Ultrasonographical findings in the urogenital organs in women and men infected with Schistosoma haematobium in northern Madagascar.

Ultrasonography (US) was applied in this community-based study in northern Madagascar to compare urogenital findings in Schistosoma haematobium-positive individuals (105 women and 116 men) from the high-endemic Sirama village, with urinary egg negative controls (100 women and 108 men) from the neighboring low-endemic Mataipako village. In addition to examination of the urinary tract, the female genitals were examined by transvaginal US, whereas the male genitals were examined by transrectal and transscrotal US. Pathology of the urinary tract was significantly more prevalent among women and men in Sirama. There were no differences in female genital tract between the two study populations, whereas significantly higher proportions of men in Sirama were detected with hyperechogenic and calcified lesions in the seminal vesicles and the prostate. Moreover, the mean size of the seminal vesicles was significantly larger in Sirama. There were no differences with respect to the external male genitals. Six months after anti-schistosome treatment, no changes were observed in the female genital tract in Sirama, whereas hyperechogenicity of the prostate and the seminal vesicles, in addition to size of the seminal vesicles, declined significantly. This study has provided new insight into genital pathology in S. haematobium-infected men and women. However, the clinical significance of these findings needs further exploration.

Postnatal challenge infections of congenitally Schistosoma japonicum-infected piglets.

The aim of the present study was to assess the effect of a congenital Schistosoma japonicum infection on the establishment, fecundity, and pathogenicity of a postnatal challenge infection. Five prenatally S. japonicum-infected piglets received a challenge infection (prenatal + challenge group), 5 prenatally infected piglets were followed without challenge (prenatal group), and 10 piglets, born by unexposed sows, served as challenge controls (challenge control group). Challenge infections were given 8 wk after the piglets were born (14 wk after the primary infection of the sows), and the study lasted another 11 wk. Variables included worm burden, tissue egg count, and liver pathology. Worm establishment and tissue egg count were comparable in the prenatal + challenge group and in the challenge control group, both exceeding at a statistically significant level those in the prenatal group. No difference in worm fecundity (eggs/female worms/g tissue) was seen between the 3 groups. Liver pathology (i.e., portal and septal fibrosis) was more severe in the challenge control group compared to the other groups. A congenital S. japonicum infection in piglets thus affected neither establishment nor fecundity of a postnatal challenge infection. In spite of this, the challenge infection gave rise to much less liver pathology than the similarly sized challenge control infection.

The pig as a host for Schistosoma mekongi in Laos.

A survey of helminths in domestic pigs was conducted in Khong District, Laos, to elucidate if these domestic animals could act as definitive hosts for Schistosoma mekongi and to obtain a general overview of their helminthological infection status. Fecal samples were collected from 98 pigs. Twelve pigs (12.2%) were found to excrete S. mekongi eggs. Infection was confirmed by detection of S. mekongi eggs in tissues of liver, rectum, and cecum of 2 pigs. A total of 75.8% of the pigs was infected with 1 or more helminth species. This study showed that pigs may act as a definitive host for S. mekongi.

The impact of a school health programme on the prevalence and morbidity of urinary schistosomiasis in Mwera Division, Pangani District, Tanzania.

The prevalence of urinary schistosomiasis among schoolchildren in Pangani District (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was adopted. Eleven primary schools in Mwera Division, Pangani District, with about 2500 schoolchildren were included in a control programme for urinary schistosomiasis. Macro- and microscopic haematuria diagnosed visually and with urine reagent strips was used as an indirect indicator of Schistosoma haematobium infection. Intensity of infection among children was monitored in class 5 (median age 14 years, range 11-17) by urine filtration techniques. Treatment was administered as 40 mg/kg praziquantel in a single dose at the beginning of the school year. The programme was implemented by schoolteachers and coordinated by the District Health Management Team in collaboration with the District Education Office. Teachers were responsible for carrying out all programme activities. Community participation was through collaboration with Teachers-Parents Associations and Village Health Committees. Coverage at yearly (1995-99) examination varied from 67.7% to 80.3%. Prevalence of haematuria decreased from 51.2% (range 22.2-89.5%) at baseline to 23.4% (range 5.8-56.7%) in 1999, a reduction of 54.3%. Macrohaematuria was 21.2% at baseline and 7.2% in 1999, a reduction of 66.0%. Prevalence of infection in class 5 was reduced by 71.4% and geometric mean intensity of positives reduced from 71 eggs/10 mL (95% confidence interval [CI] 52.5-97.7) to 28 eggs/10 mL (95% CI 25.7-55.0), a reduction of 60.6%. Teachers were highly committed, and secured community participation and a smooth implementation of the programme. The community accepted the introduction of a cost-recovery system, whereby parents pay for the treatment of children with episodes of visible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools.

