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African Journal of Biomedical Research
Ibadan Biomedical Communications Group
ISSN: 1119-5096
Vol. 6, Num. 2, 2003, pp. 69-72
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African Journal of Biomedical Research, Vol. 6, No. 2, May, 2003, pp. 69-72
SCHISTOSOMA HAEMATOBIUM : PREVALENCE AND SOCIO-ECONOMIC
FACTORS AMONG STUDENTS IN CAPE COAST GHANA .
OKANLA E.O *, AGBA B.N. AND AWOTUNDE J.O
Department of Biological Sciences, University of Ilorin , Ilorin Nigeria
Code Number: md03013
ABSTRACT
Prevalence of Schistosoma haematobium infections was assessed among 160
students of Twohofo Holy International School , Cape
Coast , Ghana . Overall prevalence was 34.4%, with males
and females having prevalence of 32.3% and 35.8% respectively. Age group
6-8 years had 30% while 24.2% were infected in age group 9-11 years. Prevalence
was 48% in age group 12-14 years and 50% in age group 15-17 years. Parental
occupation had effect on prevalence with children of self employed parents
showing significantly higher prevalence than children of salaried employees
of government and private companies. Knowledge of the disease was very low
among the subjects.
Keywords: Schistosoma haematobium, prevalence, Cape coast, Ghana ,
students
INTRODUCTION
Schistosomiasis is a disease caused by blood flukes of the family Shistosomatidae.
They infect different vertebrates, but three of them in particular cause disease
in man. These are Schistosoma mansoni , S. Japonicum and S.
haemaiobium (Adams and Maegraith, 1976). The first two are found in the
veins of the large intestine and small intestine respectively while haematobium
is found in the veins of the bladder. Among other places, S. haematobium is
found widespread in Africa . Many factors influence the epidemiology of schistosomiasis.
Edungbola (1980) reported the relationship between water utilization and schistosomiasis,
while Okanla (1991), reported that parental occupation may be a factor in contracting
schistosomiasis.
Surveillance for schistosomiasis is very important in establishing endemicity
and in the planning of control operations. Many areas of the world are yet
unsampled while some have been sampled without making definite data available
on the socio-economic factors that have influence on prevalence in such localities.
This study was designed to look at a number of parameters including socio-economic
contributors to the prevalence of S. haematobium infections among the
students of Twohofo Holy International School in Cape Coast , Ghana .
MATERIALS AND METHODS
Study area:
Akotokyir is in the Cape Coast district of the Central Region, Ghana . It
is located between latitude 5°30' N and longitude 10 15' and 10 13' W of
the Greenwich Meridian. It lies 2.2 km from University of Cape Coast. The vegetation
is mainly Savannah . The Kakum river flows through the area. This attracts
ctivities such as bathing, swimming, laundry and other activities. Information
obtained from the Regional Health office indicated that urinary schistosomiasis
is prevalent in the area, but useful data were not available.
Pre-sampling formalities
A total of 160 pupils comprising 68 males and 92 females were involved in
the study. They included students in Basic Ito Basic 6 (i.e. Primary Ito Primary
6) of the Basic Educational System as it is known in Ghana . Weeks before sampling
started, a letter was sent to the Head teacher of the School to give him an
idea of what the study was about and to seek his cooperation. Students were
given letters of consent to be signed by their parents as only those who obtained
parental consent were included in the study. On the day before the sampling
further notification was made to the Head teacher.
On the day of sampling, the Head teacher had got the students ready and a
brief explanation was made to the students to let them know what schistosomiasis
is and to instruct them on how to obtain the samples correctly.
Collection of samples.
All samples were collected between 12.00 noon and 2.00 p.m. (Mahmoud, 1987).
Urine samples were collected in graduated plastic bottles, Subjects were told
to empty their bladder completely into the bottle and put on the lid tight.
As the students arrived one by one each was given a serial number. This was
immediately pasted on the corresponding sample also.
Collection of other data.
The weight in kilograms and height in centimetres was obtained for each subject.
Information on age, parental occupation and residence history (i.e. whether
subject lived in Akotokyir or elsewhere) were also obtained. Further information
was obtained on whether subjects had any knowledge of the disease, and on the
subject's history of water contact.
