-

University of Nigeria Research Publications

NWANGWU, Nwanneka Victoria

Aut

hor

PG/M.Sc./95/21345

Title

Post Treatment Evaluation of the Characteristics of Urinary Schistosomiasis

Among Primary School Children of Amagunze, Okpoto, Ntezi Communities of

Enugu and Ebonyi States Nigeria

Facu

lty

Biological Sciences

Dep

artm

ent

Zoology

Dat

e

May, 1999

Sign

atur

e

POST TREATMENT E V A L U A T I O N OF TH6 CtIARXC7lfS2I S T I C 3 OF

U R I N A R Y S C H I S T O S O M I A S I S AMONG PRIMARY SCHOOL C 3 I L D H O I O F

D6PARTirIXirPl' OF ZOOLOGY

FACULTY OF B I O M C I U A L S C I E N C B

UNI VISRSITY o F N I C E R I A , NS@KA

POSF TREAI'NENT E V A L U A T I O N O F TI1 E C ~ A I I A C T % R I S T I CS OP

URINARY S C 1 I I S O S O M I A S I S P.MON~; F,Zi;?ii?'rT SZfiiNI, CfTIL'DRS?!

O? AMACCNZIE, OKPOTO, NTEZI COMMTF!ITIES CE' SNDCI!

AND s n o , m STATES, NIGERI A.

9 (PG / MSS / 95 / 2-1 34,)

PROT. A X Y A 0 . A P U A

NVANC1tm WdPLUNl3KA ' VICTORIA A p o s t g r a d u a t e s t u d e n t

i n t h e Departmcnt o f 2oolop;y and w i t h t h c re:;istr:ition

number PC / NSC / 95 / 21345 has s a t i s f a c t o r i l y completed

t h e r e q u i r e m e n t s f o r c o u r s e a n 3 r e s e a r c h work f o r t h z degree o f

Plas ter o f Science i n P a r s s i t o l o k 2 v . The work embodied i n

t h i s p r o l e c t r d p o r t i3 o r g i n i a i and has not been s~ ibn l i t t ed

i n par t o r full f o r any o t h e r d ip loma o r d e g r e e o f

this o r any o t h o r u ~ i i v o r ~ i t y ,

Prof . Anya 0. Anya

Dephrtment o f zoo lo,^

Un ive r s i t y o f N i g e r i a

Nsukka.

P r o f . F. C. Okafor

Departnent of Zoology

U n i v e r s i t y o f N i g e r i a

Nsukkci.

--:. Head o f Department

D r , N o M o Inyang

Department of Zoolo,vy

Un ive r s i t y o f Nigeria

Nsukka.

D e d i c a t i o n

Th i s work is d e d i c e f e d t o our d a u g h t e r

Chisomaga Peace I f eanyi

My sincere g r a t i t u d e goes t o m y superv isa rs Pro f .

F. C. Okafor whose advice, encouragement and cons t ruc t ive

c r i t i c i s n s enabled m c cmry o u t t h i n s t u d y . He aLso t o o k

time t o rea:! th r su ,yh th:.s work and xade u:;cful su~ge: : t ions ,

. b d to P r o f h j ra 0, any^ who spsrcxl 30inc o f h i s t i n e t o road

th roueh t h i s work ~ n d s l s o make v ~ r y neecmary corn.etion3.

My t h ~ n k s also ~cier ; t o my f r i c r t d Xiss IJ j u N n s j c h u who32

s:lpport and p r a y e r 3 were l i k e t h e v e r y tlecrleil balm tcl an ach ing

back.

F i n s l l y , 1 wish t o thank m y husbsnl , f o r h i s riti'incial

and moral Sup;art , w i t h o u t which this ?570rk xiiuld n a t hsve

bean p o s ~ i h l e .

To Co.3 be all t h e lory -2nd honour f o r i I i s mr:rcios

and pxxlncss tm to mc.

T i t l e Paga

C e r t i f i c a t i o n

D e d i c a t i o n

Acknowledgement

Table o f c o n t e n t s

List o f Tables

L i s t o f Plates Cist , . o £, Figures

h 9 S FR4CT

Chapter One :

i. 1

1.2

103

1.4

! 05

Chapter Two :

201

2-2

2m3

2.4

2.5

2.6

Chapter Three

Chapter Four

ehapler Five

i

i i

iii

i v

v

vi

vi i

v i i i i x

I n t r o d u c t i o n a

I n t r o d u c t i o n

c r a t u r o Review

Geograph ica l D i s t r i b u t i o n

g p i d e m i o l o ~ j of Schis to sun ias i s

Socio - ecozomic f u c t o r s

D i e g n c s i s o f S&is toso tn ins i s

MATERI4LS hYD M!??HODS

The Study Area

Human Ecology

Study Method

Collection o f Urine

Urine. Analysis

s t a t i s t i c a l Methods

rnSULTS

DISCTJSSIONS

Tabl e

Table

Table

T a b l e

Table

TaSl e

Pnbl e

Tabl e

T a b l v

TsSle

Tsbl e

TnSl e

T 1 1 b i ~

D i s t r i b u t i o n o f Urinary Schistosomisais i n t he

four r u r a l s c h o o l s s t u d i e d .

Prevslence Rate of i n f e c t i o n by sex i n t h e

f o u r schoo ls .

D i s t r i b u t i o n o f i n f e c t i o n according t o age groups

i n t h e f o u r schools.

Sex d i s t r i b u t i o n o f i n f e c t i o n a c c o r d i n g t o age

groups (males) in t h e different :;chc~l:<,

Sex d i s k r i b u t i o n of infection accorJing age groups

(~emales) i n t h o d i f f s r u n t schools,

P r e v : ~ l u n c e o f i n f e c t i o n arid C e o m A r; c rirean o f t h e

or:: output ( f r o m t;ho:;e i n f e c t e d in t h e various

s c h o o l s ) by age,

Ef fec t o f tr;ilt:t t m i . i 2 i l i t y un t h e d i s t r i b u t i o n of

Vrinaly S z h i s tosomiasis nnong ;,ilpils.

g f feot o f domas t ic wster sollrce on t h ~ d i s t r i b g t i o n

u r i n a r y Szh i s t ;~somiar , i r ; m.:on:; p u v i l s .

D i s t r i b ~ ~ t i u n o f intc: 'l?.itg c; f i!lrec!. l.on according t o

a!; c ,.: co up . Incidence rn tc s ,nt 4 t h nn3 1 2 t h aont'r:~ p o s t -treatment.

Cure ra tes a t 4 t h mo:ltn p o z t - t r t i s t c n n t .

R c i n f t t c t i o n ra te 1 2 t h montkr p o s t - t r::?t':iient.

Cure r9te ~ c c 6 r 3 i n s kto nf;c t:w1ql.

Rcinf i :c t ion ra te s c ,x rd inc t o agc ZrGtip.

Cure rate ~cc.arm3ing t o s t ~ x .

Rein fec t i on rste a c c o r l i n g t o sck.

Pla t e 1

Plate 2

P l a t e 3

P l a t e 4

~ i S t o f P la tes

P a r t o f Atnvu River in Ishielu v i l l n ; y e ,

Arr,spnzt!.

Ndundu s t resn Ndiag-d-Oxbar, ibmgunza

showing h m s n a c t i v i t y .

M!qunye St rcm ITmtlnevo , Amngmze

s h o v i n g hurnm a c t i v i t i e s

A local t o i l e t in .use a t Ri'diagu-O~'nor,

Amaeunze.

Fig 1 A map of Nigeria showing ur inary schistosomiasio

f o c i tind t h e projec ted s i t e s f o r dam and hydroe lec t r i c

p ro jec t s .

The prevalence and post treatment p r o f i l e s of S, hamatobiurn - infect ion was lnvestfgated in school dildren i n four rural schools

wii'nin ?:Ram East and Ishiulu L. G. A. of EnugU and Ebonyi Stakes.

out of 400 pupils examined in the four schools, 110 (27.5%) w e r e

Infected w i t h S. hamratobiurn. In % i s number'were 719 males out - of which' 5 (& 1%) were infected while out of the 181 f m a l e s i?

the study, 55 ( 30.4%) were Infected. There was no difference in khc

i n f e c t i o n rate betwcm males and f analcs s t a t i s t i c - l l y ( P 0.05).

Prevalence studies among tine schools si.owtd t h a t central 'school

L'unevo, Arnaqunze had the Fi4r3.1est Infection rate (47%) followed by

om scnwl. ~ d i a g u - wbor, Amagunzc (38%) &her include: T s i r l k p m a

primary s&ool ~ d l e z e , Okpoto (1%) and cam1inlty primary school

ulepa, Ntczf (w).' The age rante of tine pupi ls lnvolved i n the .

s b J y f e l l betwelr! 6 - 16 years. Across the age groups the

vrevalu~ce r a t e s recorded Include: 6 - 9 yrs I 24.9%; 10 - 13 yrs = 32.2% and 14 yrs = 40%- An assessment of'the i n t c n s f t y of

l i g h t 3nfcction group ( i e 100 tgg/l0ml urine). T'ne type of

s ignif icant ly af fez t the infection rate , with tine bush 'users having

xne hlqhcst infection rate (35,?%), followed by Pit users (35,1%)'

Ynm Local t o i l e t ilsff s (17.3%). ~keatment of tho.-,c jnfectcrc! with

pra7Lquantcl a t 40mg/kgbwt: showed that pmziquantel i s an cffecW1~e

drug again st sci?istoscmIasi s.

The cure rate recorded in t he f o u r schools were 80$ in

Centra l School Umunevo, Amagunze, 88.w in Town School

Ndiagu - Ogbor, Amagunze, 85,6$ in Isinkpma Primary

School Ndieze- Okyot,o and 10fl in ~ o r n m b i t ~ Primary School

U l e p s N t e z i ,

rTo r e i n f e c t i o n was recorded among t r e a t e d p u p i l s i n

Isink$ma Primary School N3iez-e - Okpato. Hovever a 31.M

r e i n f e c t i o n rst e w s s recorded at central School Umunevo,

. Amsgunze . 30.43 in Town School Ndiagu - Ogbor, and 3 3 . 3 in Conununity Priarnry School Ulepn, N t e z i , The

s i g n i f i c n n c e o f t h e f i n d i n g s was d i s c u s s e d an3 the need

f o r s u s t a i n e d s u r v e i l l n n c e even a f t e r ~ s s s chemotherapy io

proposed,

INTRODUCTIOFT AND LITERATURE RGVIEW

sciristosomiasis i s a water borne p a r a s i t i c disease. It is c n d a n i c

i n most p a r t s of the t h i r d world, Tne world H e a l t h o r g a n i s a t i o n (m)

ranks i t as second t o Malaria among tine prcdaninant t r o p i c a l diseases .

