PREVALENCE AND TRANSMISSION FACTORS FOR URINARY SCHISTOSOMIASIS AMONG SCHOOL AGE CHILDREN IN LANG’ATA, MWANGA DISTRICT
MUHIMBILI
UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL
OF PUBLIC HEALTH AND SOCIAL SCIENCE
DEPARTMENT
OF PARASITOLOGY AND MEDICAL ENTOMOLOGY
RESEARCH
REPORT
CODE:
RP399
TITLE: PREVALENCE AND TRANSMISSION
FACTORS FOR URINARY SCHISTOSOMIASIS AMONG SCHOOL AGE CHILDREN IN LANG’ATA,
MWANGA DISTRICT
Erick
Innocent Kakore (BMLS PE Candidate)
2018-04-11852
SUPEVISOR:
Dr. LWIDIKO EDWARD
TABLE OF CONTENTS
Figure
1.1: Conceptual Framework
Table 4.1 Socio-demographic
characteristics of study participants
Table 4.2 Prevalence of urinary
schistosomiasis among study participants
Table 4.3 Knowledge about urinary
schistosomiasis among the study participants
Table 4.4 Knowledge level about urinary
schistosomiasis among the study participants
Table 4.6 Self-reported uptake of praziquantel
among study participants in the last round of MDA
2.2 Source of domestic water supply
2.3 Knowledge about urinary schistosomiasis among school
children
2.4 Occupation of parents or legal guardian
2.5 Children habits and behaviors
2.6 Availability and use of toilets in the community
2.7 Uptake of praziquantel for prevention of urinary
schistosomiasis
3.5 Sampling technique and procedures
3.8 Data collection and methods
3.8.1 Sample
collection and investigation
3.8.2 Risk
factors associated with urinary schistosomiasis among school age children
3.9 Data management and analysis
3.9.1 Recruitment and training of research assistants
3.9.2 Pre-testing of data collection tools
3.9.3 Data processing and analysis
3.11 Study limitation and mitigation
4.2
Socio-demographic information of the study participants
4.3
Prevalence of urinary schistosomiasis among school age children
4.4 Level of
knowledge and awareness about urinary schistosomiasis among school age
children
5.3 Source of
domestic water supply
5.4 Knowledge
level about urinary schistosomiasis among school age children
5.5 Occupation
of parent or legal guardian
5.6 Children habits and behaviors
5.7 Availability and use of toilets in the community
5.8 Uptake of praziquantel for prevention of urinary
schistosomiasis
6. CONCLUSION AND RECCOMENDATIONS
Appendix 1: Questionnaire English version.
Appendix 2 Questionnaire Swahili version.
Appendix 3: Consent form English version.
Appendix 4: Swahili version of consent form.
CERTIFICATION
The
undersigned certify that, he has read and here by recommend for acceptance by
Muhimbili University of Health and Allied Sciences a research entitled
“Prevalence and transmission factors for urinary schistosomiasis among school
age children in Lang’ata, Mwanga district.” in fulfillment of requirement for
the Bachelor of Medical Laboratory Sciences in Parasitology and Medical
Entomology at Muhimbili University of Health and Allied Sciences.
Supervisor’s
name: Dr. Lwidiko Edward
Signature………………………………………
Date…………………………………
COPYRIGHT
No any part of this dissertation shall by any means be reproduced,
stored in any retrieval system, or transmitted in any form being electronic,
mechanical, photocopying, recording or otherwise without prior permission of
the author or Muhimbili University of Health and Allied Sciences on that
behalf.
DECLARATION
Researcher’s signature……………………………………….
Date………………………….
DEDICATION
This
entire research work is dedicated to my brother Joseph Hubert, who has been a
constant source of support and encouragement during the challenges of undergraduate
school [LEM2] and life. I am truly thankful for
having you in my life brother. Moreover, this work is dedicated to my parents
Innocent Kakore and Hortensia Kakore, who have always loved me unconditionally
and whose good examples have taught me to work hard for the things that I
aspire to achieve, lastly to my young sister Neema Kakore, who has always
supported me throughout the process.
ACKNOWLEDGEMENT
This
research work becomes a reality with the kind of support and help of many
individuals, I would like to express my sincere thanks to all of them.
Foremost,
to GOD ALMIGHTY for without His immeasurable graces and blessings, this study
would not have been possible. I would like to express great recognition to my
supervisor (Dr. Lwidiko Edward) for his helpful and constructive ideas during
planning, the initial development of the proposal and the final completion of
this report. Really, his contribution is honored and respected as it has made
this work valuable and useful.
