ANAMBRA STATE RECORDS SCHISTOSOMIASIS CASES IN PRIMARY SCHOOLS

The research work carried out by Dr. Ekwunife Chinyelu Angela and Okafor Fabian Chukwuemeka - both of the Department of Biology, Nwafor Orizu College of Education, Nsugbe, Anambra State, Nigeria assisted me a lot in developing this report. Their research revealed how contagious and infectious the great and revered Agulu lake is and the health implications on Agulu people and her neighboring communities.

Agulu has different water bodies. Two big major arms of Agulu Lake are in Agulu town, across which is a bridge and a wide tarred road. Agulu is a very large semi-urban town with twenty villages. There is pipe borne water, bore holes in some parts which are far away from the lake. Of the 20 villages in Agulu, 8 or more use the Agulu Lake as source of water for domestic purposes. Water from the lake is also sold to villages and towns farther from the lake by water tanker drivers.

Other sources of water for domestic uses in Agulu are spring water and streams, namely Nemoku and Idemili Streams, Iyi ofu, Iyi Nwaduru, Mmili Ugwu, Agbana and Iyi Nwangwo. The inhabitants of the area are mainly yam and cassava farmers. Some are also traders. Most villages have primary schools located in them. Few without primary schools make use of neighbouring village schools.

Investigation was made to reveal the state and level of Schistosomiasis haematobuim infection in the whole of Agulu town in Anaocha local Government Area of Anambra State, Nigeria where this lake (Agulu lake) is implicated in the transmission of the disease. Urine sample was collected from 3029 children for Schistosoma egg identification. This was used to calculate the level of infection in the different schools. Schistosomiasis prevalence was highest (55.2%) in Umuowelle primary school and lowest (4.1%) in Obeagu primary school.

Males had higher infection rate than females in the endemic schools. In Umuowelle,Community and Nneogidi primary schools, infection rates in males were 36.4%, 13.3% 11.3% respectively while infection rates in females were 25.2%, 11.7% and 6.8% respectively. However, the sex differences were not statistically significant at 5% confidence level (t-test = 2.179, df = 12). Infection levels investigated in all the schools revealed that the age group 10-14 years recorded the highest level while 0- 4 years had the lowest. There was also shifts in peaks of infection within the varous age groups, for instance, in the 10 - 14 years age group of Ifiteani primary school, infection peak was in 14 years while in Nneogidi primary school it was in 13 year old pupils.

Schistosomiasis is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma. After malaria and intestinal helminthiasis, schistosomiasis is the third most devastating tropical disease in the world, being a major source of morbidity and mortality for developing countries in Africa, South America, the Caribbean, the Middle East, and Asia.

More than 207 million people, 85% of who live in Africa, are infected with schistosomiasis,  and an estimated 700 million people are at risk of infection in 76 countries where the disease is considered endemic, as their agricultural work, domestic chores, and recreational activities expose them to infested water. Globally, 200,000 deaths are attributed to schistosomiasis annually. Transmission is interrupted in some countries.

Sometimes referred to as bilharzias, bilharziasis, or snail fever, schistosomiasis was discovered by Theodore Bilharz, a German surgeon working in Cairo, who first identified the etiological agent Schistosoma hematobium in 1851.
Most human schistosomiasis is caused by S haematobium, S mansoni, and S japonicum. Less prevalent species, such as S mekongi and S intercalatum, may also cause systemic human disease. Less importantly, other schistosomes with avian or mammalian primary hosts can cause severe dermatitis in humans (eg, swimmer's itch secondary to Trichobilharzia ocellata).

Characteristics of schistosomiasis
Schistosomiasis is due to immunologic reactions to Schistosoma eggs trapped in tissues. Antigens released from the egg stimulate a granulomatous reaction involving T cells, macrophages, and eosinophils that results in clinical disease. Symptoms and signs depend on the number and location of eggs trapped in the tissues. Initially, the inflammatory reaction is readily reversible. In the latter stages of the disease, the pathology is associated with collagen deposition and fibrosis, resulting in organ damage that may be only partially reversible.

Eggs can end up in the skin, brain, muscle, adrenal glands, and eyes. As the eggs penetrate the urinary system, they can find their way to the female genital region and form granulomas in the uterus, fallopian tube, and ovaries. Central nervous system (CNS) involvement occurs because of embolization of eggs from the portal mesenteric system to the brain and spinal cord via the paravertebral venous plexus.

Snail hosts
The different species of Schistosoma have different types of snails serving as their intermediate hosts; these hosts are as follows:
  • Biomphalaria for S mansoni
  • Oncomelania for S japonicum
  • Tricula ( Neotricula aperta) for S mekongi
  • Bulinus for S haematobium and S intercalatum
At-risk populations
Today, 120 million people are symptomatic with schistosomiasis, with 20 million having severe clinical disease. More than 200,000 deaths per year are due to schistosomiasis in sub-Saharan Africa. Women washing clothes in infested water are at risk. Hygiene and playing in mud and water make children vulnerable to infection. Forty million women of childbearing age are infected. Approximately 10 million women in Africa have schistosomiasis during pregnancy. In endemic areas, the infection is usually acquired as a child.
In Brazil and Africa, refugee movements and migration to urban areas are introducing the disease to new locations. Increasing population size and corresponding needs for power and water have led to increased transmission. Infections are not uniformly distributed within communities. It has been estimated that 5-10% of an endemic community may be heavily infected, and the remainder has mild to moderate infections. The risk of infection is highest amongst those who lived near lakes or rivers. In Uganda, almost no transmission was found to have occurred at altitudes greater than 1400 m or where the annual rainfall was less than 900 mm. 
With the rise of tourism and travel, an increasing number of tourists are contracting it. Tourists often present with severe acute infection and unusual problems including paralysis.
The intensity and prevalence of infection rises with age and peaks usually between ages 15 and 20 years. In older adults, no significant change is found in the prevalence of disease, but the parasite burden or the intensity decreases.The disease is not endemic in United States.
Complications
Complications of schistosomiasis include the following:
  • Gastrointestinal (GI) bleeding
  • GI obstruction
  • Malnutrition
  • Schistosomal nephropathy
  • Renal failure
  • Pyelonephritis
  • Hematuria
  • Hemospermia
  • Squamous cell bladder cancer
  • Sepsis ( Salmonella)
  • Pulmonary hypertension
  • Cor pulmonale
  • Neuroschistosomiasis - Transverse myelitis, paralysis, and cerebral microinfarcts
  • Infertility
  • Severe anemia
  • Low ̶ birth-weight babies
  • Spontaneous abortion
  • Higher risk for ectopic pregnancies
  • End-organ disease
  • Portal hypertension
  • Obstructive uropathy
  • Pregnancy complications from vulvar or fallopian granuloma
  • Carcinoma of the liver, bladder, or gallbladder

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