About 200 m i l l i o n people i n 7 1 dwe lopcd countries are af fecttd',by it,

L, 500 t o 600 mi l l i on people are a t r i s k o f acqu i r ing it as Yney perform

t'ncfr d a i l y water - re la ted activities ( s u b as swimming, fis:?Sng farming,

washing and ba th ing ) (m, 1984). schistosomiasis i s predominantly

a disease of the r u r a l poor. Trdvc l lers to mdanic areas arc a l s o at

great r i s k of acqui r inq the i n f ec t ion . It i s a cn ron ic disease t h i y t . saps the energy of its victims and causes agonizing debility w h i &

l i n g e r s and i n severe cases culminates in d e a t h

History h ~ s it that tjjc ancient ~ g y p t i a n s knew vesical

~ci?ir*,-emiasis as d good c l i n i c a l account of the d i s ~ s e was found

i n a papyrus (shous'na et al , 1949) and t he ova w e r e i s o l a t e d from -- nummfes 2nd canopic jars of mummified viscera (Ruffer, 1910).

~ n e c a u z a t i v t agent of schi stosorniasl: was The 1st publ ished recox! of &'

dated 1852 a yea r a r t e r it was discovered a t autopsy i n mesenteric

veins of a patient i n Kasrel Aini Hospi ta l , cairo, Egypt by Dr. Theodore

~ i l h a r z . In '1860 both Harley and cobbold held the v i e w t h ~ t .molluses

serve as tine i n t e rmed ia t e hosts b u t it was n o t u n t i l 1913 tirat ~ i y a i r i

and ~ z i k i ' found t h a t Ype mollusc Katayama nosopnor? was t i c

vector of 5. japonicurn in the k$-~!;'nu area in Japan. F-.d years l a t e r , - Miyagawa veric ied their findinqs.

Tn china there are records of scFistosomiasis of comparable

a n t i q u i t v , sc'nistosomiasis i n f a c t i o n s I n t'ne lvew world are mcre

~ - w : m t in origin, prohcl:,ly b s g h n i n g w i t h A f r i c a n s lave t rade to the

schistosomiasis i n ~ z r i c a is a very serious p u b l i c h e a l t h pro1:lm

and it is endemic in rnmy subsanara coun t r i e s including ~ i g & i a . T h i s -,

inf e t t i o n h3s attracted, an? i.5 s t i l l dttr;tctir.q, numerous surveys and

reports. Despi+e this fact , some areas of the country h~ave remained ,

u n s t u d i e d (Anos ike et 51 1392 ). Tir ib d i s e a s e has h e m known to - -' exist In Vicerid S ~ I ~ C L - d very long tircte, over h a l f a cen tury dqn

~ r e v a l e n d e snd incidence s t u d i e s have been ca r r i ed out i n

d i f f e r e n t par t s of the world. A survey i n Malumfashi d i s t r i c t of

Kaksina S t a t e , Nigeria c a r r i e d out i n two communities, Mahuta and Ruwan

Sanyin showed a prevalence r a te o f 8.7$ and 38.M r e spec t ive ly 'with

the 10 - 12 yrs age group having t h e highest prevalence rate i n bo th

comlmi ties (~e11, 1973).

Information on t h e prevalence o f schis tosomias is i n t h e Rivers

S t a t e and izdeed i n t h e whole o f the Niger Del ta is scanty ( ~ ~ i , 1995).

A g i stated that apar t f r o m t h e account o f Arene, Ulcpeibo and Nwanze

( 1989), t h e r e is no documented repor t on schis tosomias is i n t h e

Niger Delta. However i n his s t u d i e s i n Odau community of Rivers S t a t e ,

a high preva la i ce and i n t e n s i t y rates o f u r i n a r y schistosomiasia was

recorded. Out of 890 people examined 514 were infected g iv ing a

prevalence rate o f 57.0%. The highest prevalence (78.755) w a s found

i n t h e 10 - 14 yrs age bracket .

Ea r l i z r s t u d i e s have shown u r ina ry schis tosomias is t o be present

in the eastern par t of Nigeria (&uper, 1963). Anya and Okafor (1986)

a l s o repor ted t he prevalence of schis tosomias is i n e igh t villages of

the then Anambra S ta t e . However more recent s t u d i e s have shown that

more areas are being a f f e c t e d by t h e d i sease Wejulu & 2 (1994).

c a r r i e d ou t an epidemiological survey f o r u r ina ry schis tosomias is

caused by Schistosoma haematobiurn i n communities around A&u l s k s ,

Agulu l ake , Anambra S t a t e , Nigeria. I n their study i t was shown t h a t

t r ansmis s ion of infection was higher at N r i t 'ollowea by Agulu t hen

Adazi-Nnukwu (where i n f e c t i o n is s a i d t o be new).

T h e i r inc idence r a t e s were 55,1v, 17.5% and 5.26T r e spec t ive ly ,

However, Onuigbo 5 (1995) in t h e i r own survey o f the same

communities r epo r t ed a prevalence r a t e o f 47.2% at Agulu, 29.$ a t

N r i and 2.4% at Adazi. The i n f e c t i o n peaked at t h e 13 - 15 yrs age

bracket ( 3 4 , s ) c l o s e l y followed by t h e 10 - 12 yrs age group

(25.5%). I n Kwars State o f Niger ia an inc idence s tudy c a r r i e d ou t by

Be110 & E d ~ g b o l a (1992) showed a 45.4% incidence rate of i n f e c t i o n

among 425 p u p i l s examined i n n ine communitieu, Children between the

ages o f 11 and 13yrs had t h e h ighes t incidence r a t e s o f i n f e c t i o n

(33.6%).

I n these s t u d i e s males have showed a h ighe r r a t e of i n f e c t i o n than

the females, except i n the last study where females had a h i g h e r

i n f e c t i o n r a t e than t h e males though t h e d i f f e r e n c e was not statistically .

s ignif icant .

The highest prevalence o f schistosomiasis occurs ameng children

and ado le scen t s (8aile - Meskal eL al, 1985). This is t h e case of

a l l Schistosoma spec i e s ( ~ c Gervay, 1992). Hence any control

programme t h a t does not take i n t o account t h i s age group w i l l no t have

much impa,ct on t h e o v e r a l l prevalence o f t h i s disease.

Due t o e t h i c a l and l o g i s t i c c o n s t r a i n t s , i t is o f t e n d i f f i c u l t

t o r i go rous ly assess using a def ined pro tocol , t h e impact o f disease

con t ro l programmes f o r sch is tosomias is in communities, especially

chemotherapy based cont ro l ( ~ a u a c h & Cline, 1995). However, a number

o f such control programmes hove been c a r r i e d out and r epor t ed by Mott

et a1 < i990), Gryscels et 31 i 1992) & King et a 1 ( 1991). -- -- -- f i r o n i c i n f e c t i o n w i t h schistosoma haematobiurn i s assdciated

w i t h signf f i c a n t u r inz ry tract morbidi ty including haematurq a,

p r o t e i n u r i a and granulomatous i n f l a ~ m a t i o n of the ureters and bladdtrs.

Lonq t e r m sci?istosorna i n f e c t i o n is a l s o a s s o d a t t i with i r o n - d t f i c i c n c ~ a n a m i a , malnutrition, bladder mctaplas ia , neoplasms and

a prc-dispos l t ion to sqamous cel l carcinoma of tine b ladder , \

\ ( p r u a l -- et a1 (199?), Stephenson (1993). WHO (14'93) & ~ o s t a f a =t . . a l -- ( l995).

Currently tin.. main o b j e c t i v e of- s cn i s to somias i s c o n t r o l i s t o

achieve a direct reduct ion of morbidity due t o tire i n f e c t i o n us ing

chemotherapy through primary heawn care (SHC) until a safe and

effective vaccine Secomes available, chemotinerapy - based con trel

programmes will remain the most effective method t o control. such

high t r m s m i s s i o n and morbidity of schis tosomlasis . ~ i g h c u r e r a t e s

of S. haematobiurn with prazicpantcl are well documented and -

Fraziyuantel is t h u s a r r e n t l y the drug o f choice for tht C r e a t m e n t

of scnistosomiasis in humans. A s i n q l e eral dose of 4Ong/kg ot body

weignt (kqbwt) i s 'at. s tandard recomnended f o r both.~. - mansoni and - S .

izaematobLum i n f e c t i o n s . The drug was i n i t i a l i y in t roduced as, n i l t r i c i d e

by t h e German - swiss Company Rayer - Merck, but i s now

a l so manufactured as Di s toc ide by t h e Korean company Shin -pang

phamaceut i c a l ,

Although cure r a t e s of 70 - 1OC$ are g e n e r a l l y stated, lower cure

rates have a l s o been repor ted oldem em an & a, 1988; El - Piasry

& al, 1988 and Stelma e t a l l , 1992). No d i f f e r e n c e s i n efficacy 7 -

were found between Dis toc ide and B i l t r i c i d e ( ~ o m e i d a gt 1989)~

Improved cure r a t e s have bsen described i f praz iquante l was

adminis te red i n s p l i t doses g iven up t o 6 h r s apart ( n - ~ a s r ~ & a, 1988). A d i f f i c u l t y i n determining cure rates is t h e problem of

d i f f e r e n t i a t i n g between failure of t rea tment and r e i n f e c t i o n , Also

cure r a t e e are dependent on the s e n s i t i v i t y o f t h e d i a g n o s t i c

technique used because, particularly a f t e r t rea tment , l i g h t i n f e c t ions

can e a s i l y be missed (polderman e t al, 1988 & De Vlas & Gryaeels , 1992).

S e l e c t i v e popula t ion - based chemotherapy f o r t h e con t ro l of morbidi ty

due t o s ch i s to somias i s has become a widely appl ied m d advocated

strategy s i n c e t h e development o f s a f e , s i n g l e .- dose drug3 (WHO, 1985).

Ejezie & Okeke (1987) evalua ted t h e e f f e c t i v e n e s s o f p raz iquan te l

i n t he t rea tment of ach i s tomias i s amongst school ch i ld ren aged 6 - 15

years i n Ajara community, Niger ia Results showed t h a t i t c l e a r e d t h e

urinary sch i s to somias i s i n a l l but o.$ of t h e s u b j e c t s a t t h e dosages

used and a f t e r 18 months only 0.59$ of t he e n t i r e school popula t ion

had new in fec t ions . prevalence r a t e was reduced f r o m 16,M t o 0.59%.

I n Senegal, 307 persons aged 5 t o 70 yrs were t r e a t e d with

praz iquante l (40mg/kgbvt$ f o r urinary schis tosomins is . Follow - up

eraminabion made a f t e r one, t h r e e and s i x months succes s ive ly

showed t h a t a f t e r t h e last examination none o f 164 persons passed

viable ova, 9 passed dead o r a and 155 had no ora i n t h e i r u r i n e

( ~ i a l l o gt & , 1984).

