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Ewemen Journal of Epidemiology & Clinical Medicine ISSN: 2488-9180

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Full Length Research

PREVALENCE OF URINARY SCHISTOSOMIASIS AMONG PRIMARY SCHOOL PUPILS IN KOFA PRIMARY SCHOOL, TAFA LOCAL GOVERNMENT, NIGER STATE, NIGERIA

*NAFIU S., INUWA B., ABDULLAHI A., ALKALI Z. and IBRAHIM B.A.

Department of Science Laboratory Technology, Kano State Polytechnic, Kano Nigeria

ABSTRACT

Received 10 March, 2016 Revised on the 12 March, 2016 Accepted 15 March, 2016 *Corresponding Author’s Email:

nafiushafiu@ymail.com

Urinary Schistosomiasis is endemic in Nigeria and is considered as one of the public health problem affecting inhabitants especially in rural areas. This study examines the prevalence of Schistosoma haematobium among pupils in Kofa primary school, Tafa local government area Niger State. Urine samples were randomly collected (December, 2015- February, 2016) from 180 pupils 6-14 years of age in the study area. The samples were examined microscopically using string sedimentation techniques and chemical reagent strip for haematuria detection. Of the 180 urine samples examined, 15.6% were recorded as the overall prevalence rate of infection among the pupils. Infections in Males was 22.9% compared to 9.3 % in females, but statistically there was no significant difference (p=0.05).The infection rate was higher among 12-14 years of age group (28 %) followed by 9-11years (12.5%) and the least was among 6-8 years (8.6%), but the differences were not statistically significant. The infection rate was higher among students whose normal sources of drinking water was stream (31.7%), followed by those whose source of drinking water was well (10.8%) and the least infection was observed among those whose source was tap water (7.1%). There was also no significant difference between pupils who were positive for S. haematobium microscopically (10.3%) and those tested using chemical strip method (6.2%). There was heavy and very heavy infection of (19.3%) and (4.8%) among males compared to females with (9.3%) and 0(0.0%) respectively. From the findings of this study, it is recommended that regular monitoring and public health interventions be undertaken if the scourge is to be eradicated in endemic areas like Tafa. Keywords: Disease prevalence, Schistosomiasis, Schistosoma haematobium, School pupils, Tafa, Niger State, Nigeria.

INTRODUCTION

Schistosomiasis also known as (biharziasis or snail fever) is a chronic and enervating illness caused by digenetic Trematode flatworms (flukes) of the genus Schistosoma (Noble and Glem, 1982). It is one of the most common parasitic infections in the world (Gracio

et al., 1992; Abubakar et al., 2006), ranking second to only malaria in terms of its socio-economic and public health importance in tropical and subtropical areas (Ogbe, 2002). It is also the most prevalent of the waterborne diseases and one of the greatest risks to

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health in rural areas of developing countries (Ogbe, 2002; Ofoezie et al., 1996). An analysis, based on African studies, showed that there is a risk ratio of 2.4 and 2.6 for urinary schistosomiasis (caused by S. hematobium) and intestinal schistosomiasis (caused by S. mansoni), respectively, among persons living adjacent to reservoirs. The analyses also showed that persons living near land that had been irrigated for agricultural use had an estimated risk ratio of 1.1 for urinary schistosomiasis and an estimated risk ratio of 4.7 for intestinal schistosomiasis (Steinmann et al., 2006).

Infection occurs through contact with water infested with the free swimming larval stages of parasitic worms (cercariae) that penetrate the skin and develop in the human body to maturity. Parasite eggs leave the human body with urine or excreta. They hatch in freshwater and infect the appropriate aquatic snail intermediate hosts. Bulinus snails are intermediate host for S. haematobium (Ukoli, 1984). Within the snails they develop into cercariae, which are, in turn, released into the water to infect new human hosts. Transmission can take place in almost any type of habitat from large lakes or rivers to small seasonal ponds or streams (WHO, 2001; Kanwai et al., 2011). In urinary Schistosomiasis, the worms live in the blood vessels of the bladder. Only about a half of the eggs are excreted in the urine. The rest stay in the body, damaging other vital organs. It is the eggs and not the worm itself which cause damage to the intestines, the bladder and other organs (Banerjee and Agrawal, 1992). Most human infections are caused by S. mansoni, S. haematobium, or S. japanicum. Schistosomiasis appears to be a neglected tropical disease, but owing to irrigation programs and hydroelectric power development, the incidence of infections is increasing in endemic areas of Africa and the near east, and the risk of infection is highest amongst those who lived near lakes or rivers (Khamis and Rollinson 2008; Kabatercine et al., 2004 ). More than 207 million people are infected worldwide, with 75% of them living in Africa alone (WHO, 2011). Recent estimates from sub-Saharan Africa have indicated that approximately 280,000 deaths each year can be attributed to schistosomiasis (Van der Werfet et al., 2003). In Nigeria, S. haematobium infection is widespread, constituting a public health problem particularly in children (Sulyman et al., 2009; Fana et al., 2009; Akinboye et al., 2011). Although there is no current estimate of the disease in the country, past estimates