Moreover,
I would like to recognize the contribution of the Directorate of Research and
Publication (MUHAS) for giving me an ethical clearance to proceed with my
research study. Similarly, I would like to thank the Head of Department of
Parasitology and Medical Entomology of MUHAS, Prof. B. Ngasala for allowing me
to conduct sample processing activities in Parasitology and Medical Entomology
laboratory. I would also like to acknowledge helpful suggestions from my
department lecturers (Mr. Abdallah Zacharia, Mr. Samwel Bushukatale, Miss. Mary
Joseph and Mr. Clemence Kinabo).
Furthermore,
boundless appreciation goes to the study participants who were involved in this
study. Finally, my thanks and appreciation also go to my classmates and
friends, this project could not have been accomplished without their endless
support.
LIST OF ABBREVIATIONS
°C
Degree Centigrade
CI
Confidence Interval
COVD19 Corona Virus
Disease of 2019
DEO
District Educational Officer
DMO
District Medical Officer
MDA Mass Drug Administration
MUHAS
Muhimbili University of Health and Allied Science
MPL
Multi-Purpose Laboratory
PPE Personal Protective Equipment
PZQ
Praziquantel
SAC
School Age Children
STD
Standard
SPSS Statistical
Package for Social Sciences
Sq. Km
Square Kilometers
W.H.O
World Health Organization
LIST OF KEYWORDS
Prevalence
Risk factors
Schistosoma haematobium
Urinary schistosomiasis
LIST OF FIGURES
Figure 1.1: Conceptual Framework
LIST OF TABLES
Table 4.1 Socio-demographic characteristics of study participants
Table 4.2 Prevalence of urinary schistosomiasis among study participants
Table 4.3 Knowledge about urinary schistosomiasis among the study participants
Table 4.4 Knowledge level about urinary schistosomiasis among the study
participants
Table 4.5 Water, sanitation and other risk factors associated with transmission
of urinary schistosomiasis among study participants
Table 4.6 Self-reported uptake of praziquantel among study participants in the
last round of MDA
DEFINITION OF KEYWORDS
Prevalence:
Is a statistical concept referring to the number of cases of a disease that are
present in a particular population at a given time.
Schistosoma
haematobium: A species of trematode worm that
parasitizes humans and causes urinary tract disease including bladder cancer.
Schistosoma
haematobium
infection: The presence of Schistosoma haematobium parasites in the urine confirmed by
parasitological methods such as urine centrifugation method.
School age children:
These are children who are old enough to go to school.
Transmission factors:
These are attributes, characteristics or individual exposure that increases a
person’s chances or susceptibility of developing a disease.
Urinary schistosomiasis:
Is an acute and chronic disease caused by blood flukes (trematode worms) of Schistosoma haematobium species.
ABSTRACT
Background
In Tanzania, urinary schistosomiasis caused by Schistosoma
haematobium is endemic especially in poor community of rural areas and it
causes significant public health problems, especially in school age children.
The risk factors for schistosomiasis among school age children include; poor personal
hygiene, playing customs in the water, distance from the nearest water supply,
knowledge about schistosomiasis among school children and education and
occupation of parents or legal guardians.
Objective of the
study
The
study aims to determine the prevalence of urinary schistosomiasis and associated
transmission factors among school age children in Mwanga district, Kilimanjaro,
Tanzania.
Methodology
A
cross sectional study was conducted in Kagongo and Bwawani primary school,
Lang’ata, Mwanga district, Kilimanjaro, Tanzania from May to June 2021. More
than ten (10) ml of urine sample was collected from each study participant,
macroscopic examination of each urine sample to determine clarity and presence
of blood was done followed by microscopic examination after processing
procedures. Data on socio-demographic characteristics and risk factors were
collected using an interview-based questionnaire. The obtained data were then
analyzed using Statistical Package for Social Science (SPSS) software version
20. Frequencies and cross tabulation were computed to obtain prevalence of
urinary schistosomiasis and also to obtain the proportion and Chi squared tests
for each of the study variables. Associated transmission factors also were
presented in frequency and proportion. Association between transmission factors
and prevalence of urinary schistosomiasis was tested by using Chi squared tests
where p< 0.05 was considered statistically significant.