I n m o t h e r study i n Tanzania t h e e f f i c a c y o f p raz iquan te l

a g a i n s t 2. haematobium and its e f f e c t on t h e morbidi ty i nd ices ,

haematuria and p r o t e i n u r i a u e r e assessed us ing school ch i ld ren

rece t v i n g praz iquant e l a t 40mg/kgbw t . Follow-up s t u d y conducted

24 weeks a f t e r i n i t a l treatment showed t h a t t h e p e r c e n t a ~ e cure r a t e

was high and reached 1@ i n t h e ' l i g h t t and 'moderate' i n f e c t i o n

groups, whi le a 5G$ cure rate was obta ined among t h e heavy' infect i on

group ( ~ a r d a e t a l p 1987). I n Msambweni a r e a o f coas t province,

Kenya a s tudy showed t h e effect o f repea ted , annual age t a r g e t e d

therapy o n prevalence and i n t e n s i t y o f s. h~ematobium i n f e c t i o n

w a s evaluated. Oral rnetriironate (10mg/kg f o r t h r e e doses each

o r p raz iquan te l therapy (40%/kg) as a s i n g l e dose each yea r for

three yea r s were administered t o i n f e c t e d sub jec t s . Annual fol low - up revealed s i g n i f i c a n t long-term suppress ion o f S. haematobium

i n f e c t i d n i n t h e t a r g e t e d school - age popula t ion (king et a, 1991 ).

Gryseels, Nkulikyinka & Engels ( 1991 ) have a s ses sed t h e impact

o f repea ted s e l e c t i v e chemotherapy on prevalences i n t e n s i t i e s o f

i n f e c t i o n with ,maneon% i n Sihungwe, Tranversa ls 1 & 2 and

~ u h n n d a ~ a z a / ~ i z i n a two v i l l a g e clusters in Burundi. Surveys were

c a r r i e d out a t months -6, -3,0,3,6,9,12,24 and 36. Treatment w i t h

p raz iquan te l wae ~ i v e n a t 0, 12,24 &36 months no subjects showing

p a r a s i t d l i v i n g eggs. Cure r a t e s o f 7% and 8% r e s p e c t i v e l y were

ob ta ined after 3 months. Prevalence at community level was reduced

by 5@ and 45s r e spec t ive ly . Reinfec t ion was noted aaong younger age

groups i n Tihungwe.

Assessment o f t h e a b i l i t y o f yearly drug therapy t o cont ro l

i n f e c t i o n i n t e n s i t y and reduce S. haematobium a s s o c i a t e d d i s e a s e i n

ch i ld ren 5 - 21 years o l d i n an endemic a r e a o f Kenya was c a r r i e d out

by King e t a1 ( 1 992), Results showed that annual oral t he rapy provides

an e f f e c t i v e s t r a t e g y f o r cont ro l . Kitange e t a1 (1993) r epo r t ed t h e

prevalence o f schistosomiaviv i n Nelela v i l l a g e , Tanzhnia a year a f t e r

a s i n g l e dose of praziquantel, 40mg/kgbut was given. Cure r a t e was 90.478,

new inc idence e s t ima te was 21 .$ i n ch i ld ren who i n i t i a l l y t e s t e d negat ive.

A community based randomized t r i a l o f praziquantel t o con t ro l

sch is tosomiavis morbidi ty i n school children was carried out i n Zambia.

Fol low up s tudy n t 3, 6 and 12 months a f t e r i n i t i a l t rea tment w a s done

w i t h the result showing t h a t t h e r e were s i g n i f i c a n t reduct ions i n

splenomegaly ; hepatornegaly and subjective symptoms of morbidi ty 6 and 12

months a f t e r i n i t i a l t rea tment ( ~ u k w a , 1993).

In Egypt, Sa raka t ~t a1 (1995) have assesse3 t h e impact of yea r ly

s e l e c t i v e t rea tment w i th p raz iquan te l (40mg/kg) on 2. manvoni

prevalence and intensity o f i n f e s t i o n s with r e s u l t showing d e c l i n e i n

prevslence snd Geometric mean egg count across a l l aEe groups

in each succes s ive follow up. Control programmes i n which t rea tment

w i t h p raz iqusn te l and health educat ion were incorpora ted has been shown

t o s i g n i f i c a n t l y reduce preva lence and i n t e n s i t y o f i n f e c t i o n among

school aged ch i ld ren i n an endemic area o f Cameroon as xhen compared

w i t h a con t ro l programme. The prevalence o f i n f e c t i o n w i t h S, .

hsernatobium i n school-aged ch i ld ren was 7$ i n t h e a r e a s where t h e

con t ro l programme Gas implemented and 71$ i n t h e excluded areas .

High i n t e n s i t y i n f e c t i o n was 1$ and 26% i n t h e two areas, r e s p e c t i v e l y

( ~ a u s c h ,& Cline, 1 995).

Although i t is g e n e r a l l y known t h a t s ch i s to somias i s e x i s t s i n

Nigeria, i ts exact d i s t r i b u t i o n md i n f e c t i o n rates have been s t u d i e d

i n some p a r t s o f t h e country ( ~ k o h , 1980; Anya &Okafor 1986; Amali,

1989; A g i , 1995 ; Onuigbo, Uke je & Ezeome, 1995 & Ehe julu &t =a,,

1995). Rowever, i n s u f f i c i e n t in format ion i a a v a i l a b l e on t rea tment

e v a l u s t i o n i t u d i e s on urinary schis tosomias is among school c h i l d r e n

i n t h e Eastem p a r t of Nigeria. Against t h i s background t h i s s t u d y

w a s aimed a t a s s e s s i n g cure rate , r e i n f e c t i o n r a t e and how o f t e n

t rea tment should be given i n order t o con t ro l h igh t ransmiss ions and

morbidity due t o sch is touomias is , Also t h e effect o f improper

t o i l e t f a c i l i t i e s and d i sposa l o f h u m n excrement on transmission of

t h e i n f e c t i o n was assessed.

1.2

i.

ii.

iii.

SGOGRAI'HICAL DISTRIBLVIOA:

Several species of t h e blood f ukcs of' t h e gems Schis tosomn

arc p - : i z f t i c in m a n rid anim:ds in vari O M par t s o f the worldrQ f

those to be mentioned here, t he f i r s t t h r e e are the common

parasites o f man.

5. &+em~tobiun which causes urinary sch.istosorniaui'r: i n man, i s

endemic i n Africa: Medi te r ranean coast, Nile valley, E m t coast to

Natal and Cape o f goad Bope, Congo,Niger. I n Asia, Iraq and

Yemen, Cyyrus and K i d d l e East. I t is no t found i n North America.

I t i s noted that t h e o r i g i n o f Schis tosoma haematobiim wan

probably t h e lake Plateau of Africa (::arfii.ld, 1986).

S.nansoni which causes i n t e s t i n u l s c h i o t o s o ~ n i n s i s in man i o - endemic i n Africa. N i l e Delta, Prom Z a n z i b a r t o Sierra-leone.

Northern areas o f S.America, t h e c n r r i b e a n , thf: Eastern

Mediterrare~n. It is not found in India or U . S . A . I t most

likely o r i s i n a t e d i n t h c U?per Nile R i w r Bas in .

S.japonisum which causes intestinal schistosoniusit; in man in - C e n k m i c in t h e valley of Yangtze Kiang, Jspan, Philippines S.E

Asia arid W e n t c n Facii'ic. It most l i k e l y originated in the

Yangtze R i v s r valley.

iv. 2. intercalatior: is undecnic in Zaire, Cameroon and Zabon.

v. 5. Mathei and 2, b o r i s both occasional1 y infect 1r::;n. They are

found in I rq , South Europr: a d I t a l y .

vi . - S. s p i n d a l e , - S. nasalis end E. indicum: These do not i n f e c t man.

They are found i n I nd i a ,

In Nignri-a t h e a p p r o v j m t o distributior. o f : l c h i s t ~ ~ ~ o m i a s i s

is shown i n rig. 1 , The two specics o f importa~icc in Nigeria a r e

Schistosorna hticrnntobium and Schistosorna mansun i . 'The i n f e c t i o n

of man w i t h b o t h s p e c i e s is widespread. b l a i r (1956) s t a t ed t h a t

t h e e x i s t e n c e o f achiutosoff i ias is i n the Northern Region has been

known s i n c e a n t i q u i t y and he quoted a lengcnd t o the effect tha t t he

invading P u l a n i b ro aght the disease wi th them from thc- upper Nile

val ley ,

S . haematobium is p r o t s b l y endemic i n Nort hem Region, with - s o w areas markedly known f o r heavy infections Eg. t h e t e r r i t o r y

e x t a n d i n g from K a t s i n a , Kano, Zariti and Kaduna t o tkie zestern

f r o n t i e r o f B i rn in Kebbi and ~ r g u n ~ u n . ' Herc a 45$ i n f e c t i o n rate

have been recorded and maybe reg:~rdz.d as LL hypcrcndcalic region

(cowper 1967). I n t h c North a l s o i n f e c t i o n with schis tosomias is

shows the n o m a l p a t t o r n o f $rcvalence i n relatively young age grmps.

I n a s tudy o f 4,574 males in Zario, Bla i r (1946), showed a n o v e r a l l

i n f e r l t l u n r a t e o f j$ w i t h 311 age group maximum o f 6 3 : at 14 yeaxs,

decrexsing t o 12.55 i.:l elderly men. 2. rnarlstjnl infi.ctl;c=. ?:'-.Jv? ~ 1 3 ~ )

been reqorded i n the Northern region such as C a r a f i n i t o P a t e e i ,

Bido, Kaduna, Zaria, Kano etc .

- . I '

1 , . . Fig. 'i . A Map of Nigeria showing urinary schistosomiasis foci and

the projected sites for dam and hyd-roclectric project.

by the Eastern Rc:gional Medics1 Divinicln i n 1561. Okafcr (1994) c a r r i e d

oiA",r! est i3at ; ion o f t h e p r a v ~ l t - : i c e o f ur in-r tq .;chlstor.;:):r.iar;is i n

j3eI lu FC FCd~lngb~&a ( 1 932) carried out, s r : tuy iy in v s r i o u s

comnunitiea of Kwarn S t a t e ~ L I assess t h e a t s t u s and i m p l i c a t i o n of

u r i n a r y schis:osomiasis among s ~ k l a o ~ ~ d 2hi. ldren. He emit up

w i t h t h e obse rva t ion t h a t o u t o f t h e 425 y i i p i l s examined jn

n i n e c ~ ~ ~ m u n i t ie:; 193 ' ( 4504)$ wcre i n f c c t e d ,

d e f i n i t i m h o s t s .

Spp o f s~h i s t3so rne

S, bovis

I n t e rmod ih t e : i n ~ i 1 host:

B u l i n u s app

% o m p h a l s r i a spp

Oncomelania spp

Dei ' in i t i vi. hoc t

k i n , a1 h i n o rats, monkeys,

baboons, hamsters,

Man, mi cc , hamsters

Kan, d(ic:<, c a t s , deer,

n x s n , b!i!'faloe:3.