have put the infection at about 25 million people, and 101 million at risk of infection (Chitsulo et al., 2000). The distribution of the disease is focal, aggregated and usually related to water resources and development schemes such as irrigation projects, rice/fish farming and dams. It occurs in all the states of the federation, with a high infection rate among school children (Mafe et al., 2000; Okpala et al., 2004; Ladan et al., 2011). This study was designed to determine the prevalence of urinary schistosomiasis in pupils of Kofa Primary School, Tafa Local Government Area of Niger State, Nigeria, since school children are often the major risk groups for the transmission of the infection. It is our hope that findings from this study will inform control managers on the status of the infection in the study area and serve as an epidemiological marker for future studies in the area. MATERIALS AND METHODS

Materials

All reagents used were of analytical grade. Dry and disinfectant- free sample containers were purchased from Sallymore (Nig.) Limited Kano, reagent strips - combi-9 (Medi-Test Macherey-Nagel, Germany), were obtained from Shugaba scientific supply, Kano State, Nigeria. The Centrifuge (Centromix) were of Huddersfield England, and light microscope used was Olympus, Japan. Study area

This study was carried out in Kofa Primary School, in Tafa local government area of Niger State, Nigeria extending an area between latitude 9°15’ N and Longitude 7°15’ E (Figure 1). The area has two distinct seasons; Dry and rainy seasons. The dry season begins from late October to May with a spell of harmattan period from November to January and sometimes to early February while the rainy season often commences in May to September and in some case to early October. Most of the inhabitants of the area indulge in farming activities, trading, rearing of animals and civil service. The pupils play vital role in the socio-economic activity of the area especially during their holidays.

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Figure 1: Map of the study area showing the sampling point

Ethical Considerations

Consent for this study was obtained from Tafa Local Government Education Authority, village heads and the headmaster of the school before commencement of the study. The anonymity of each pupil was treated with high level of confidentiality for the purpose of this research. Sample Size calculation

The sample size (n) was estimated using the single population proportion formula as described by Otuneme et al. (2014). Sample Collection

A questionnaire was administered randomly to pupils to obtain vital demographic data which include: sex, age, source of drinking water supply and name of their school. One hundred and eighty (180) urine samples were collected from the pupils in a clean, wide mouth, screw capped, transparent, dry and disinfectant- free containers between December, 2015 and February, 2016. The pupils were guided on how to collect the urine to ensure the first and the last few drops were included. Collection was done between the hours of 10am - 1pm following a short physical exercise to potentiate maximum egg yield (Udonsi, 1990; Mu’azu, 2008; WHO, 1980; Cheesbrough, 1998). The samples were transported to laboratory for investigation not later than two hours after collection as described by Harrisons et al., (1987).

Analyses of samples for Schitosomiasis

Microscopic method (Sedimentation technique)

Urine samples were examined to detect the presence of egg using string sedimentation technique as described by (Cheesbrough, 2002). Each urine sample was thoroughly shaken and 10 mL was decanted into a test-tube and centrifuged at 3000 rpm for 5 min and the supernatant was discarded leaving the sediments. A drop of the sediment was placed on a clean microscope slide and stained using Lugol’s iodine and left for 15 seconds for the stain to penetrate the eggs and viewed under microscope at low power (x10 and x40). Ova of S. heamatobium were identified by the possession of terminal spine. The number of eggs were counted and recorded as eggs/10mL of urine (Cheesbrough, 2002). Reagent strip method For haematuria examination, chemical reagent strip method as described by Cheesbrough (2002) was employed. Reagent strip combi-9 (Medi-Test Macherey-Nagel, Germany) was dipped into each urine sample and the colour was matched with the standard colour by the side of the container as recommended by the manufacturer. Statistical Analysis The data obtained in this study was statistically analysed using the chi-square test at p = 0.05. RESULTS AND DISCUSSION

The demography of the samples pupils are as depicted in Table 1. Table 1: Distribution of sample population in relation to age group and sex