Examination of urine samples for eggs of S. haematobium
The method of Okanla (1991) was used. All samples were taken to the laboratory
immediately and the total volume of urine passed by each subject was recorded
Samples were allowed to settle for 30 mins. The urine in each sample was drawn
off with an aspirator leaving the last 10 ml. In the bottle. The content of
each bottle was shaken to suspend the sediment and was emptied into a 20 ml.
centriftige tube. The serial number for each sample was carefully transferred
so as not to get the samples mixed up. The tubes were centrifuged at 1000 rpm
for 5 mm. The top 9 ml. was aspirated off. The sediment was re-suspended in
the remaining 1 ml. A Pasteur pipette, which was calibrated to discharge 1
ml. in 20 drops, was used to release I drop of the sample unto a microscope
slide. A cover slip was placed on it and all haematobium eggs present were
counted under the 10x objective of a light microscope. The number of eggs counted
in 1 drop was multiplied by 20 to obtain the number in 1 ml., which is also
the total eggs passed in the total volume of urine originally obtained. The
number in 10 ml. of urine was then calculated. This is important for determination
of epidemiological implications.
RESULTS
A total of 160 subjects (68 males and 92 females) were examined S. haematobium was
found in males and females alike A total of 22 males and 33 females were positive.
This gave prevalence of 32.3% for the males and 35.8% for the females. Overall
prevalence was 34.4% (Table 1).
Prevalence by age showed increase in S. haematobium infection with
age except in age group 9-11 years which showed a decrease (Table 2).
Table 1. Prevalence of urinary schistosomiasis among pupils of Twohofo
Holy International School .
CLASS |
|
MALES |
|
FEMALES |
TOTAL |
|
Number Examined |
Number (%)
Infected |
Number
Examined |
Number (%)
Infected |
Total No
Examined |
Total No (%)
Infected |
BASIC 1 |
12 |
7(58.3)* |
19 |
5 (26.3)* |
31 |
12 (38.7)** |
BASIC 2 |
11 |
3(27.2)* |
17 |
10 (58.8)* |
28 |
13 (46.4)** |
BASIC 3 |
12 |
1(8.3)* |
10 |
2(20.0)* |
22 |
3(13.6)** |
BASIC 4 |
16 |
4(25.O)* |
16 |
3(18.7)* |
32 |
7(21.8)** |
BASIC 5 |
12 |
3(25.0)* |
17 |
7(41.2)* |
29 |
10(34.4)** |
BASIC 6 |
5 |
4(80.0)* |
13 |
6(46.1)* |
18 |
10(55.5)** |
TOTAL |
68 |
22 |
92 |
33(35.8)* |
160 |
55(34,4)** |
* Percentage of students that were infected; ** Total percentage of infected
students.
Table 2. Prevalence of S. haematobium infection by age.
Age Group (Yrs) |
Total
Examined |
Number
Infected |
%
Infected |
6-8 |
40 |
12 |
30.0 |
9-11 |
62 |
15 |
24.2 |
12-14 |
56 |
27 |
48.2 |
15-17 |
2 |
1 |
50.0 |
TOTAL |
160 |
55 |
34.4 |
Table 3: Prevalence of S. haematobium infection by paternal
occupation
|
*Blue/White Collar
|
Other Jobs
|
Total
|
NO EXAMINED |
89
|
71
|
160
|
MALES
INFECTED |
45 |
35 |
80
|
5(11.1%) |
17(48.6%) |
22 |
FEMALES
INFECTED |
44 |
36 |
80
|
15 (34.0%) |
18 (50.0%) |
33
|
TOTAL
INFECTED |
20(22.4%)
|
35(49.3%)
|
55(34.4% |
*Upper class/Lower class salaried employees of Government and the private
sector.
Table 4: Prevalence of S. haematobium infection by maternal
occupation
|
*Blue/White Collar
|
Other Jobs
|
Total
|
NO EXAMINED |
82
|
78
|
160
|
MALES
INFECTED |
32 |
36 |
68
|
7 (21.8%) |
15(41.7%) |
22 |
FEMALES
INFECTED |
50 |
42 |
92
|
15 (34.0%) |
18 (50.0%) |
33
|
TOTAL
INFECTED |
20(24.3%)
|
35(44.8%)
|
55(34.4% |
*Upper class/Lower class salaried employees of Government and the private
sector.