Cat t,l e , s i l~sep , ,mats.

Shecp, c::tkle, zebra Monkey

Xpidemiology has t o do w i t h t h e trausmi;:;ilrn nnJ s p r e a d o f t h e

disease. A n u ~ h e r o f f ~ A o r u ,%re i n ~ o l v e d in t h o e p i d n r i o l o g y o f

-I I he presence o f n a t u r a l bod ies o f w a t e r whi ch sre su i t , t~ l . . l c s

h a b i t a t s f o r t k e s n a i l i n t e r m i d i a t e h o s t s &:; v e l l as ~ a t i s f y i n ~ ;

l r u r n m needs.

The presence o f t h e app ronr i a t e sni l i l intermediate host .

Human con t sc t w i t h Natural bodies o f water'.

P o l l u t i o n of water w i t h infec ted human excreta

Fac to r s which promote t h e devolcpuent o f t h e ysrasitc x i t h i n the

a n a i l s and i ts t ransmiss ion t a man,

The ubscrved d e c l i n e i n p rcva lcncc an2 i n t e n s i t y o f ir i i 'cction w i t h

riel: ( i e r e s i s t a n c e t o r a i n f a c t i o n a f t e r the se .xnd decitrll? o f l i f e .

Socio-econonic s t a t u s o f the people ( ~ k o l i , 1 9 9 ~ )

P r w . nce o f n a t u r a l bodies o f water and h..vnan contact .

T r a n s m i s s i o n o f s ch i s to somias i s predominantly depends on the

p r e s e n c e of f r e s h wa te r - bodies. The m a i l hos t s of' schis tosomes

are found i n f r e s h water hab i t a t s . The s i t i n g o f t5c::c: f r e s h

water 3 u d i c s i s a consequences of man's developnerltal a c t i v i t i e s

eg cons t ruc t ion o f d a m , 5 r r i ~ n f ; i ~ n c a n : i l s bur row pit.';, art i f i c i n l

rondt; e t c . -

Ukof i ( 1 990) pointed o u t the para l le l e v o l u t i o n ol' t h e p a r a s i t e s

:in:! t h c i r a n a i l and human host-? and showed bow man cuntiniled t o be

closely a s s o c i a t e i f o r most of h i s o c c u p a t i o n a l , r e c r e s t i o n a l and

domes t ic needs, w i t h t h e f reshwater h a b i t a i s .

Occupat ional ly man comes i n contac t wi th fresh water bodies

i n Agr icu l ture , With a growing world populat ion t h e moun t o f

water available f o r e f f i c i e n t Agr icu l ture has dwindled l e a d i n g t o

t h e development of extensive i r r i g a t i o n schemes throughout, Africa

and many other p a r t s o f t h e world. I n the p a r t s of t h e t r o p i c s

where condi t ions f o r s ch i s to somias i s are favourable i r r i g a t i o n has

s imvl taneous ly r e s u l t e d i n t h e s r read of e i t h e r 2. hlansoni or

S. haernatobiu- (w.H.o. , 1984). - A good example e x i s t s i n F,gypt where farming has always depended

on i r r i g a t i o n . A system o f bas in i r r i g a t i o n has been i n use u n t i l

i n 1821 when e systea of perennial i r r i g a t i o n -mu introduced, u t i l i z e d

a vast network o f canals and drains, These open watercourses

provide s t and ing wa te r i n which s n a i l vec tors t h r i v e hence the

transmission o f b i l h a r z i a s i s ( ~ a r o q 1967) such canals are common

i n Sudan and i n Migeria,

In most r u r a l communities, f r e s h water bodies o f f e r r e c r e a t i o n a l

o p p o r t u n i t i e s e s p e c i a l l y t o c h i l d r e n who go there t o s w i m . Haile - Meskal ,& a (1985) in t h e i r prevalence s tudy o f u r i n a r y

s chistosorniavis i n t h e midd le Awash valley o f Eastern Ethiopia

found that persons from 5 - 19 years o f age had t h e h ighes t rate

o f i n f e c t i o n associated wi th 'cater-contact a c t i v i t i e s ( c a r f i e l d , 1986).

The more s o c i a l and a c t i v e t h e children t h e h iuhe r t h e prevalence

o f i n f e c t i o n . Use i s made of f r e s h water f o r cooking, washing,

b a t h i n g at home. This water sou rce when i n f e s t e d , tend t o

perpetua te t h e disease as t hey a r e being used.

U l u t i o n of water w i t h human wsstes:

Thi s is one o f t h e most i m p o r t a n t factor i n the epidemiology

of schiatosorniasis . I n most rural communities i n Africa maintainance

of clean environment is very peramount. Aence t h e use of f a s t

f lowing streams and rivers as l a t e r i n e s , o r even *hem l a t r i n e s are

provided, they are constructed on e ros ion pathways f o r easy

clearing as soon as t h e f loods come. Urinat ion is done v i r t u a l l y

everywhere, .While t h i s cult-ma1 h a b i t might be o f the best

i n t e n t i o n s by the vi l lagers , t h e snail host living in these

bodies of water are being infected when i n f e c t e d persons pas s out

t h e i r faeces on2 ur ine .

Cbserved decline in prevalence and i n t e m i t y o f i n f e c t i o n with

ape a f t e r t h e 2nd decade of life.

Wile a large percentage of the popula t ion i s infected in

, endemic areas. schistosomiasis is most prevalent i n certain age gmups,

The h ighes t prevalence o f schistosomiasis occurs among c h i l d r e n and

adolescents. Th i s is the case f o r a l l schistcsome species. Since

8chistosomiasis occurs a f t e r contact w i t h infective fresh water,

in fec t ions &re rare in those less than 4 gears of age who do not

range f ree ly outs ide the immediate household. Children and

adolescents have the highes t i n f e c t i o n rates because of a

~ ~ ~ 3 i n a L i o n o f two related f ac to r s . F i r s t , they are pmbably

more e x p o s e t o i n f e c t e d water bodies due t o the p a t c e m kof t h e i r

,P

18

p h y s i c a l a c t i v i t i e s . Secondly, l o n g i t u d i n a l s t u d i e s i n s e v e r a l s c h i s t o -

some s p e c i e s sugges t t h a t immunity t o r e i n f e c t i o n develops i n some

i n d i v i d u a l s c h r o n i c a l l y exposed t o i n f e c t i v e water source-. This -f-

age re1 a t ed develol!rrrent o f r e s i s t a n c e appears dur ing oT' a f t e r adolescence

and nmy account i o r tk~c l o x ~ r preva lence of s ch i s to somias i s i n a d u l t s

McCullough 2 (1974) e a r l i e r observed a sha rp dec l ine i n

preva lence o f S. haematobim i n t h e 3rd and subsequent decades of

l i f e i n h i s s tudy a t Nwanza Tanzania. Other such s t u d i s 3 i n Niger ia

show s i m i l a r r e s u i ts,

. Presence o f s n a i l h o s t , development o f the p a r a s i t e w i t h i n the

s n a i l and i t s t ransmiss ion t o man,

Fo I' s ch i s to somias i s t o invade .a community and probably become

endemic t h e r e , t h e r e must be t h e presence o f i t s s p e c i f i c s 'nai l

i n t e r m e d i a t e hos t w i th in an a v a i l a b l e f r e s h water body i n the conlmunity.

The s n a i l must be capable of being i n f e c t e d by mirac id i a hatched * f r o i n eggs and capable o f producing c e r c a r i a i n f e c t i v e t o a m n , The

a p p r o p r i a t e tempe-ratura, r a t e o f flow, s a l i n i t y , a c i d i t y o r

a l k a l i n i t y and o rgan ic m a t t e r 'content o f t h e water must bi? opt imal ly

maintained.

I t has been noted t h a t t h e planorbid s n a i l s tire n o t s o widely

d i s t r i b u t e d i n dense ly shaded, ovar watered a reas , I n tile savanna

and semi-ar id reg ions o f Afr ica , f reshwater h a b i t a t s ara more exposed

and t h e r e f o r e provide more e c o l o ~ i c a l l y conducive condi t ions f o r t h e

s n s i 1s ,

19 ,

Socio - econhmic fac tors :

t h e p r i o r i t i e s snd major preoccupation o f t h e underdeveloped

na t ions of the t h i r d world need t o be recorded. Health have not

assumed a major p r i o r i t y i n some o f t h e s e coun t r i e s and even

where it hss assumed p r i o r i t y , a l l i n d i c a t i o n s show t h a t heal th

s e r v i c e s are provided t o s a t i s f y t h e needs o f a se lezted minor i ty who

have t h e purchasing power ( ~ k o l i , tg90).

What r e a l l y i s needed is the provis ion o f b a s i c h e a l t h care

s e r v i c e s f o r t h e e n t i r e community which w i l l involve 70 - 8@ o f

the rura l poor who o - ~ f f e r from t h i s disease.

A t t i t u d e s of people i n t h e r u r s l areas tend t o perpetrP.te

the t ransmiss ion o f :he d i s e m e i n t h a t a number o f villagers may

n o t be wi l t ing t o p a r t i c i p a t e i n t rza tment programes and i ts follow-

up, their reasons he ing t h a t t h e i r stream and r ivsr3 h ~ v e been t h e

same all t h e i r life! and as such could not understand why they have

not a71 d ied i f eeally there is a d i s e a s e being t r n n s n i t t e d through

the uater. T h i s is a c l e a r case o f i g n o r ~ n c e and require a l o t of

health educa t ion t o erase.

Bringing h e a l t h care t o any rural communit$ i s a p r o j e c t which

would t a x not only t he resources but t he will o f any community

tremendously. However w i t h t h e a i d o f t h e .government t h e people

could be mcbiitized and rnotiv;%tcd t o do something about t h e i r

hea l th .

1 .5 DI AGNBSIS-OF SCHISTOSONIASIS :

D e f i n i t i v e d i a k l o s i s of sch is tosomiavis is gene ra l ly made by

d e t e c t i n g eggs i n t h e stool o r u r ine sample of t h e p a t i e n t . Two

s tandard methods f o r s t o o l e&j i d e n t i f i c a t i o n a r e t h e formalin - e i t h e r technique and The quick ks to smear t e c h n i q u e (Garfield, 1986).

For urine egg i d e n t i f i c a t i o n t h e fo l lowing s tandard method

are t h e bes t . The u r i n e concent ra t ion method and The u r i n e

f i l t r a t i o n technique ( ~ l e c k ?c moody, 1900).