Results
This study revealed that the prevalence of urinary schistosomiasis among
school age children in Langa’ata, Mwanga district was 1.2%. Overall, prevalence
of infection was slightly higher in males (1.7%) than in females (0.7%) though
the difference was not significant statistically. High prevalence rate (2.7%) was also
recorded in 12 to 15 age group and moreover, standard seven school age children
recorded the highest prevalence (2.1%) of infection when compared to other
classes but there was no statistical association with the disease. [LEM3]
The study revealed that almost three quarter (74.9%) of study participants
had heard about urinary schistosomiasis while the
remaining quarter (25.1%) had never heard about it. Study finding show that
85.1% of participants use river water as a source of water for washing clothes
and utensils at home, 54.5% for drinking and 83.5% for bathing. In addition 85.9% of
school age children had habits of swimming, also 95.3% of study participants
reported to have toilet facilities at home, with pit latrines been the most
used type of toilet facility (59.2%). Finally out of 255 of study participants,
only 53.3% reported fishermen as father’s occupation.
Conclusion
The
current study showed the low prevalence of urinary schistosomiasis among school
age children in Lang’ata, Mwanga district. Despite the low prevalence it’s an
indication of the ongoing transmission of the disease in that endemic setting. Therefore,
more community-based study in these endemic settings would be vital in
determining the status of Schistosoma haematobium infection and risk
factors in other age groups to consider them for preventive chemotherapy.
CHAPTER
01
1.0 INTRODUCTION
1.1
Background
Urinary
schistosomiasis is a common disease in school age children. The causative agent
of urinary schistosomiasis is a blood trematode called Schistosoma
haematobium, these worms inhabit in blood vessels around the infected
person’s bladder. A person becomes infected with Schistosoma haematobium
when coming into contact with water harboring the free-swimming cercariae,
infective stage of the disease which penetrate the intact skin of humans who
are doing water related activities such as swimming, fishing and bathing.
Children are at more risk of acquiring urinary schistosomiasis because of their
habits of playing in water which makes them more susceptible to infection. (1) In
chronic urinary schistosomiasis common signs and symptoms includes blood in the
urine and other urinary system organ defects, including the kidney. (2)
Schistosomiasis
is worldwide distributed with more cases found to be in poor rural communities
with poor access to safe drinking water and poor sanitation, a typical feature
of most “world’s least affluent” country communities. (3)
Globally, it is believed that about 500 million people are at risk of getting
infected with Schistosoma haematobium, with more than 230 million people
considered to be infected with schistosomiasis. (3)
At the moment,
the prevalence of schistosomiasis is still high in sub Saharan African countries
with approximately 90% of world estimated 250 million victims of
schistosomiasis present in this region. (4)
Tanzania has many cases of schistosomiasis as it is only ranked second to
Nigeria on the total number of cases of schistosomiasis in sub-Saharan Africa.
Moreover, about half of Tanzania population are at risk of acquiring
schistosomiasis as the result of living in areas exposed to disease causative
agent. (4)
Epidemiological data shows that, urinary schistosomiasis is common in Africa
and Middle East, with countries in these regions being the only place where Schistosoma
haematobium is present. Praziquantel (PZQ) is the widely used drug for
preventive chemotherapy of schistosomiasis. In the present circumstances, WHO
recommends mass drug administration of praziquantel to at risk school age
children in order to reduce the disease burden. (5)
Urinary schistosomiasis is a major public health
problem in Mwanga district, Kilimanjaro Tanzania. From the previous
study concerning the prevalence of urinary schistosomiasis among school
children in Mwanga district, it has been shown
that there is a high, 79.9% prevalence of schistosomiasis among primary school
children in both areas with irrigation or farming and fishing activities
despite control measures through mass drug administration programs (MDA). (6) The
high prevalence of urinary schistosomiasis in Mwanga district can be the result
of lack of enough knowledge about the risk factors associated with urinary
schistosomiasis in this area. Therefore, this epidemiological study focused on
determining the prevalence of urinary schistosomiasis and associated
transmission factors among school age children at Mwanga district in
Kilimanjaro, Tanzania.