Age group (in years)

Number of male

Number of female

Total number

6 – 8 26 32 58 9 – 11 29 43 72 12 – 14 28 22 50 Total 83 97 180

Results obtained in this study showed that of the 180 samples collected from the pupils in Kofa primary School (83 males and 97 females), 28 were found to contain eggs of Schistosoma haematobium while the remaining 152 were uninfected giving a total prevalence of rate of 15.6% (Table 2) which is an indication that schitosomiasis is endemic in the

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community. The prevalence rate obtained in this study was lower compared to the findings of Imam et al. (2012) who recorded 20.4% of S. haematobium infections in Bauchi Metropolis; Damen et al. (2006) recorded 19.0% among students in a local Government Area of Kaduna State; Sulyman et al. (2009), 71.3% in school aged children in Ogun State, Ondo State, Niger State and Borno State; Duwa et al. (2009), 52.5 % in primary school pupils in Minjibir local Government Kano State; Agere et al. (2010), reported 28.8% in Jalingo and Ardokolo Taraba State; Sarkinfada et al. (2009), 41.6% in Danjarima Kano State and Oniya and Olofintiye (2009) 43.69% in Ondo State. Table 2: Prevalence of Schistosoma haematobium infection among pupils in relation to age group

Age group (in years)

Number of examine

Number of positive

Number negative

Prevalence (%)

6 – 8 58 5 53 8.6 9 – 11 72 9 63 12.5 12 – 14 50 14 36 28 Total 189 28 152 15.6 X2 = 8.53, Df = 2, P< 0.05

However, the prevalence rate (Table 2) obtained in this study was higher than the findings of Okoli et al. (2015), who recorded 5.5% among community primary school pupils in Amagunze, Enugu State; Bigwan et al. (2012), 6.0% in Potiskum, Yobe State; Okpala et al. (2004) reported 0.67% and Goselle et al. (2000) recorded 4.6% in Jos. The prevalence of the disease in many rural areas were attributed to ignorance, poor living condition, inadequate sanitation, water supply, personal and environmental hygiene as well as water contact activity with snail infected rivers, stream, and ponds (WHO, 2003). Table 2 also shows the prevalence of S. heamatobium in relation to age groups. The result revealed that there was an increased in prevalence with increase in age. Age group 6-8 years had the lowest rate (8.6%) followed by 9-11 years with 12.5% and 12-14 years age group recorded the highest prevalence with 28.0%, though statistically there was no significant difference at p = 0.05. This conforms with the findings of Agere et al. (2010) and Biu et al. (2009) who reported that as age increases the infection rate increases by showing a significant difference between age and the prevalence of the infection. Table 3 to 5 illustrates sex specific prevalence and it be can deduced from there that the percentage prevalence was not statistically significant among males (22.9%) than females (9.3%). This could be due to frequent water contact by the males, who often engage in

swimming, fishing and washing, than the females (Joachin et al., 2015). This in agreement with the findings of Sarkinfada et al. (2009) who observed a significantly higher prevalence rate of infection with S. haematobium among males than among females. Table 3: Prevalence of Schistosoma haematobium infection among the pupils according to sex Sex Number

examined Number positive

Number negative

Prevalence (%)

Male 83 19 64 22.9 Female 97 9 88 9.3 Total 180 28 152 15.6 X2 = 6.31 DF = 1 p = 0.05

Table 4: Prevalence of S. haematobium infection among male pupils in relation to age group

Age group (in years)

Number examined

Number positive

Number negative

% infected

6 – 8 26 2 24 7.7 9 – 11 29 6 23 20.6 12 – 14 28 13 15 46.4 Total 83 21 62 25.3 X2 =11.20, DF = 2, p = 0.05

Table 5: Prevalence of S. haematobium infection among female pupils in relation to age group

Age group

Number examined

Number position

Number negative

% infected

6 – 8 32 2 30 6.2 9 – 11 43 5 38 11.6 12 – 14 22 8 14 36.4 Total 97 15 82 15.5 X2 = 9.9, DF = 2, p = 0.05

Table 6: Prevalence of S. haematobium in relation to sources of water supply Source Number

examined Number positive

Prevalence %

Dam/Stream 92 19 31.7 Well 94 8 7.18 Tape water 14 1 7.1 Total 180 28 15.6 X2 = 3.84, DF = 2, p = 0.05