I n view o f t h e cumbersomeness o f t h e use o f microscopy

rnethod i n f i e l d d iagnos is of sch is tosomias is , Mott et aJ (1985)

has developed a s imp l i f i ed , i n d i r e c t ( approach t o the d i agnos i s o f

u r i n a r j schistosomia::is, t h a t i~ t he use o f reagent s t r i p s f o r

I

d e t e c l i o n of h~lem:itu.~.ia which they found : i d e ~ i t i f i e d n high

propor t ion o f i n fec t ed ind iv idua l s , The reagent st r i p s were

considered a powerful t o o l i n d e t e c t i n g haematuria with a lower

l i m i t o f d e t e c t i o n oE on ly five erythrocytes p e r ul or O.Ot5mg of

o f soluble haemoglobin p e r 100 ml of u r ine (~avyibliii: Watt, 1989)

Nworgu Fk Anigbo (1992) has slso proved the h i ch s e m i tivity and

specificity o f haemat uria as a diagnost ic parameter.

I n csses cIf l igh t ; and chronic i n f e c t i o n s , e g p may riot be

found, henccthe use of serological and immunolo~ical t e s t s msybs

u se fu l .

2 1

Recently u l t r a s o n i c scanning has been used i n Tanzania t o d e t e c t

b ladder and kidney pa tho log ie s a s soc i a t ed wi th u r ina ry sch is tosomias is .

The e f f i c i e n c y of u l t rasound i n d e t e c t i n g l e s i o n s caused by

sch i s to somias i s has been ~ s s e s s e d by Burki & a (1986).

The use o f cystoscops a n instrument which enables t h u i n s i d e o f Ohe

b ladder t o be viewed hss Seen repor ted by S h e r i f (1381). f h i s enables

the i n s i d e o f th;. b ladder t o be v i w e d and any d i sease i n s i d e i t

de t ec t ed be fo re i t can be f e l t by an examining hand. However t h e

experiences needed i n us ing t h e i n s t ~ u n e n t and the discomfort t o t h e

i n d i v i d u a l s l i m i t s t h e use o f t h i s method m k e s i t unsu i t ab l e f o r

wide scale use.

According t o Laughlin ( 1984), t h e s e s e r o l o g i c a l tes ts are most

u s e f u l f o r epidemiological surveys and i n ~ a s e s o i n i : i nd iv idua l

response to t rea tmect ,

Deelder L Kornel i s ( I981 ) i n t h e Netherlands compared the

s e n s i t i v i t y o f var ious s e r o l t g i c i J t e s t s and came up with the r e s u l t

t h a t imrnunu f luores cent a n ~ i b o d y technique and t h e enzyvmel inked

immunosorbent assay (ELISX) were t h e most s e n s i t i v e techniques i n

d e t e c t i n g ant i -bodies i n 5. msnsoni i n f e c t e d p a t i e n t s not pass ing

eggs, f h e ELISA can give valuable information in both ind iv idua l

d iagnos is and t h e r a p e u t i c drug monitoring, as well as i n epidemiological

s t u d i e s o r d isease con t ro l programmes ( ~ 3 n ' t wont & al, 1992).

Other s e r o l o g i c a l t e s t s i n use f o r t h e d i sgnos i s o f s ch i s to somias i s

inc lude : - G e l p r e c i p i t a t i o n techniques

I n d i r e c t heemagglutination t e s t

Latex a g g l u t i n a t i o n t e s t

Circumovaria l ~ r e c i p i t i n test.

Eosinophi lur ia has been evaluated as a d i a g n o s t i c parameter i n

schistosomiasis. In a f i e l d - based s t u d y c a r r i e d out by Eltoum & 9

(1932) they were ab le t o show an 80$ s e n s i t i v i t y , €!6$ s p e c i f i c i t y and

8 3 p r e d i c t i v e value o f c o s i n o p h i l u r i a as a d i a & o s t i c i ndex f o r

Schistosomiagis haematobium. These ra tes were s i g n i f i c a n t l y higher I

t h a n those of p r e t e i n u r i s , haematuria and l m k o c y t u r i n taken s i n p l y o r

i n c o m b i n ~ t i o n according t o them. However u n l i k e t h e l a t t e r three

measurements, this method involves microscopy.

Pntraderma'l s k i n tt?. t3 itnd plmms-card t e s t are o th : . r d i a g n o s t i c

methods which hilve been proved by several s t l ld ics i n Was: Afr ica t o be

unrel iable f o r use i n t h e f i e l d f o r estimating t h e p r e ~ x l e n c e o f

S. hncrnatc~bium i n f e c t i o r l , o r f o r d i a e n u s i n , y i n f e c t i o n i n i n d i v i d u s l - pati~nts, ( ? o r u y t h , 1971).

The p r e n e n t s t u d y e!nployed the u r i n e concent rat ion rn~t hod cis

its d i a g n o s t i c parsmeter,

HATERIALS AND METHODS:

1 The Study p.roat

H i ~ o r i a is i n t h o Voat African mub-region of Africa, lying

betwean l a t i tudam 4' and 8' North of the aquator and 1on~itud.m

4' and 12' Ilrst of thm braenwich m r i d i a n , Tha mmn. carsred by

th ir i n r e s t i g 8 t i o n warm mainly Ikanu Bast h c 8 l Gort. Are8 and

fmhialu Local Go*, Arm. o f Enugu and Bbonyi S t a t e s r e spec t ive ly .

All are a i t u a t e d i n t h o martern zomm o f the country.

Imhiolu Local C o v t , Area f a l l a wi th in 6 O 25'N m d 6' 35'N

l a t i t ude . and between longitude. 7' 45* I4 and 7' 55l E. It i m a

reuion o f g r a s s lands, punctuated by l o r l y i n ~ h i l l . , mot17 of lime

mtonm. S e v e ~ a l mtranrm intermoct t h e a r e a r h i l a nurerow pool and

ponds c roa ted by the quarrying ac t i r i t5 . r o f the nerrby cement f a c t o r y

and road cons t m c t i on p r , ~ j e c t a abound.

of evergreen forest occ~sionally i n t e r spa rued with few grasslands.

The soil i a clayey nr,C aevt.ra2 st reams and r i v u l e t s in tersect the a r m .

24

2.': Rtimsn 26:c t lo~y:

N t s z i i s o c o n ~ r w i t y i n l a h i e l u h e a l Covt. Area o f Ebonyi State.

I t i a a r u r a l conmuaity w i t h most o f i t a residents as farnee and

p e t t y tradera. Their dialect is Kori as c u r r y ) which is

far removed from the 1850 language. Rice cu l t iva t ion i s prominent

in t h i a community t h w q h other crops such as cassava, sweet potatoes

are equally c d t i v s t d . The area i s o p p o r t m e d t o have p i p e borne

water or bore holes , though t h e ex is tenca o f ponds and streams are

also cosmon. Despite the fact that bore holes supply t h e community

w i t h d r i n k i n q w n t t r ch i ldren tnjoy ming t o t h s streams and ponds t o

bath, swim mnd do t h e i r washinys.

Olcpcto - a co-munity within the same Lozsl Covt. Area i a also

a rural community. I t a residents are mainly f a n n s n and ~ e t t y traders

equally, T h e i r dialect is Igbo t h o u ~ h with an accent t h a t is different

from the central Igbo t o n e e . Farming practic3 is Sam* here as in

N t e z i . Bore holes , ponds and streams exist within ths community.

The same a t t i t u d e to water f a c i l i t i e s obta in i n Okpoto as i n Ntez i .

llmu~unze in Nkanu-East Local Covt . Area i n a mral communi ty with

most o f its resident populat ion us farmers and local p e t t y traders.

Thair houses. ere b u i l t with e i t h e r mud o r cement t h o u ~ h mont often

roofed w i t h corru~atad i r o n shee t a , Thmir hauses are usually

sunrounderl by t h e i r farms - u a u a l l y f o r yam and cssssvn; T n e i r s o i l

be in^ c l ~ y e y , encourages the cu l t iva t ion o f rice which i s a l s o

fogn$ k,oing cultivaLed ir. thlzi r fii-q ia:,242 ;<:!. ;c.?; . ?,c: tl.r-ir

l i v i n ~ houses .

25

This community k ? i b ~ I;C p i p - b o r l l e water ur bore hole3 hence, t h e i r

main s o u r c e of water is the ir stream and r i v e r s and are found at

many l o c a t i o n s i n t h e comm~ni t ies . T h e r e are two m a j o r Rivers

w i t h i n t h e cornm~mity t h e A t a v u and t h e lynba.Rivers, t h e n o t h e r ntreana

such a s NLpu:lyt and S l ~ m r i u streams. These bodies of water are

highly i n f e s t e d w i t h h l i n i d s n l i l s , hosts of Schist?soma haernatobiurn

infection ( ~ k a f o r , 1984 and Ds!cor, 1995). Other sources cf water

in t h i s comnmity is rain w a t e r which is a v a i l a b l e orrly during t h e

ra in$ s easona . 2.3 Study Method:

The following ~ c h o l s were chosen f o r t h i s study:

6 Central school 'Jmunavo, hagunze.

( b ) Town school Ndingu O@or

( c ) Isinkpuma Primary school Ndieze , O'qoto.

( d ) Cornuni ty Pr imsry achool , Ulepa , N t e z i .

A f o u r month\ y v i s l t t3 esch achool s t a r t i ng frm ~ a ~ / ~ u n e 1996

t a FIag/~une 1937 was mdertakan. T h e s chos l s were v i s i t e e for

c o l L e c t i o n o f u r i n e ssrnples from 100 p u p i l s s e l ec ted randomly. The

urine samples were packed in a plastic basket an3 transported back

t h e same day t o t h e laboratory f o r examin.ation. A visit back t o t h e

same s c h o o l was made and t h e i n f e c t e d p u p i l s were t r ea ted with

p r a z i q u ~ n t e l 40 m d k R bwt . The subsequent 4 monthly interval visits were made t o each

achool o n l y for u r i n e c o l l e c t i o n , no f u r t h e r t reatment8 uars

administered.

The v i a i t s were scheduled to b e f our on t h e whole t o each

achool i e (a ) the first initial v i s i t ( b ) V i a i t a f t e r 4 month and

( c ) V i s i t a f t e r 8 mantha and (d) V i s i t a f t e r 12 months. Unfortunately

the 3rd v i a i t could not be made to any o f the schools becauae of

closure o f the institutions which a f f e c t e d a l l students, both

under graduates and post - gr~duate s tudents alike. Hence tho v i a i t a

fo l lowed t h i s pattern: I n i t i a l v i s i t at 0 modth, visit after 4 months

and v i a i t after 12 months.

2.4 Collection of Urine:

Wide - mouthed press- cap contaidera of about 75m1 volume

capac i ty were numbered t o t a l l y with t h e aames o f the pupi l s as

recorded i n a notebook, they were used to c o l l e c t urine sanples from

the p u p i l s o f each school on v i s i t a t i o n . The time of c o l l e c t i o n

usually f a l l s between 12.00pm - 2.00pm. The urine samples were

taken straight to the laboratory and stored i n t h e fridge that same

day, On the fol lowing days t h e samples were examined and egg counts

were taken.