1.2 Problem
statement
Urinary schistosomiasis remains a public
health problem in Tanzania. Praziquantel (PZQ) is the current drug of choice
for the intervention of Schistosoma haematobium infection in Tanzania and
other Sub Saharan African countries. “High safety, ease of distribution to
school children, and affordability, due to drug donation, all contribute to the
drug being the intervention of choice”. (3) World Health
Organization (WHO) has determined school age children as a principal target
group for the preventive chemotherapy, with praziquantel administration
directed to school age children (SAC) located in most endemic areas. The
communities at risk are evaluated either by traditional parasitological methods
and sometimes supported by a validated questionnaire method. (3)
In Tanzania,
human exposure to schistosomiasis is mostly related to occupational activities
such as fishing, farming or recreational activities around the basin or within
the permanent or temporal water bodies such as lakes, rivers, dams, swampy
areas or road side ditches. (5) The prevalence of urinary schistosomiasis in
Mwanga district is high but the factors associated with transmission of urinary
schistosomiasis are not well known in the community.
This
study is therefore designed to determine the current prevalence of urinary
schistosomiasis and associated transmission factors among school age children
in Mwanga district in Kilimanjaro, Tanzania.
1.3 Conceptual framework
Fig 1.1: Conceptual framework of
the study
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1.4 Rationale of
the study
The
results of this study will assist public health authorities of United Republic
of Tanzania to refine control measures and complement preventive chemotherapy
with specific information about infection prevalence and intensity, and to
enhance education and communication approaches that are readily tailored to
specific social-ecological contexts especially at Langa’ata ward in Mwanga
district, Kilimanjaro Tanzania.
1.5 Research
questions
1.
What is the burden of urinary schistosomiasis among school age children?
2.
What is the source of water for domestic use among school age children?
3.
What is the level of knowledge and awareness about urinary schistosomiasis
among school age children?
4.
What is the occupation/job of parents or legal guardians?
5.
What habits and behavior that put school age children at risk of getting
infected?
6.
What is the availability and use of toilets in the community of school age
children?
7.
What is the percentage uptake of praziquantel among school age children in the
last round of MDA?
1.6 Objective of
the study
1.6.1 Broad objective
To
determine the prevalence of urinary schistosomiasis and associated transmission
factors among school age children in Mwanga district, Kilimanjaro Tanzania.
1.6.2 Specific
objectives[LEM4]
1.
To assess the prevalence of urinary schistosomiasis among school age children.
2.
To assess the risk factors associated with the transmission of urinary
schistosomiasis among school age children.
3.
To assess the uptake of praziquantel among school age children in the last
round of MDA.
CHAPTER 02
2.0 LITERATURE
REVIEW
2.1 Prevalence and
associated transmission factors of urinary schistosomiasis infections among
school age children
The
Schistosoma haematobium infection is highly prevalent among school aged
children and it is an important public health concern in Mwanga district. A
cross sectional study of primary school children aged 5-15 years that was conducted on
April 2019 in Mwanga district, revealed an alarming 79.9% of Schistosoma
haematobium infection. [LEM5] This prevalence was remarkably high
despite the previous control efforts of mass drug administration, this
distressing high prevalence can be due to high level of re-infection. (6)
In
another study in Sokoto state, North-Western Nigeria reported the prevalence of
urinary schistosomiasis increased with age, with the highest prevalence (33.7%)
seen in 11-14 age group. (7) This was
supported with another study from South-Western Nigeria which revealed the
presence of large numbers of Schistosoma haematobium eggs urine samples
collected from school aged children (10-14 age group). (8) On the other
hand, the study in Gambella regional state, Southwestern Ethiopia reported
higher frequency of urinary schistosomiasis was found among school age children
in the 13 to 14 years age group (39.1%) than 15.6% found in 7 to 9 years age
group and the 10 to 12 age group (34.9%). (9)
Numerous
risk factors are associated with the transmission of Schistosoma haematobium
infection among school age children. A cross sectional study on biosocial
determinant of persistent schistosomiasis among school children in Tanzania
despite repeated treatment reported that, there is a need of acknowledging
“ecological, behavioral and social risk factors” that are associated with the
transmission of urinary schistosomiasis in communities where the prevalence of
the disease is high. (3) The study reported
bio social factors such as use of latrines, main source of drinking water,
occupation of the parent and child habits among the factors which increases the
chance of being infected with Schistosoma haematobium. (3)
2.2
Source of domestic water supply
Improved
water supply is important for public health as the use of contaminated water
for drinking or any other domestic work may lead to transmission of diseases,
with one of them being urinary schistosomiasis. The study on impact of praziquantel mass drug
administration campaign on prevalence and intensity of Schistosoma haematobium among