The infection was higher (31.7%) among pupils whose usual source of drinking water is Dam/stream, followed by those whose source of drinking water is well (10.8%) and the least recorded was (7.1%) whose source of drinking water is tap water, although statistically, there was no significant difference at p = 0.05 (Table 6). This was in agreement with the findings of Damen et al. (2006). This may be attributed to the fact that the snail intermediate hosts thrive more in ponds, streams or slow flowing rivers as such those

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using such water bodies for drinking, domestic purposes, fishing, swimming and farming are more at risk of exposure to the infection. Male pupils within the age group of 6-8 years had a higher prevalence (7.7%) of S. haematobium infection than their female counterparts (6.2%) within the same age group (Table 4 and 5). This could be due to frequent water contact by the males than the females in which they often engage in swimming, fishing and washing than females (Joachin et al., 2015). Table 7: Level of infectivity in relation to the sex of the pupil in Kofa primary school

Intensity of infection

Males n (%) Females n (%)

Light infection 63 (75.9) 8 (90.7) Heavy infection 16 (19.3) 9 (9.3) Very healthy infection

4 (4.8) 0 (0%)

Total 83 (100%) 97 (100%) Key: Result given in number of pupils and (%), X2 = 8.86, DF = 2, p = 0.05 Light infection = (1 – 49 eggs per 10 mL of urine), Heavy infection = (50 – 499 eggs per 10 mL of urine), Very heavy infection ≥ 500 eggs per 10 mL of urine (WHO, 1991).

Table 8: Prevalence of haematuria in relation to age group among the pupils

Age group Number examined

Number positive

Haematuria status (%)

6 – 8 58 5 2 (40%) 9 – 11 72 9 4 (44%) 12 – 14 50 14 9 (64.2%) Total 180 28 15 (53.5%) X2 = 0.402, DF = 2, p = 0.05

The intensity of infection recorded in this study showed that females had 90.7% light infection (1-49 eggs per 10 mL of urine) while male recorded heavy infection and very heavy infection of 50-499 eggs per 10 mL of urine and ≥500 eggs per 10 mL of urine, respectively. However, there was significant difference at p = 0.05 (Table 7). The high intensity recorded in males exceeds the WHO threshold value of 50 eggs per 10 mL of urine for heavy infection and so calls for some form of intervention such as the school based treatment with a single dose of praziquantel (Duwa et al., 2009). A high intensity of infection implies repeated exposure to infection (Betterton et al., 1988). This is in agreement with the findings of Macgarvey et al. (1996), and WHO (2003 and 2011). Out of the 180 urine samples examined 53.5% tested positive for haematuria. Higher prevalence of haematuria 64.2% was recorded among pupils within the age group of 12-14 years followed by 9-11years 44.6% with the least 40% among pupils within 6-8 years of age (Table 8).

Thus, higher prevalence of haematuria appears to be associated with the age differences between the older pupils and the younger ones, although statistically there was no significant difference. Table 9 shows the sex related distribution of visible haematuria which was found to be well pronounced in males (10.3%) than in females (6.2%) even though there was no significant difference, which shows a close association between haematuria and the presence of S. haematobium and results indicated that those who tested positive to urinary schistosomiasis were at greater risk of haematuria. Table 9: Sex related distribution of visible haematuria among those with Schistosoma haematobium infection in Kofa Primary School.

Sex Number examined

Number positive

Number negative

% positive cases

Male 83 9 74 10.3 Female 97 6 91 6.2 Total 180 15 165 16.5 X2 = 1.27, DF = 2, p = 0.05

CONCLUSION

Despite concurrent researches on the epidemiology of Schistosomiasis, it appears to be one of the neglected tropical diseases. The present research found a high prevalence of Schistosomiasis in the study area. Infection was common among sexes but different with age and water contact activity. It is therefore recommended that integration of complementary intervention strategies by Government and non-governmental organizations should be conducted in the study area and the country at large. The inhabitants of Kofa village should be educated on the effect of urinary schistosomiasis and other related diseases in order to achieve successful control interventions. ACKNOWLEDGMENT

The authors are highly grateful to Muhammed S. Kallamu, the chief technologist, Model National Primary Health care, Gauraka, Tafa Local Government area, village heads and head master of the school for their kind permission and support during this research. CONFLICT OF INTEREST

The authors declared that they have no conflict of interest

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Article’s citation:

Nafiu S, Inuwa B, Abdullahi A, Alkali Z and Ibrahim BA (2016). Prevalence of urinary schistosomiasis among primary school pupils in Kofa primary school, Tafa Local Government, Niger state, Nigeria. Ew J Epidemiol & Clin Med 1(1): 7-13.