Schistosoma japonicum infection in the pig as a model for human schistosomiasis japonica.

Valuable information on human schistosomiasis japonica has been provided using primates and experimental rodent hosts. However, major drawbacks such as high costs and ethical concerns for the primate models and large biological deviations for the rodent models have led to the search for more appropriate models. Recent data on the pig indicate that this natural host for Schistosoma japonicum might be a realistic alternative. As only very few research groups have investigated the S. japonicum/pig model, the present review mainly deals with the experimental methods and the major host/parasite findings obtained from the authors own research group. With emphasis on a critical evaluation of the work, the results are compared to the scarce information existing on human schistosomiasis japonica. Like in humans, S. japonicum establishes mainly in the large intestinal veins, with high faecal egg counts during the acute phase of infection, which varies greatly within and between days. Concomitant resistance is another shared feature, but studies in pigs have indicated that the phenomenon is more complex than generally thought. Clinical signs as eosinophilia and diarrhoea with mucus and blood in the acute phase of infection and hepatomegaly, increased portal diameter, periportal fibrosis and ascites in chronic infections are common findings in both humans and pigs. Low protein diet aggravates the disease in pigs by increasing the establishment rates, the faecal egg excretion and the morbidity. A 100% cure rate is achieved when treating S. japonicum infected pigs with praziquantel at 40 mg/kg, and 4 weeks post treatment pigs remain resistant to reinfection. Lastly, human congenital S. japonicum infection has been confirmed in pigs but the implications of such infections for the pathogenesis of schistosomiasis japonica remain to be investigated.

Schistosoma japonicum: day to day variation in excretion and hatchability of parasite eggs in the domestic pig, Suis suis.

The aim of the present study was to describe the course of an Schistosoma japonicum infection in individual pigs over time, with special regards to fecal egg counts and egg hatchability, emphasizing the extent of variation during and between days. Five specific pathogen free Danish Landrace/Yorkshire/Duroc crossbred male pigs were each given 3500 cercariae intramuscularly. From day 36 to 62 post infection, fecal samples were collected from each pig, morning and evening. Pigs were perfused 62 days post infection. Actual fecal egg counts, miracidial counts, and worm burdens were determined. The trend of fecal egg excretion was adequately described with a third order polynomial and logarithmic link function. Miracidial counts were related directly to morning fecal egg counts through a simple linear function. The study revealed a fairly similar overall pattern of egg excretion for all pigs, showing an increase in egg excretion until week 8, followed by a marked reduction to almost zero. In general, large fluctuations around this trend were seen for all pigs, as revealed in variations in egg counts within the same day as well as between days. However, as revealed by the estimated model lines, these fluctuations are due to random variation in egg density in stools rather than being caused by biologically determined cycles. An exact time for both first occurrence of eggs in feces (days 35-38 post infection) and for peak egg counts (days 44-48 post infection) was predicted for each individual pig. Furthermore, the model revealed that miracidial counts can be related directly to the expected fecal egg counts of the same day through a parameter, which represents hatchability. This hatchability parameter was found to be independent of time post infection for each pig, but large individual differences were seen in hatchability between the pigs.

Quantitative assessment of eosinophiluria in Schistosoma haematobium infections: a new marker of infection and bladder morbidity.

Eosinophiluria, as quantified by measuring eosinophil cationic protein (ECP) in urinary extracts, microhematuria, egg excretion, and ultrasound-detectable bladder pathology were recorded in Schistosoma haematobium-infected Tanzanian school children at a baseline survey and during an 18-month post-treatment follow-up study. Significant correlations were seen between urinary ECP levels, intensity of infection, and bladder pathology. Treatment resulted in a marked reduction in prevalence and intensity of infection, in a delayed and less marked reduction in ECP levels, and in a resolution of pathology. The overall diagnostic efficiency of the ECP test (cut-off value for the ECP > or =5 ng/ml) in relation to infection was comparable with that of egg count and microhematuria, but with a better sensitivity than a single egg count. In relation to bladder pathology, the diagnostic performance of the ECP test (cut-off value for the ECP > or =25 ng/ml) exceeded that of a single egg count. In addition, the ECP was better in discriminating between different grades of bladder pathology. The present study points to the ECP as a useful marker of both S. haematobium infection and of associated bladder morbidity reflecting the inflammatory status of the bladder wall.