Age group 6-8 years had a prevalence of 30.0%, while age group 9-11 years
had 24.2%. Age group 12-14 years had 48.2%. Only 2 subjects were sampled in
age group 15-17 tears. One of them was infected giving a prevalence of 50.0%.
Prevalence by paternal occupation is presented in table 3. Among those whose
fathers have white collar/blue collar jobs, 11.1% of the males and 34.0% of
the females were infected while in the other jobs group 48.6% of the males
and 50.0% of the females were infected. Also, prevalence by maternal occupation
has 21.8% of the males and 26.0% of the females infected in the white collar/blue
collar group while 41.7% of the males and 47.6% of the females were infected
in the other jobs group (Table 4)
Table 5 shows prevalence by residency. Among the 146 subjects who lived in
the study area, 51 (were infected while only 4 out of 14 subjects who lived
outside of the study area Akotokyir were infected. About 66% of those who were
infected had egg output of 50 eggs or more/10mI. of urine. One female had an
output of 180 eggs/10ml. of urine.
The relationship between water contact habits of males and females to prevalence
showed that among male students 41.2% engaged in swimming activities whereas
only 29.3% of females were involved. Also 36.7% of the males and 32.6% of the
females actually bathed in the Kakum river. Other activities in the water like
washing of dishes and clothes attracted 22.0% and 3 8.0% of males and females
respectively.
Knowledge of the disease was very little, with about 61.2% having no idea
of what causes the disease, while 12.5% thought that it was caused by contact
with a body of water. Some 15.6% believed that it was caused by drinking of
dirty water.
There was no relationship between prevalence and weight to height ratio. Also
there was no relationship between sex and prevalence. Relationships however
existed between the paternal occupational groups and between the maternal occupational
groups using the Chi square test.
For paternal occupational groups,
Calculated χ2 = 12.595
Tabulated χ2 =
3.841
For maternal occupational groups,
Calculated χ2 7.429
Tabulated χ2 = 3.841
Thus we accept alternative hypotheses in both cases.
DISCUSSION
Before the onset of this study information was obtained from the Regional
Health Office that S. haematobium was prevalent in this area, but recent
published data were not available to cover the information obtained in this
study. This study has indicated a prevalence of 34,4% among the students of
Twohofo Holy International School . This is high. Parental occupation has influence
on prevalence, with children of salaried workers exhibiting less prevalence
than children of those who do other jobs. This observation agrees with the
results obtained by Okanla (1991 ), in Ilorin , Nigeria . The relationship
between schistosomiasis and occupation has long been known (Edungbola, 1980;
Fenwick and Jorgensen, 1972). Also contact with water for recreational or other
activities has also been associated with infections with schistosomes. (Fernwick
and Jorgensen, 1972).
This study utilized the centrifugal sedimentation method to finally determine
the number of eggs in 10 ml. of urine (Okanla 1991). This method is very sensitive
since it utilizes the total urine passed by the subject.. It is however not
as fast as the membrane filtration technique which uses a nylon mesh to filter
a sample of 10 ml. drawn from the total urine passed by each subject. The membrane
method is therefore more frequently used for epidemiological purposes. This
study was intended to look at overall prevalence as well as determine the epidemiological
significance of the disease. The sedimentation method was therefore preferred.
Single urine samples only were examined in this study, although multiple examinations
may reveal slightly higher prevalence. Two thirds of the infected subjects
passed more than 50 eggs per 10 ml. of urine, which is considered to be epidemiologically
significant. One girl passed 180 eggs/10ml urine. This was very high. S.
haematobium infections may cause discomfort, but rarely lead to death.
However, when intensity of infection is so high mortality may eventually result
(Mahmoud, 1987). Significant difference did not exist in the nutritional status
of infected and uninfected subjects. This agreed with the findings of others
(Hiatt et al, 1977; Lehman et at. 1976; Hiatt 1976; Cook et a!. 1974; Okanla
1991). This study also showed that most of the subjects had no idea of the
cause of the disease. Good education is therefore needed in order to increase
the general awareness of people in the community.
ACKNOWLEDGEMENT:
This study was supported by Students Project
Funds of the Faculty of Science, University of Cape
Coast .
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