Infomation on peroonal data (name, a ~ e , w e i ~ h t , sex, source of

domootic water, type o f t o i l e t f a c i l i t i e e ) were obtained by direct

quas t i on ing through an interpreter.

2,5 Urine Anal?rsis:

The sample was agitated t o suspend the ova evenly and a IOnl

aliquot was measured into a centrifuge tube and rotated at 1500 rpm

for 3 minutes. The supernatant was discarded careful ly .

The sediment was nade up t o 2 m l with water and transferred to a

mamaster slide for egg count, The meen of 3 egg counts for each

sample was taken. The number of ova per lOml of sample was

used t o quan t i fy the in tens i ty of' in fec t ion .

2.6 Stat i s t ica l Methods:

The data collected was analysed using t he one way - enalysie

of variance (ANOVA) and F - t e s t .

-

I'LATd 1: P a r t o f h % ~ v u R i v e r ~i t I s i e n u , A ~ ~ q y m z e , Nkanu-East LOG.,\

PLATS 3: Mkpmye stream a t Thunevo, Anagmze showing human a c t i v i t y ,

PLA'FE 4: A type o f

t a i l e t f a c i l i t y i i va i l ab le

at .Id d ingu-0gbo r, Lnag~inze ( h c s l t o i l c t ) ,

I

'I:

Denogmph.y o f t h e studied p o p u l a t i ~ n / ~ o p u l a t i o n s t ruc turg .

A t o t a l o f 400 p u p i l s p a r t i c i p a t e d in t he sLudy f r o m f o u r

d i f f e r e n t s c h o o l s . From each s c h o d l ri hund red p u 2 i l s were

s e l e c t e d a t random f o r t he e x e r c i s e . A t o t a l o f 219 mfilcs and

191 f e m a l e s were involved i n the study. The age raftge o f t h e

s t u d i e d p o p d : l t l o - is 6 - !5 year:;, The clvcmii age

d i s t r i b u t i o n is as f o l l o w s : ( 6 - 9) y e a r s 1 260, ( 1 3 - 13) y e a r s

= 12; 1 4 y r s .above = 110. T h e i r . w a i & t s f e l l betwcen

( 4 k g ( b u t ) t o 50kg(bwt).

2nd b'pidemio].ogic:11 S t u d i e s

A t o t a l o f 400 p u p i l s i n t h e f o u r s c h o a l s p r u v i d e d u r i n e * specimens a t t h e i n i t i a l c o l l e c t i o n . T a b l e 1 below s h o ~ s

t h e d i s t r i 5 u t i o n of t h e disease in t h s s c h o a l a s t u d i e d .

TABLE 1: Distribution of ur inary Schistoso~iasis in t h e f o u r rural

Schools studied,

L. C. School --

Nkonu Bnst L.C . A

Enugu S t a t e I Cent. Sch.

i Umun evo ,

Town Sch.

I Ndiaqu -

Ogbor

Amapynze - ---- ---

IshieZu L,G. A I

Ndieze,

Okpo t.0

Comm, Pri Sch

Nu.. Gxaained 1 Nun. i n f e c t e d / $ i n f e d i o n )

T a b l e 1 shows t h a t t h e disease is preva len t in all t h o f o u r achools

s t d i e d . The highest prevalence ra te o f t h e d i s e m e was rocorded i n

C e n t r a l School Umunev~ Am,tgmze (47.M) followed by Town Sah, N d i a g u - Ogbor, b ~ g u n z e ( 3 8 , @ ) , then I ~ i n k p u m ~ P r i . Sch. nldiezo, Okpoto (17.C$)

a n d Community Pri. Sch. T l e p n , Ntezi ( 8 , ~ ~ ) .

Table 2:

Prevalenee Rate of i n f e c t i o n by sex i n t he four schools.

Schools

Schools I---- ?EM ALES

4 .---

I Central School%v.in+vo

Amagunze. 41 24 58.5

---- -. - Town School Ndiagu

Ogbor, Amagunze. 55 25 45.1

Is inlquma P r i . a ry

school Ndieze okpto . j C o r n u n i t 9 Primary

~choo!. Ulepa, lutezi. 55 6 10.9 45 4.4

T o t a l 30.4

--

T a b l e 2 Y ~ O W J ? 3 4 t two of t h i ~ s c h ( ~ o l 3 had i n f e c t i o n m t w hicher i n t h e

f enn le p u p i l s than ifi t h e males. While i n t no u t h c r two a z h o o l s the

i n f e c t i o n r n t e s were hit:her in t h e males than i n t h e females.

Xhen brought t o g e t h e r females had a higher p r e v n l e n z e r a t e t h a n t h e

m n l e , H,:wever t h e d i f f u r c n c c . in premlcnca r r t e betwekn t h e sexes is not

s t a t i s t i c a l l y sigrl if icsnt at S$ l e v e l o f p r p b s b i l i f y , m i n e one way

analysis of variance,

T a b l e 3 shows that there is a higher

in fec t ion among the ( 6 - 9) years age

except Community Primary School Ulepa,

d i e t r i b u t i o n of

group in all the schools

Ntezi. Whme i n f e c t i o n

occurred in t he (6 - 9 ) years and (10 - 13) yzars age group

w i t h eqllal d i s t r i bu t j -on , No i n f e c t i o n was recorded in t h e 1 1 4

yr3 age grorjp in t h i s school.

Thi s d i f r e r e n c e in i n f e c t i o n rate smong t h e age t-roltp3 is

shown not t o be s i g n i f i c a n t statistically a t 55 l e v e l o f

p r o b a b i l i t y using o r e way analysis o f vs r iancc .

To

tal

1 i S

1

infe

ct r

:d

4

I t could be d e d l u c ~ d frua t ab les 4 and 5 t h s t

females have a higher o v e r a l l prevalencs o f i n f e c t i o n

t h a n m s l e s in t h e (6 - 9) J T R r S and (10 - 13) years

age gp w h i l e t h e a 14 years age gmup showed a

h ighe r prevalence of i n f e c t i o n in males than in the

f e n ~ l es,

However this difference is not statistically

s ign i f i can t a t 57! l eve l o f p rubab i l i t y , u s i n z onQ way

analysis of vsr ianze .

! X

( in

fec

ted

( a

w

ll,

b

4

I 2

1 'rota1

1 T

i

u3

cj

--

--

'I

P

I -P

ru

UJ

1 in

fec

ted

LA

\N

U

I i

+

Table 7 shows t h a t even t ha11~~h i n Central Scl-ioiil Umunevo, h s g u n z e ,

a g r e ~ t e r number (55) o f p u p i l s use ',ha buah as t h e i r place of

d e f e a c a t i o n , t h e percenf.'sga r a t e o f i n f e c t i o n is h i ~ h n n t (50%)

a m n e t p u p i l s using p i t t o i l e t . This saae t r e n d was also observed

i n Town School. Ndiagu Orbor, Amagunze, w i t h -12 o f t h o p u p i l s b e i n g

buah usera w h i l e highest prevalence o f i n f e c t i o n of 46.4% occurred

a s o n g s t p i t users.

A t Isinkpuma Primary School Ndieze, Okpoto and Community Primary

School Ulepa, Nteei , h i ~ h e s t number of p u p i l s were found using

l o c a l t o i l e t s being 54 and 77 respectively, while highest

prevalence of i n f e c t i o n of 2% occurred amon~st bush user5 i n

Isinkpuma Primary School Okpoto and t h ~ t o f IT.& was a l s o

observed amongst p i t toilet users i n Comnunity Primary School

Ulepa, Ntez i .

T h i s dirL'9renca in i n f e c t i o n rate when t a s t e d st~tistically was

shown t o b e s i g n i f i c a n t , hence indicating t h a t t h e type of toilet

facility available i n o ~conmpnity a f f e c t t h e rate of infection in

that community,

i 1 I 1

f i

infe

cte

d

GI

-cl

rd

lo.

T a b l e 8 shows t h a t in Arna,ynze Community t h e r e i.s o n l y one

source of domestic water for the use of the cumunity and that

is t h e stream river, hence the s o u r c e o f infection is obvious.

In Isinkp-ma Primory School Okpoto, ou t of t he 100 p u p i l s

interviewed 61 o f them claimed t o get t h e i r water fmm b o r e h o l e ,

28 f r o m a t ream and 11 f r o m t h e ponds. However t h a h i g h e s t

p r e v a l e n c e o f infection of ( 1 9 . e ) 'as recorded aaong

b o r u h l r s use rs . I n Cornuni ty Primary School Ulepa Ntezi , o u t

of the 100 pupi le interviewed, 90 of them c l s i m d t o cet

t h e ~ r water fmm t3e stream, 6 from +,he boret io le a r ~ d 4 fmin

t h e p l l d . i n H L ~ ~ t i ~ ; - / c r pruzcrlee u f i r i f c c t i u n was recordell ortly

snniir:s t Y trem u s c r ~ ~ .

I ' l l ~ l t ? c4:

Uiskribukion o f i n t e n s i t y o f i n f e c t i o n ricco todi?g t o a p group.

Sch. 1 Centr3l School 0muner.0, Amq:unzc (C.S) .

Sch, 2 Town School Ndiagu - Ogbor, hmsgunzs (T.s.)

I 1 Age groups,l! I n t e n s i t y of i n f e c t i o n ( ~ g p / l 9 n l urine)

Nurn I e xac i ned

T o t a l !

Sch. 4: Com-wlity Primary Schoo l Ulepa N t e z i . (c.P)

1 1 Age groups

I Intensity o f i n f e c t i o n (&:~s/l~rnl u r i n e ) 1 I , 1 -I- '--

I ) Mod high !very hi&

100 e g E s 1 100 - 500 eggsj ,500 eggs L,

In centra l school Umunuvo, bagunee Table 9 showed thRt

a great ~r p e rcunt age (116.8) of i n f e c t e d p u p i l s have moderately

h i e h i n f e c t i r , ~ . f r ~ Tawn S-hool Mdiagu - Ogbor, Anngunze and

Is inkpuma P r i n a r y School Ndieze, O'q~oto i n f e c t i o n int~nsity

is predaminsntly l i g h t r i t h aercentagen o f (68.4) arld (73,5)

respect i v e l y . I n Comaunity Primary Schml Illepa Ntc.zi a

g r u ~ t c r p c r c x + . n p c o f i n f c c t e d pupi 1 s (scF') hnve mo-ierately

h i p h i n f e c t i o n ,

Howevar s n ovi?r+.il l ns:;cznrn~nF in the f o u r ::chc)~l ~ h o w u t h ~ t

a [:renter numysr o f i n f e c t e d p u p i l s f c l l w i t h i n t h c

l i y h t i n f c ~ t l o n ran,:?.