Morbidity assessment in urinary schistosomiasis infection through ultrasonography and measurement of eosinophil cationic protein (ECP) in urine.

In a Schistosoma haematobium-endemic village in western Madagascar we evaluated ultrasonography and Eosinophil Cationic Protein (ECP) in urine as means to detect the associated urinary tract pathology. 192 individuals were matched according to age and sex, and grouped into infected persons with bladder and, if present, kidney pathology (n = 96); infected persons without pathology (n = 48) and noninfected persons without pathology (n = 48). The median urinary egg count was significantly higher in individuals with ultrasonographically detectable urinary tract pathology (115 eggs/10 ml urine) than in infected persons without (45 eggs/10 ml of urine). At 136 ng/ml, the median ECP level was significantly higher in the 144 infected individuals than in the 48 noninfected persons (0.35 ng/ml). Egg excretion correlated positively with ECP level. The median ECP level was significantly higher in the group with ultrasonographically detectable urinary tract pathology than in the group without (183 ng/ml vs. 67 ng/ml). The results suggest that minor degrees of pathology, particularly at an early stage of infection with S. haematobium, might be overlooked by ultrasonography despite the presence of marked inflammation, as indicated by markedly increased urinary ECP levels in infected individuals without ultrasonographically detectable urinary tract pathology. ECP may therefore provide important information on the evolution of S. haematobium-associated urinary tract morbidity.

Peroral infection of pigs with Schistosoma japonicum cercariae.

Infections with the zoonotic trematode, Schistosoma japonicum in pigs serves as a valuable model for studying natural definitive host/parasite relationships and a model for human schistosomosis japonica. In the present study the efficiency of a peroral infection route was compared with that of an intramuscular route of infection. Eleven specific pathogen-free Danish Landrace/Yorkshire/Duroc crossbred male and female pigs were divided into two groups of five and six pigs, respectively. Each pig was given 1000 cercariae, either placed in droplets on the mucosa in the buccal cavity, or as medium-suspended cercariae injected into musculus biceps femoris of one of the hindlegs. Ten weeks post infection, all pigs were killed with pentobarbital and the venous system perfused. Worm burdens and liver egg counts were determined and worm fecundity was calculated. S. japonicum infections were established in all individuals in both groups of pigs. When comparing the two groups, the peroral group had significantly higher number of immature worms, whereas the intramuscularly infected group had significantly more worm nodules. However, no difference was seen in total number of worms. No statistical significant differences were found in neither tissue egg counts nor worm fecundity when comparing the two groups. The results from the present study showed a delay in maturation of infection following a peroral infection as compared with an intramuscular infection, but comparability was seen between overall worm establishment and egg production.

Congenital transmission of Schistosoma japonicum in pigs.

Congenital transmission of Schistosoma japonicum in pigs was investigated by experimentally infecting sows at four weeks gestation (n = 3), 10 weeks gestation (n = 3), or a few weeks prior to insemination (n = 2). None of the piglets born to sows infected prior to insemination or in early pregnancy were found to be infected. However, all of the piglets (n = 26) born to sows infected at 10 weeks gestation were found to harbor schistosomes with S. japonicum eggs recovered from both their feces and livers. The findings show that congenital S. japonicum infection of pigs can occur if sows are infected during mid-to-late pregnancy and may have important implications not only for pigs but also for other mammalian hosts of schistosomes, including humans.

Schistosoma japonicum in the pig: a new technique for estimation of intestinal tissue egg counts.

