Helminthiasis and malaria co-infection among women of reproductive age in a rural setting of Kilifi County, coastal Kenya: A mixed method study.

Soil transmitted helminthiasis (STH), Schistosoma haematobium and malaria co-infection lead to increased susceptibility to other infections and poor pregnancy outcomes among women of reproductive age (WRA). This study sought to establish risk factors, burden of co-infection with STH, S. haematobium and Plasmodium sp. among WRA in Kilifi County, Kenya.A mixed method cross-sectional study was conducted on 474 WRA in 2021. Simple random sampling was used to select WRA from four villages in two purposively sampled sub-counties. Study participants were interviewed, and stool samples collected and analysed using Kato-Katz technique for STH. Urine samples were collected for examination of S. haematobium while malaria microscopic test was done using finger prick blood samples. Further, 15 focus group discussions (FGDs) were conducted with purposively selected WRA and qualitative data analyzed thematically using Nvivo software. Quantitative and qualitative methods were triangulated to comprehensively strengthen the study findings. Prevalence of S. haematobium was 22.3% (95%CI: 13.5-36.9), any STH 5.2% (95%CI: 1.9-14.3) and malaria 8.3% (95%: 3.8-18.2). Co-infections between any STH and S. haematobium was 0.8% (95%CI: 0.2-3.2) and between S. haematobium and malaria 0.8% (95%CI: 0.2-3.1). Multivariable analysis showed increased odds of any STH infections among participants in Rabai Sub-County, (aOR = 9.74; p = 0.026), businesswomen (aOR = 5.25; p<0.001), housewives (aOR = 2.78; p = 0.003), and casual laborers (aOR = 27.03; p<0.001). Qualitative analysis showed that the three parasitic diseases were common and responsible for possible causes of low birth weight, susceptibility to other infections and complications such as infertility and cancer later in life.The study demonstrated that STH, S. haematobium and malaria are still a public health problem to WRA. Some of the associated risks of infection were geographical location, socio-economic and WASH factors. Hence the need to implement integrated control efforts of the three parasitic infection.

Safety, efficacy and acceptability of praziquantel in the treatment of Schistosoma haematobium in pre-school children of Kwale County, Kenya.

BACKGROUND: The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school children (PSC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSC in Early Childhood Development Education (ECDE) Centers are only eligible for treatment with albendazole (ABZ) but not with PZQ. METHODOLOGY/PRINCIPAL FINDINGS: 400 PSC were enrolled, from 10 randomly selected ECDE Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with orange juice, at a single dose of 40 mg/kg. Adverse events were assessed 24 hours post-treatment through questionnaires administered to the parents or guardians. Acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment. Efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group's geometric mean egg counts per 10 ml of urine) following treatment expressed as a proportion of the pre-treatment infection intensity. Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4-24.2%). Of these, 41 had infections of heavy intensity (51.3%) while the rest (48.7%) were of light intensity. Five weeks post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5-4.9%). Infection intensities decreased significantly from 45.9 (95% CI: 31.0-68.0) eggs/ 10 ml urine to1.4 (95% CI: 1.1-1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. There were no severe adverse events during follow up 24 hours post treatment. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study. CONCLUSION/SIGNIFICANCE: The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. It is therefore recommended that PZQ should be administered to the PSC in Kwale County.

Schistosoma haematobium infection is associated with increased urine foam.

We compared urine microscopy and dipstick results for urine foam from 59 children in a Schistosoma haematobium-endemic area in a blinded manner. The sensitivity and specificity, respectively, for diagnosing S. haematobium compared with microscopy was: 74% and 72% for the shake test; 61% and 97% for microscopic hematuria; and 43% and 83% for proteinuria. When >17 eggs/10 mL urine was detected on microscopy, the sensitivity and specificity, respectively, were: 100% and 72% for the shake test; 90% and 97% for microscopic hematuria; and 80% and 83% for proteinuria. Urine foam height >34 mL was significantly more likely to have S. haematobium eggs detected on microscopy (P = 0.001) than urine foam ≤34 mL, indicating that S. haematobium-infected urine is associated with increased urine foam.

Evaluation of a novel rapid diagnostic test for Schistosoma haematobium based on the detection of human immunoglobulins bound to filtered Schistosoma haematobium eggs.

OBJECTIVES: To determine whether the detection of human IgG bound to Schistosoma haematobium eggs from filtered urine could be used as a rapid diagnostic test (RDT-Sh). METHODS: We filtered 160 urine samples from children in the Kwale District of Kenya to isolate S. haematobium eggs and used anti-human IgG antibody conjugated to horseradish peroxidase to bind to the human IgG attached to the eggs. We then added 3,3'5,5'-tetramethylbenzidine base (TMB), which turns blue in the presence of horseradish peroxidase to detect the S. haematobium eggs. The RDT-Sh was compared in a blinded manner to urine microscopy. RESULTS: The RDT-Sh was positive in 89% of urine samples containing >1 egg/10 ml (58/65 samples) and 97% of urine samples containing >11 eggs/10 ml urine (35/36 samples) seen by microscopy. The RDT-Sh was negative 79% of the time when no eggs were seen on urine microscopy, but because up to three times more urine was used for the RDT-Sh, there were likely cases in which eggs were on the RDT-Sh filter but not detected by microscopy. We used latent class analysis incorporating urine microscopy, haematuria, proteinuria and RDT-Sh results to determine an overall 97% sensitivity and 78% specificity for RDT-Sh, 96% and 81% for urine microscopy, 71% and 98% for microscopic haematuria and 46% and 89% for proteinuria, respectively. CONCLUSIONS: The RDT-Sh is quick, inexpensive and easy to perform in the field for the diagnosis of S. haematobium.

Urinary soluble egg antigen levels in Schistosoma haematobium infection in relation to sex and age of Kenyan schoolchildren following praziquantel treatment.

Schistosoma haematobium soluble egg antigen (SEA) secreted in urine can be assayed to determine egg tissue load and hence morbidity in infected individuals. A cohort of 158 infected children aged 4-18 years was followed-up for 33 days pre and post treatment with a single dose of praziquantel. There was a significant difference in the prevalence of S. haematobium between males and females (P < 0.05). There were also significant differences in egg counts between age group < or = 5 years compared with 6-8 years, 9-11 years and 12-14 years, and age group > or = 15 years compared with 6-8 years, 9-11 years and 12-14 years (P < 0.05). Comparison of SEA among age groups indicated a significant difference between age group < or = 5 years compared with 9-11 years, 12-14 years and > or = 15 years, and age group > or = 15 years compared with 9-11 years and 12-14 years (P < 0.05). There was a statistically significant correlation between levels of SEA and egg output (r2=0.961, P=0.010). These results are useful in the development of a SEA-based dipstick assay for field diagnosis of urinary schistosomiasis.