C Uneke, M Egede
nutritional status of school children, schistosoma haematobium, urinary schistosomiasis
C Uneke, M Egede. Impact Of Urinary Schistosomiasis On Nutritional Status Of School Children In South-Eastern Nigeria. The Internet Journal of Health. 2008 Volume 9 Number 1.
Urinary schistosomiasis caused by
Urinary schistosomiasis caused by
Urinary schistosomiasis affect 66 million children throughout 76 countries and in some villages in Africa, over 90% of the children are infected by the diseases . Nigeria is one of the countries known to be highly endemic for urinary schistosomiasis with estimated 101.28 million persons at risk and 25.83 million people infected . Studies in Nigeria among school aged children in various parts of the country and in both rural and urban environments have shown that
The negative influence of infection on child growth in developing countries has been extensively documented . While under-nutrition has been cited as the common cause for such growth patterns, the influence of infections including urinary schistosomiasis are also considerable . Infection with hookworm and
The purpose of this study therefore is to assess the impact of
Materials and Methods
Study Area and population
This study was conducted from April 2007 to February 2008 in Ezza-North local government area (LGA) of Ebonyi State, south-eastern Nigeria. The climate is tropical and the vegetation characteristic is predominantly the rain forest with an average annual rainfall of about 1600mm and average atmospheric temperature of 30oC. There are two distinct seasons, the wet and the dry season. The former takes place between April and October, while the latter occurs from November to March. The study took place in selected primary schools in the rural communities of the LGA. The schools were Community Primary School CPS Ugalaba, and Community Primary School CPS Achiagu. The major sources of water supply in these communities are rivers, streams and ponds. Systematic schistosomicidal treatment had never been applied in the LGA. Primary school pupil were selected for this study because: (i) schools are accessible without much difficulties, (ii) the peak of prevalence of schistosomiasis is to be found in this group  and (iii) experience shows that there is general good compliance from children and parents .
This study protocol was approved by the Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine Ebonyi State University. The study was also approved by the Ezza-North Local Government Council Authorities, the Local Government Health Departments and the Parent-Teachers Association (PTA) of each of the schools used for the studied. Informed consent was obtained from each of the pupils before inclusion in the study. All work was performed according to the international guidelines for human experimentation in biomedical research .
About 20ml of clean-catch, midstream urine samples were collected in 50ml capacity autoclaved wide mouthed, leak, proof universal containers by subjects themselves, who were previously carefully instructed with illustration aids. Samples were obtained between 10:00hrs and 14:00hrs . Samples with visible haematuria were noted. The specimens were appropriately labeled with identification numbers and placed in a cold box with ice packs, immediately after collection. They were processed 1-2hrs of collection. In situations where delay in transportation of specimens to laboratory was inevitable, ordinary household bleach was added to the urine samples (ratio; 1ml bleach: 50ml urine) to preserve any schistosome ova present .
Assessment of nutritional status via anthropometric parameters
Anthropometric measurements were conducted for body weight, height and mid-upper arm circumferences. Body weight was measured with minimum clothing to the nearest 100g with minimum clothing (only T-shirts and shorts) and using battery-operated digital scales (SECA, manufactured for UNICEF). For height, the child stood erect against a stadiometer affixed to a wall for measurement to the nearest 0.1 cm. Mid-upper arm circumference (MUAC) was measured with a flexible tape and recorded to 0.1 cm.
The urine sedimentation technique described previously  was used to detect the presence of S. haematobium ova in the urine samples and to determine the intensity of the infection in each case. Intensity was reported as the number of ova/10ml of urine and was categorized as light (≤ 50 ova/10ml of urine) and heavy (≥50 ova/10ml of urine). A few drops of saponin solution were added to samples with visible haematuria to enhance clarity in microscopy .
Differences in proportion were evaluated using the Chi-square test. Statistical significance was achieved it P < 0.05.
Of the total of 403 school children who participated in the study, 320(79.4%) were infected with
The result of the association between
The findings of this study indicate that the prevalence of
The public health significant of this cannot be over stated as it is has been established that the chronic character and steady increase in morbidity in infected individuals in such endemic areas result in diminished working capacity and prolonged suffering, hence disability looms if treatment with anti-schistosomal drug, such as praziquantel, cannot be provided and more so early on when the pathology is still reversible . Extreme poverty, the unawareness of the risks, the inadequacy or total lack of public health facilities plus the unsanitary conditions in which millions of people lead their daily lives especially in the rural areas of developing tropical countries are all factors contributing to the risk of infection . These are perhaps the major reasons why urinary schistosomiasis remains endemic and a matter of public health concern in many parts of developing tropical countries including Nigeria .
The male children were significantly more infected with
In this study a clear relationship was established between
In this study, despite the occurrence of a very high prevalence rate of
Although the role of other factors in the development of the poor nutritional status in the affected children in this study may not be completely overruled, it is however obvious that
Regular school-based deworming programmes and health education can cost-effectively reverse and prevent much of the morbidity associated with urinary schistosomiasis in children. Furthermore, schools offer a readily available, extensive, and sustained infrastructure with a skilled workforce that is in close contact with the community. With support from the local health system, teachers can deliver the drugs safely and teachers need only a few hours of training to understand the rationale for deworming and to learn how to give out the pills and keep a record of their distribution . The importance of information and education for children and the role of school and teachers in disease prevention is easily demonstrated by diverse examples of successful strategies that reflect the progressive drop in prevalence and incidence of certain health problems, verified through longitudinal analyses.
Authors are grateful to the Parents-Teachers Association of all the primary schools used in this study for logistical support.
C.J. Uneke Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, P.M.B 053 Abakaliki, Nigeria, Telephone: 234-08038928597, e-mail: firstname.lastname@example.org