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Trop. Med. Infect. Dis. 2017, 2(4), 58; https://doi.org/10.3390/tropicalmed2040058

Schistosoma mansoni-Associated Morbidity among Preschool-Aged Children along the Shores of Lake Victoria in Uganda

1
Child Health and Development Centre, College of Health Sciences, Makerere University, P.O. Box 6717 Kampala, Uganda
2
Disease Control and Prevention, School of Public Health, Makerere University, P.O. Box 7062 Kampala, Uganda
3
Neglected Tropical Diseases, Vector Control Division, Ministry of Health, P.O. Box 1661 Kampala, Uganda
4
Parasitology and Aquatic Pathobiology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-1870 Frederiksberg C, Denmark
*
Author to whom correspondence should be addressed.
Received: 22 September 2017 / Revised: 27 October 2017 / Accepted: 30 October 2017 / Published: 5 November 2017
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Abstract

Schistosoma mansoni causes morbidity in human beings, with the highest prevalence in rural sub-Saharan Africa. Prolonged S. mansoni infection with egg deposition in intestinal blood vessels leads to liver and spleen enlargement, and thus chronic morbidity. The objective of this study was to assess whether preschool-aged children develop severe S. mansoni-related morbidity. Parasitological, clinical, and ultrasonographic examinations were carried out in 916 preschool-aged children in five schistosomiasis-endemic districts (Bugiri, Buikwe, Jinja, Mayuge, and Namayingo) along the Lake Victoria shoreline in east-central Uganda. Anaemia and anthropometry measurements were also taken. Using the Kato-Katz technique on one stool sample collected on three consecutive days, 74.9% (686/916) were found infected with S. mansoni; the majority were lightly infected (57.9%), while 22.7% and 19.4% were moderately and heavily infected, respectively. The overall geometric mean intensity (GMI) of infected children was 294.2 eggs per gram faeces. Mayuge and Jinja districts had the highest (51.2%) and lowest (2.2%) number of infected children, respectively. Hookworm infection was found in 7.8% (71/916) of the children. Both liver and spleen were significantly more enlarged in the infected children than in the uninfected children (p < 0.0005), as measured by ultrasonography. Physical palpation of the spleen was more often detected in the uninfected children. A significantly (p < 0.0005) higher proportion of S. mansoni-positive children were anaemic (359/686; 52.3%) compared to the children who had no eggs in their stool samples (81/230; 35.2%). Schistosoma mansoni infection did not have any severe effect on the nutrition status of preschool-aged children. Neither infected nor uninfected children were found to be underweight or stunted. Liver fibrosis with distinct Symmer’s ‘pipe stems’ was found in a few heavily-infected children (0.3%). In a linear multivariable regression analysis, age of the child, anaemia, liver fibrosis, and size of the left liver lobe were associated with S. mansoni intensity of infection (adjusted R2 = 0.11; p < 0.0005). Our results demonstrate that S. mansoni-related morbidity does develop in children less than six years of age, and that older children (37–60 months) are at higher risk (regression coefficient 0.33; p <0.0005) compared to younger ones (12–36 months). We recommend that preschool-aged children be included in the target population for schistosomiasis mass treatment so as to prevent the childhood chronic form of schistosomiasis. View Full-Text
Keywords: Schistosoma mansoni; morbidity; preschool-aged children; Lake Victoria shoreline; Uganda Schistosoma mansoni; morbidity; preschool-aged children; Lake Victoria shoreline; Uganda
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Nalugwa, A.; Nuwaha, F.; Tukahebwa, E.M.; Olsen, A. Schistosoma mansoni-Associated Morbidity among Preschool-Aged Children along the Shores of Lake Victoria in Uganda. Trop. Med. Infect. Dis. 2017, 2, 58.

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