This study introduced a new method for estimating intestinal tissue Schistosoma japonicum egg counts, based on scraping of the mucosal layer of different sections of the intestines. Twenty-eight Danish Landrace/Yorkshire/Duroc crossbred pigs were divided into 3 groups of 15, 5 and 8 pigs, respectively. Pigs were fed either a high- or low- protein diet and were infected by an intra-muscular or per-oral route of infection with doses of either 1,000, 1,500 or 3,000 S. japonicum cercariae. The pigs were killed 9-11 weeks post infection. For all 28 pigs the intestines were divided into 3 sections: cecum, colon and rectum and the entire mucosa was scraped off the serosa of each section and homogenized. Subsequently, samples corresponding to 5 g homogenised mucosal tissue were digested and egg counts were determined and correlated to liver egg counts. In order to compare the relative distribution of eggs in the mucosa and the serosa, small intestinal wall subsamples formerly taken from each section from a subgroup of 5 pigs were homogenized and egg counts determined for both the mucosa and serosa. The number of eggs were significantly higher in the mucosa than in the serosa. Egg counts estimated from digestion of mucosa subsamples either over or underestimated egg counts based on scrapings of the entire mucosa when compared, reflecting the very patchy distribution of S. japonicum eggs in the intestinal wall. Correlating liver egg counts with the number of eggs based on scrapings from the entire mucosa from cecum, colon and rectum, respectively, significant correlations were found for 2 out of 3 groups of pigs. The present study revealed that estimating intestinal tissue egg counts based on scrapings of the entire mucosa is a reliable and convenient approach, nicely supporting the liver tissue digestion approach. In addition, a reduction of the processing time of intestinal tissue in general was achieved due to the very simple scraping technique.

Water contact patterns and behavioural knowledge of schistosomiasis in south-west Nigeria.

Human water contact patterns were studied in two resettlement communities at the Oyan Reservoir in south-west Nigeria in all four seasons in 1991 and 1992. Water contact was most intensive in the afternoon and in the hot dry season, but different types of activities exhibited different daily and seasonal patterns. Both communities were highly endemic for urinary schistosomiasis. However, knowledge regarding schistosomiasis transmission was very limited and the infection was, in spite of a very high frequency of blood in the urine, not considered a major public health problem. Most water contacts were of either a recreational (swimming, bathing) or economic (fishing) nature, and age- and sex-related patterns were evident. The overall level of exposure peaked in the 10-14 years age group but water contact of an economic nature peaked in the 20-39 years age group. Females had generally more water contact than males.

PIP: The establishment of the Oyan Reservoir in southwestern Nigeria in 1984 resulted in the relocation of people from 22 villages to Obaro and Abule-titun, on the bank of the reservoir. These 2 new villages, however, were not provided with adequate basic health care, water, and sanitation facilities. Conditions favorable for snail breeding, an influx of people from other areas, the location of the resettlement villages on the reservoir bank, intensive water contact, and an overall low environmental health status resulted in the introduction of urinary schistosomiasis. By 1988, the disease had reached epidemic proportion. Findings are presented from a study of human water contact patterns in Obaro and Abule-titun in all 4 seasons of 1991 and 1992. Water contact was most intensive during the afternoon and in the hot, dry season. However, different types of activities exhibited different daily and seasonal patterns, and both communities were highly endemic for urinary schistosomiasis. Knowledge regarding schistosomiasis transmission was very limited and infection was not considered to be a major public health problem. Most water contacts occurred either for recreational or economic ends, and age- and sex-related patterns were evident. The overall level of exposure was highest among people aged 10-14 years, although water contact for economic reasons was highest among people 20-39 years old. Females generally had more contact with water than did men.

Schistosoma japonicum in the pig: the host-parasite relationship as influenced by the intensity and duration of experimental infection.

Parasitologic, clinicopathologic, and pathologic aspects of Schistosoma japonicum infections of varying durations and intensities were studied in growing pigs injected intramuscularly with a dose of either 0, 100, 500, or 2,000 cercariae and killed at 4, 11, 17, or 24 weeks postinfection (PI). The number of viable worm pairs decreased significantly in the high dose group after 11 weeks PI but not in the lower dose groups; however, a stable population of immature worms persisted throughout the study in all dose groups. Liver egg counts also tended to decrease in the high dose group after 11 weeks but not in the other groups. Fecal egg excretion began at six weeks PI, was highest at eight weeks PI with a pronounced peak occurring only in the high dose group, and then decreased to low levels by 14 weeks PI in all groups. Egg counts from the feces as well as the liver correlated strongly with worm pair numbers during the acute phase of infection. The only clinicopathologic abnormality observed was an increase in circulating eosinophils corresponding to cercarial dose in all infected pigs by week six with peak counts occurring between six and eight weeks PI. The pigs exhibited no clinical signs of disease aside from diarrhea at the onset of patency. However, lesions were present throughout the large intestine of all infected pigs from 11 weeks PI, gradually decreasing with time. Severe liver fibrosis occurred in the 500 and 2,000 dose groups mainly at 11 weeks PI and then decreased in severity. In the liver, but not in the intestine, the severity of lesions at all time points was proportional to the cercarial dose given. The results indicate that after several weeks of patency, pigs with high intensities of S. japonicum infection are able to effectively eliminate the majority of adult worms while maintaining a stable population of immature schistosomes.