4ht h 4mth 129th 12mth

Num. of

S C ~ . 2 73 23 35 3.1 47,4

25 5.4 12.0

Sch. 4 74 , 5.4 i , I 1

T a b l e 10 shows t he inciEence r a t e s a t 4 a d 12 loths post t rea tment rrom

t h e t a b l e it c o u l d b e seen t h a t Torn School Xd iaga - O g h r (sch 2)

had the hiches t i nc idence rate b o t h at 4 mths and 12 mths, followed

by C e n t r a l School Umunevo, Amagunze ( ~ c h 1) then, Isinkpuma Primary

school, Ndieze Okpoto ( s c h 3 ) and l a s t l y Community Primvry School

U l e p a N t e z i .

Table 11.

C u r e Hate a t 4th nun th Post treatment;.

Nurn. p?e;ii.nt I 4 m t h

R e i n f e c t i o n ra te 1 ?th ~ ~ 1 1 t h post- t re .? tacnt .

'Table 11 % 12 snow the curs ra te and r e in fec t ion ra tes

rcspectivelg in t h e f o u r nciiools. A nwnbef of pupils involved

in the initial t reatment were absent at t h e f o u r month

f o l l o w up exercise. However, assessment was based on t i lose

p r e s e n t who were i n i t i r i l l y t rea ted , Community Primary schoo l

Ulepa, N tez i r ecorded t h e hi~hest, cure rate o f 10M fol lowed

by Town School Ndiagu Oibor then, Central school Umnevo and

lastly Isinkpuna Fr inary School Ndieze , Okpo to. The overall

cure r a t e of 0 5 . $ agrees with t h e 72% - 95y cure rates

p r e v i o u s l y documented b:r o t h e r rosrtarckem, ( ~ l k o ~ m i , 1992).

Reinfection r a t e at. 12 month p o s t treatment p e r i o d showed

Community Primary 1Tlep.s Ntezi to have 33.$, Cer~tr,?l Sehaol

Umunevo had 31.8$, Town School Ndiagu - Ogbor had 30,4!

whi l e none o f the treste3 pupils a t Isinkpuma P r i n a r y

School were p r e s e n t t o ba ~ s s e s s e d ,

Cure

n

ra

te

I -

4

or

-'

Num.

V.

-4

I 4 a

ss

es

se

d

o

r Li

! 1 t tr

ea

ted

I

t

Nun

.

J I 1

j p. .

Num

. 'd

as

se

ss

ed

L

! W

I

- a P

.

"1

c

4

m

cu

re

' E3

UI

W

F:

I ;

rate

2 2

-. 13

ul

I c

are

I

I*

I

I '-1

1 rq

tr:

!

rain

fec

tio

n

'TT-I

I o

1 vl

i, tr

ea

ted

i

n

f! CJ 1

-.

I A

I re

inf.

-1 I

m

4

(D

W

I-'.

T a b l e 13 A , B, C, 3 TI shows t h e cl.lre r n t e 2 n d r e i n f e c t i o n r a t e

~ c c o r d i n g t o a@ group an3 sex. Cure ra te Rcross t h e atye groups

were r e l a t i v e l y high ( 7 ) . The d i f f e r e n c e in the cure rate

across the age groups were n o t s t a t i s t i c a l l y significant using

F r t e s t a t 5$ and l e v e l o f p r o b a b i l i t y . Reinfect ion rate

wao below l5$ a c r o s s t h e age groups i n all t h e s c h o o l s w i t h the

exception o f Community Primary School Ulepa - N t e z i where only

one p u p i l was assessdd and was found t o be re infec ted . Here i t could

be said t h a t r e i n f e c t i o n was 10& however t h e sample nz i s so

small that it cannot b e rel iably used f o r asscssrnent,

Between t h e sexes c u r e rate seeaed t o be h i ~ h e r i n t h e

males than t h e Pemale while r e i n f e c t i o n is h ighe r in t h s

famales then the males. However when analyaed statistically and

and tested using F - t e s t the d i f f e rences were s h ~ w n not t o be

s i g n i f i c a n t (P < 0.05) using one-way analysis o f variance.

nI snrssE

O f the f ~ u r primary schools surveyed, two belong t o the Nkanu East

Ls C. A , comunity, While the remaining two belong t o the Iahialu

L. G. A . community, Both L. G, A . ' a are located i n Enugu and Ebonyi

%tat8 respectirely. The establishment of patent 'achistosomiasia i n some

of t h e achool chi?_drsn is an i n d i c a t o r that schistosomiasis is endemic

i n . these communities. Okafor (1984) reported that a vil lage may be

almost frem f r o m infect ion while another within a distance of one to

three kilometers may show very high incidence. This could be due t o

several fact o m however effective transmission takes placee only where

the s u i t a b l e snail host i s found in compact b c d i e s of wator vis i ted

Trequcntly .by the community inhabitants.

Cent r n l School Umunevo , Amagunze recorded the highest prevalence

rate o f 4796 followtd by Town School Ndisgu - Ogbor, Amagunze having

38$, than Isinkpuma Prinary School, Ndieze Okpoto having 17$ l a s t l y

community Primary School Ulepa N t e z i recorded &. This result is

sirniler tc t h a t rccodad 37 Onuigbo & pl (1995). Prevalence in

schools differed s ign i f i cant ly at 5$ level of probability as opposed

t o the study done by ( ~ n e j u l u & al, 1994). Thie difference i n the

prevalences among the schoola could be as a result o f the fact that i n

Amagunze mmrnunity for instance there is no other 8ource o f water except

streams and rivers which are in thenselves infested with Bulinus snails.

The members of the community having no o t h e r source o f drinking water

are forced to dr'ink f r o m t h e streams, b ~ t h and wash i n t h e water,

Unlike the Ntezi and Okpoto community where a l t e r n a t i v e s t o t h e stream

water a r e ava i lab le i n t h e fona of bore hales and pond water. H~wever,.~

desp i t e t h e presence of t h e s e alternatives children i n the v i l lages uaually

lore t o still go t o the streams to s w i m and bathe t h e r e *

More females were shown t o have higher r a t e of i n f e c t i o n t h a n males

i n the four achools sampled although the difference is not a t a t i a t i c a l l y

s ignif icant . This is i n agreement w i t h t h e f ind ings o f Enejulu & al ,

( 1 9 9 5 ) where sex d i d not play a s i g n i f i c a n t r o l e i n prevalence and

intensity' o f infect ion. However, t h i s report is a t variance with t h e findings

of Anya & Okafor (1986) in which ssr played a s i ~ n i f i c a n t role i n

prevnlence of i n f e c t i o n , Also Okpala (19:71) recarded a higher

prevalence o f i n f e c t i o n among t h e males, T h i s difference in i n f e c t i o n

r a t e between the sexes could be a t t r i b u t e d t o the d i f f e r e n c e s i n t h e

domestic r o l e s played by males and females. It could also depend on

t h e area s t u d i e d and the cultural h a b i t s of t h e community ( ~ a r f i e l d , 1986).

D i s t r i b u t i o n o f in fec t ion according t o age groupa revealed t ha t a

h ighe r infection rate occurred among the (6 -9) years age ,qmups in

a l l t h e schools except i n community Primary School Ulepa Ntezi where

infection rate UPS same f o r both (6-9) years and (10-19) years - age

group, When tested s t a t i s f i c a l l y this difference was shown not t o be

s i g n i f i c a n t ,

When sexes are separate, i n t e n s i t y o f i n f e c t i o n peaked a t d i f f e r e n t

age groups i n t h e d i f fe ren t schools . This is at variance with t h e

f i nd ings o f Rmajt~lu ( 1 4 9 ~ ) i n which peak infection occured i n t h e same

age group for a particular sax i n t h e d i f f e r e n t schools , However,

o v e r a l l assessment of t h e schools show t h a t males peaked at the 2 1 4 .

age group while, t h e females peaked at t h e ( 10-13) years age group. T h i s

ag rees with t h e findings o f Anya & Okafor ( 1986) saying t h a t peak

preva lence of infection is different in both sexes , This d i f f e r e n c e i n

age with respect to i n t e n s i t y o f i n f e c t i o n between the sexes could be

a t t r i b u t e d t o t h e degree of exposure t o various t ransmiss ion f o c i .

Egg output generally Roes toge the r with prevalence but v a r i e s w i t h

age. I n t h i a i n v e s t i g a t i o n egg output peaked i n t h e (10-13) yea r s age

group. It has been recorded t h a t peak i n f e c t i o n i n t h e (10-14) years

age bracket is cons ia ten t v i t h observa t ion of S. haematobium, However,

i t d i f f e r s from t h e f i nd ings o f Anya & Okafor (1986) which recorded a

higher age group f o r t h e peak of in fec t ion .

Assessment of t h e ef fec t of the t y p e o f t o i l e t f a c i l i t i e s t o the

prevalence of the i n f e c t i o n uas done. I t was however observed t h a t

buah users showed t h e highest rate o f in fec t ion , followed c l o s e l y by

p i t users t h a n those who use t h e l o c a l t o i l e t s . The d i f f e r e n c e i n

i n f e c t i o n rate v i t h regards t o t h e u s e of d i f f e r e n t types of t o i l e t

f a c i l i t i e s was shown t o be a i g n i f i c a n t s t R t i s t i c a l l y a t 5$ l e v e l o f

p robab i l i t y . P i t t o i l e t being a more hygeinic way of d i s p o s a l of human

waste, ought t o have showed the least rate o f i n f ec t ion . Rowever a

number o f f a c t o r s could ha7re cont r ibu ted t o this discrepancy. One being

t h e f a c t t h a t i n v e s t i g a t i o n s had t o depend on t h e t r u t h f u l n e s s of t h e

p u p i l s i n answering the o r a l ques t ions aeked them, as i t was not possible

under t h e situation t o visit t h e i r homes i n d i v i d u a l l y t o verify.

An overel l assessment of t h e effect o f t h e domestic water source

on t h e d i s t r i b u t i o n o f S . haematobiurn i n f e c t i o n showed t h a t i n

Amagunze corninunity t h e r e i s on ly one sou rce of domestic water supply

the s t reams, hence t h e source o f i n f e c t i o n becomes obvious and t h e

r e l a t i v e l y higher prevalence o f i n f e c t i o n i n t h i s community as compared

t o t h e o t h e r s is hence explained. In Isinkpuma and Okpoto co rnun i t i e s

sources o f domestic watdr are bore holes, streams and ponds. However,

i n Isinkpuma t h e hf~hest prevalence o f i n f e c t i o n o f 19.% was recorded

among borehole users, this could be a t t r i b u t e d t o t h e fact t h a t even though

a larger popula t ion of pup!ls claimed to get their dr ink ing water from bore-

holes, almost a l l , if n o t all o f them wash and ba the i n t h e streams and

t h e s e streams are in fe s t ed .

