by a Wellcome Trust Strategic Award WT095831.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The study received institutional approval from the University of Edinburgh and ethical approval from the Medical Research Council of Zimbabwe.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.