The use of a stereological method to estimate the volume of Schistosoma mansoni granulomas: the effect of zinc deficiency.

A quantitative, stereological method to assess the volume of Schistosoma mansoni granulomas is presented and its use demonstrated in a study of zinc-deficient animals. Twenty-six mice were divided into two groups, and given zinc-deficient or control food. After 4 weeks, the mean weight gain and thymus size were lower in the mice on the zinc-deficient diet. Eight mice in each group were then each infected with 60 S. mansoni cercariae and these mice were killed 12 weeks post-infection. There were then more eggs in the livers of the zinc-deficient mice than in those of the infected controls (7400/female worm v. 3300/female worm; P = 0.02), probably because of impaired intestinal egg expulsion and impaired resorption of eggs in the deficient mice. The median proportion of each liver occupied by granulomas was 0.11 among the zinc-deficient mice and 0.09 among the pair-fed, control mice (P = 0.08), and the median liver volumes were 1400 and 1450 microliters (P = 0.49), respectively. The computed median volume of all the granulomas in each liver was 160 microliters in zinc-deficient and 132 microliters in control mice (P = 0.32), while median granuloma volume per egg was 8.6 and 8.7 nl (P = 0.93), respectively. In contrast to conventional methods, modern stereological methods can provide estimates of granuloma volume or granuloma volume fractions without any assumptions about the size, shape, orientation or distribution of the granulomas in the liver.

In vivo labeling of Schistosoma japonicum cercariae with 35S.

A technique was developed for in vivo labeling of adult Schistosoma japonicum worms using 35S bound to methionine and cysteine. The isotope was applied in an in vivo labeling system in which Oncomelania hupensis snails harboring a patent S. japonicum were individually exposed to the label. Following exposure to cercariae, mice were perfused after 6 wk. For autoradiography and fluorography, the worms were mounted on cardboard, covered with x-ray films, and exposed for 5 wk. With both techniques, images of both male and female worms were obtained in the 1- and 2-microCi groups, but not in the 0.5-microCi group. Fluorography proved more sensitive than autoradiography. Snail survival, labeled cercariae, and worm establishment were not affected by the radiolabeling. 35S was thus found useful for radiolabeling adult S. japonicum worms.

Experimental Schistosoma bovis infection in goats: the inflammatory response in the small intestine and liver in various phases of infection and reinfection.

In a histopathological study of goats experimentally infected with Schistosoma bovis, the characteristics of the inflammatory response in the small intestine and liver related to tissue egg counts and fecal egg excretion were compared between goats at different time periods of primary infection and of primary infection followed by challenge. At early patency, coinciding with increasing egg excretion, the intestinal lamina propria showed numerous intact schistosome eggs devoid of any inflammatory reaction, whereas egg-associated inflammatory foci in the intestine were significantly few. Later in primary infection and after challenge, intestinal changes were marked by a granulomatous anti-egg response, with only a minor component of eggs lacking inflammatory change, and were consistent with a reduction of egg transfer into the gut wall. Hepatocellular necrosis with eosinophil infiltration was pronounced only during the early patent stage. The results indicate that the early cascade of fecal egg excretion in caprine schistosomosis bovis is aided by a low degree of tissue reactivity to eggs in the intestine. They also lend support to previous findings indicating that an anti-fecundity effect is operative after exposure to challenge in this parasitic infection in goats.

Schistosoma japonicum infection in the pig: the effect of a patent primary infection on a challenge infection.