Ulepa - Ntezi a g r e a t e r proport ion o f t h e populat ion claimed t o

get t h e i r water from t h e stream, consequently, i n f e c t i o n occurred only

mong s t ream mars, f n v a s t i g a t i o n revealed t h a t t hese stream users live

i n t h e area o f the vi l lages where bore holes are not eas i l y accessible. H

Hence, their i n accessibility to bore holes cause them t o depend wholly on

the s t reem f o r their source of domestic water, The difference i n

i n f e c t i o n rate among t h e users of d i f f e r e n t water sources was statistically

s i g n i f i c a n t at l e v e l of probabil i ty , Anya & Okafor ( 1986) i n t h e i r

s tudy o f some v i l l a g e s i n .barnbra S t a t e repor ted that durin.? the dry

season, most i nhab i thn t s of these villages depend on pe renn ia l r i v e r s and

streams f o r the ir water supply. I n t e n s e svrimrning a c t i v i t y was also

observed in these h a b i t a t s a t t h i e time a l so . A quick look at the

incidence of 2. haemetobiun i n f e c t i o n t a b l e i n r e l a t i o n t o sources of

domestic water supply showed that the people using Rivers and stream8 had

t h e h ighes t incidence of 46.40$. However, t h e r e was no s i g n i f i c a n t

d i f f e r e n c e i n i n f e c t i o n r a t e s a s soc i a t ed with source o f wa te r supply

(?>o.o~).

I n t e n s i t y of i n f e c t ion was c l a s sed i n t o l i g h t i n f e c t ion , moderately

high i n f e c t i o n and h igh i n f e c t i o n groups. A cursory l ook a t all t h e

echools revealed t h a t c e n t r a l school Umunevo and cornunity Primary school

Ulepa-Ntez!. had a g r e a t e r ' percentage (46,& and TO$.) r e s p e c t i v e l y o f

t h e i r i n f e c t e d pupi la c l a s sed i n t o t h e moderately high i n f e c t i o n group,

while Town school Ndiagu - O ~ b o r and Isinkpuma Primary School had a

g r e a t e r pdrcen tage o f t h e i r i n f e c t e d pupils c lassed i n t o light infect i o n

group, (68.4 and 70.6%) r e spec t ive ly , However an o v e r a l l assessment

o f a l l t h e f o u r schools brought toge t her reveals t h a t a h i g h e r percentage

of i n f e c t e d pup i l s (53.G) f e l l i n t o t h e l i g h t infection group.

Inc idence r ~ t e increased w i t h time as shown i n t a b l e 10. A t 4 months

pos t t rea tment the inc idence r a t e s recorded i n the sc3ools were 17.s

f o r cmtrril ~cl iot , l U ~ m e v o , Z9.$ f o r Town School Ndiagu- Ogbor, 5.4%

f o r Iainkpuma Primary School Ndieze Okpoto and 3.4% fo r CommunityP

Primary School Ulepa Ntezi. A t 12 month post t reatment a s i g n i f i c a n t

increase was noted as fol lows 32.$ f o r . t h e 1st school 47.4% f o r t h e

second school, t 2 . d f o r t h e 3rd school and 3.474 f o r t h e fou r th school

r e spec t ive ly . Schools 1 and 2 recorded r e l a t i v e l y high inc idence r a t e s

when compared with schools 3 and 4, Thi s could be AS a r e s u l t o f the

f a c t t h a t t h e two schools have a stream each loca t ed w i t h i n a k i h r n e t e r

o f i ts environ, hence children are o f t e n seen swimming t h e r e , a l s o a

higher p r e v a l e n c e r a t e was recorded o r g i n a l l y for both schools . Again

t h e r e is no primary h e a l t h c e n t r e w i t h i n t h e environment o f t h e s e school

hence the children could not have received t reatment from them aga ins t

i n f e c t ion.

P raz iquan te l i n t h e newest and most e f f e c t i v e drug f o r t r e a t i n g

sch is tosomias is . It ie e f f e c t i v e o r a l l y i n a single dose against a l l

species o f schistosomes i n f e c t i n g man w i t h 7@ t o 9% cure r a t e s

( ~ l k o u n i , 1992). T h i e drug was used f o r treatment; i n t h i s s tudy. A

40mK/bwt regimen was administered t o a l l p u p i l s who t e s t e d p o s i t i v e t o

S. haemetobium eggs i n their urine. Assessment of a f o u r month a cure - rate of treated p u p i l s i n t h e f o u r schools studied was 80% f o r cen t rn l

- . School Umsmevo, 88.841, f o r Town School Ndiagu- Ogbor, 85.H f o r

lainkpuma Primary School Ndieze Okpoto and 10M f o r community Primary

School Ulepa Ntezi. These p e r c e n t a ~ e s a g r s e s with t h e cure rate

recorded by El-kouni, (1492) i n d i c a t i n g tha t praz iquante l is effect ive

i n reducing morbidi ty due t o 3. h~ernatobium i n f e c t i o n ,

Gryseels & (19~11) recorded a low cure r a t e f o r children.

However this investigaticn could not confirm o r d i sag ree w i t h that report

because the age d i s t r i b u t i o n o f o u r sample s i z e is l imi t ed .

Across t h e ages cure r a t e s have beer, recorded wi th t h e ( 314) yea r s

age- group r e c o r d i n g the highest cure rate o f lo@. The (6-9) year8

age group fohlovs nit h 85.45 cure rats then, ( 10-13) years having 80.&.

Howwver cure r a t e is no t affected by age hence the difference between

the age groups are not s i g n i f i c a n t s t a t i s t i c n l l y at !$ l e v e l o f

p r o b a b i l i t y .

6 1

I n v e s t i g a t i o n i n t h i s study reveal t h n t m l e s have 2 liigFLer cur2 rate

than females with 81.1% and 53.4% respect ive ly . However, when t e s t e d

t tat is tic ally a t 5$ level a f p r o b a b i l i t y , t he d i f f e r e n c e between the sexes

was shown not t o be s i g n i f i c a n t .

Reinfection i n a l l the ~ Q h o o l s was s l i g h t high w i t h an o v e r a l l rate o f

31 .%. The o n l y s c h o o l that recorded no reinfection was Isinkpuma Primary

s c h o o l Ndieze - Okpoto where a g r e a t e r number of pup i l s indicated t h a t the ir

w a t e r 'source is bore hole (61 o u t o f 100 pupi l s ) .

The d i f f e r e n c e i n r e i n f e c t i o n rate across the age group and between

the sexes is not s ign i f ican t s t a t i s t i c a l l y hence i t could be concluded that

age and s e x do not p l a y any r o l e i n t h e reinfection ra te o f 2 haematobium

i n f e c t i o n i n t h e s e schools. This conclusion however does not agree with

the f i n d i n g s of Oryseels (1991) and o t h e r n w h o rapor ted t h a t

re infect ion is related t o age, e s p e c i a l l y i n t h e 0- 9 and 10 - 19 year old

age gmup30

One of the probable reasons for this level o f r z i n f e c t i o n among t h e

p u p i l s 12 montha post t r e a t m e n t is t h e f a c t t h t these children though

nwore to some certain extent t h a t t h e streams are i n f o s t e d have no choice

but t o go there f o r water c o l l e c t i o n , ba th ing o r l a u n d r y purposes. Some

are, b o n e out of i m o r a n c e o f t h e t ransmiss ion p a t t e r n of 5. haematobium . O t b e r s sra as a resultr of the f a c t t h a t t h e y e n j o y swimming and doing some

o t h e r things t h a t b r i n g them i n c o n t a c t with the water.

Summary and Conclusion.

The f i nd ings o f t h i s s tudy showed t h a t t reatment with praz iquan te l

is very effective in the reduct ion o f morbidi ty due t o ~ lch is tosorn ias i s .

A very hiah cure rate was observed wi th an average o f about ~ . 6 $ i n

a l l t h e schools. sampled. A follow up s t u d y carried out 4 and 12 months

a f t e r t reatment showed t i a t r e i n f e c t i o n is p o ~ ~ i b l e as soon as 4 months

a f t e r t reatment hence a more c l o s e l y spaced r e t reatment schedule and

c l o s e r monitoring a r e needed t o control schis tosomias is effectively i n

these communitites, Drug t r ea t aen t a lone is not sufficient f o r e f f e c t i v e

con t ro l . I t m u s t be aided by provis ion of safe water supply,

- and P u b l i c H e a l t h Education o f t h e masses.

The idea o f yearly mass t reatment of i n fec t ed i n d i w i d u a l s w i t h i n a

community i s not an e f f e c t i v e way of control as r e i n f e c t i o n i a very fast,

especially i n communities where people have no a l t e r n a t i v e sou rce of

water s u p p l y kc the local streams,

Government should embark on an i n t e n s i v e control programme where not

only chemotherapy ia invblved, but all t h e o t h e r con t ro l measures end

r e t r ea tme~ t achedriloa planned in such n way t h a t tho time l apse between

one t r e s t a c n t schedule and t h e next is not e n o u ~ h t o allow r e i n f e c t i o n t o

s e t i n , A monitoring o r e v a l u a t i n g body made up mainly o f v i l l a g e r s and

v i l l a g e health personnels should be i n s t i t u t e d t o i d e n t i f y cases o f

r e i n f e c t i o n early enough. T h i s will make f o r s u s t a i n a b l e con t ro l and will

in turn reauce the overall cost of maintaining e f f e c t i v e cont ro l .

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Table 2 AXOVA TABLE

f I I 1 I P. t a b

f Source d.f S?S M.S I ~ c a l 55 1%

I I

F csl < F t ~ b

90 we accept n u l l hypothesis

'There is no s i i l i f i c a n t ; d i f r'erunces Setween t h e sexes.

F cal. > F tab.

Hence we r e j s c t null hypot h e s i o

There is a s ign i f ican t d i f f e r e n c e in i n f e c t i o n ra te among

t h e d i f f e r e n t types o f t o i l e t w e r z ,

i ,360' (0,3578)

0.7012 (two t a i l e d t e s t )

P c a l ' > F t a b

- I I 1

Hence we r e j e c t n u l l hypothes is

,?hare is a s i g n i f i c a n t d i f f e r e n c e i n i n f e c t i o n r a t e

I source d.f 1 S . S bl , S

i 2 1.146 1 0.575

I

j E r r o r I

398 18.634 0.197 I

among t h e users o f d i f f e r e n t

F, t a b 1

-7 . ca1

2.91 2.90 4.60

1

- -. --

F - L S D . = I S D q 2

= (0.05, 398

1 i 1 i !

To ttii 1' I

water sources.

5 (ty2. E r r o r d . f , ) s?f

= 1,960 (0.3624)

= 007103 ( t w o t n i l e d t a s t )

I i @,I33 0 - ? 7 9 0,302

n . :: 0.302 i 0 . i 6 9 ~ ' ~ 0.123 0. 0o

I

F - E D Cs1. c P. L 3 D t a b hence t h e mean

differences are no t 3tati::ticill i y ~ i ~ : l i i f i i : r ~ i ; t ,