The response of pigs to a challenge infection of Schistosoma japonicum following a primary infection was assessed using parasitological parameters and eosinophil counts. Twenty-five Danish Landrace/Yorkshire/Duroc crossbred pigs were divided into four groups. Group A (n = 10) received a primary infection, group B (n = 5) received both a primary and challenge infection, group C (n = 5) received a challenge control infection and group D (n = 5) received no infection serving as helminth-free controls. A dose of 850 cercariae was administered by intramuscular injection at the primary infection (week 0) and challenge infection (week 12). The pigs were perfused at week 21, except for half of the group A pigs which were slaughtered at week 12. Challenge infection did not result in higher worm burdens or tissue egg counts in group B than group A at week 21 and mature/immature worm ratios were similar for the two groups. In addition, no increases in faecal egg counts or eosinophil counts were observed in group B after challenge infection. The results indicate that pigs are able to mount a very rapid and effective response to reinfection with S. japonicum following a patent primary infection resulting in prevention of establishment of challenge infection schistosomes. An anti-worm effect appears to be the main feature of this regulatory host response.

The impact of primary Schistosoma bovis infection on a subsequent challenge infection in goats.

Experimental primary and challenge Schistosoma bovis infections were studied in West African Dwarf goats, using clinicopathological and parasitological parameters. The experiment included 44 goats divided into 4 groups of which group A received primary infection, group B received primary and challenge infection, group C received a challenge control infection, and group D included noninfected controls. Primary infection (wk 0) and challenge infection (wk 16) both comprised exposure to 1,000 cercariae per goat, and necropsies took place 16, 22 and 32 wk following primary infection. Clinicopathological effects were moderate in all infected groups. Egg excretion became gradually reduced following peak levels during early primary infection, and egg excretion increased only marginally following challenge infection in the primary- and challenge-infection group. Similarly, challenge infection of primary-infected goats did not result in an increase in tissue egg counts. Worm recovery and tissue egg counts in primary-infected goats remained comparable throughout the experiment, and although evidence was obtained for a delay in maturation, challenge worm establishment was comparable with challenge-control worm establishment. An anti-fecundity effect is thus an essential component of the regulatory response to both primary and challenge S. bovis infection in the goats. However, it was also shown that the intrauterine egg count is an unreliable parameter for fecundity assessments.

Host-parasite relationships in infections with two Kenyan isolates of Schistosoma mansoni in NMRI mice.

To relate the marked differences observed in morbidity due to Schistosoma mansoni infection in the Kangundo and Kibwezi areas of Machakos District, Kenya with possible parasite-related differences in pathobiological characteristics, a quantitative comparison of the host-parasite relationship in infections in NMRI mice with S. mansoni isolates from the 2 areas was conducted. One hundred and 20 cercariae were used per mouse, and necropsy took place between 35 and 94 days following infection. Parameters assessed comprised worm establishment, tissue egg counts, fecal egg excretion, egg production/worm pair, and weights of liver and spleen. Central findings included a higher worm establishment and a lower egg production/worm pair in Kangundo infections than in Kibwezi infections, comparable total tissue schistosome egg counts, and a higher liver/intestinal tissue schistosome egg ratio in Kibwezi infected mice than in the Kangundo infected mice. In addition, a much higher fecal egg excretion, expressed as eggs/g feces and eggs/g feces/worm pair, was observed in mice infected with the Kangundo isolate of S. munsoni than in mice infected with the isolate from Kibwezi. Although possible limitations in the use of mouse models need be realized, the results provide some support to the hypothesis that parasite-related differences in pathobiological characteristics may at least contribute to the marked difference observed in S. mansoni-induced morbidity between the Kangundo and Kibwezi areas.

Patterns of infection with Schistosoma haematobium in lakeside resettlement communities at the Oyan Reservoir in Ogun State, south-western Nigeria.

Patterns of infection with Schistosoma haematobium were studied in 1991 and 1992 in two, lakeside, resettlement communities at the newly established Oyan Reservoir in Ogun State, Nigeria. Prevalence and intensity of S. haematobium infection and frequency of haematuria and proteinuria all increased markedly from 1991 to 1992, indicating intensive transmission. This was confirmed in an incidence study. In both years, infection patterns were highly age-dependent, with peaks in those aged 10-14 years. These patterns deviate from those seen during a survey carried out in the same communities in 1988, providing strong evidence that infection had changed from an epidemic to an endemic stage. Although sex, tribe, religion, occupation, and village of residence had little if any effect on infection pattern, the patterns in settled and migrant groups differed considerably. The study provided a thorough elucidation of the complexity and instability of transmission of S. haematobium in a resettlement community characterized by social instability and extensive population movements. Although haematuria was very common, the subjects knew little about its cause.