schoolchildren in Bahi district, Tanzania, reported that, the behavior of
having more than one source of water for domestic use increase the chances of
coming into contact with water sources that may not be safe and may be infested
with the intermediate host of Schistosoma haematobium and therefore
increasing the chances of getting infected with the parasite. (2) Moreover, the study on biosocial
determinant of persistent schistosomiasis among school children in Tanzania
reported significantly high chances of schistosomiasis for children who used
unsafe water for drinking compared to those who used safe water. (3)
2.3 Knowledge about urinary schistosomiasis among school
children
Awareness, attitudes and perceptions of
urinary schistosomiasis are likely to have a significant effect on prevention
and control efforts, therefore for an effective preventive and control
measures, it is necessary to improve the knowledge of the community at risk. A
cross sectional study carried out in Edo state, Nigeria reported that only 4.8%
of the interviewed children had knowledge about urinary schistosomiasis and
moreover they understood that the presence of blood in their urine was the
result of coming into contact with contaminated river water. Also on further
investigation, about 80% of the tested children had hematuria and claimed to
have reported the scenario to their parents or guardian but surprisingly, among
those who reported the scenario, about 86.3% didn’t receive any feedback from
their parents or guardians, while 13.7% were cured through herbs and drugs. (10) In addition,
the study in Edo state, Nigeria is in compliance with another study on low levels of awareness despite high prevalence of schistosomiasis among
Communities in Nyalenda
Informal Settlement, Kisumu City, Western Kenya which reported that most
participants have heard of schistosomiasis but only few had the correct
knowledge on signs and symptoms, causes, transmission and control of the
disease. (11)
2.4 Occupation of
parents or legal guardian
The
prevalence and intensity of urinary schistosomiasis among school children has
either direct or indirect association with the work that the parents and legal
guardians engage with regularly. A study on prevalence, intensity, risk factors and knowledge
assessment among some rural communities in Southwestern Nigeria reported the
prevalence and mean intensity of 66.2% and 64.71 egg per 10 ml urine to
children whose father’s job was farming. Moreover the prevalence and mean intensity
of 76.8% and 75.67 egg per 10 ml was reported to children whose mother’s job
was farming.(8) In
addition, the study on prevalence of urinary schistosomiasis among primary school
children in Gadabuke district, Toto LGA, North Central Nigeria reported that, children whose parents are farmers and fishermen had the highest
prevalence infections when compared to children whose parents were artisan,
civil servant and businessmen. (12)
2.5
Children habits and behaviors
The habits
and behavior of children especially in poor communities have a relationship
with the transmission of urinary schistosomiasis. These habits include
recreational activities, with swimming being one of them. The cross-sectional
study in Gambella Regional State, southwestern
Ethiopia observed the high prevalence of Schistosoma haematobium
infection among school age children with habits of swimming in contaminated
water sources. The study reported that “long duration of hours to
water contact was considered as an important risk factor for exposure to
urinary schistosomiasis rather than frequency of water contact”. (9) The
prevalence of 21% of urinary schistosomiasis was recorded in children who swim
regularly but in shorter duration of time while the remaining 79% was recorded
to those who swim sometimes but in longer duration of time, therefore the
provided data support the statement that the frequency of water contact has
less impact in transmission of Schistosoma
haematobium infection when compared to duration of hours to water contact. (9) The
study was supported with another cross sectional study on prevalence of urinary
schistosomiasis among primary school children in Kwalkwalawa Area, Sokoto
State, North-Western Nigeria which reported prevalence of 43.6% to pupils who
swim regularly and prevalence of 23.2% to pupils who do not swim. (7)
The place of urination is notably
significantly associated with Schistosoma haematobium infection. The
study on community knowledge, perceptions and practices associated with
urogenital schistosomiasis among school aged children in Zanzibar, United
Republic of Tanzania reported that as far as human health is concerned, the
behavior of urinating in fresh water sources such as rivers and lakes expose
others to Schistosoma haematobium infection. (13) During the
study, an older boy reported, “Boys don’t like
to urinate in the house. They urinate everywhere… even in the bushes. Men
aren’t shy. Men will urinate anywhere. Especially the young ones, they will
urinate in the water, whereas an elder hide when finding a place to urinate.”
In addition to the statement provided by the boy, a parent reported, “When a
boy is at home, he uses the toilet, but if he is somewhere else, he will
urinate anywhere. I have been through all that. When I was a child I urinated
in the river and everywhere.” (13)
2.6
Availability and use of toilets in the community
There is a significant relation of Schistosoma
haematobium infections and the availability of latrines, cleanliness of
latrines, the washing hands with soap before eating and after visiting toilet
since the parasite egg leaves the definitive host in the urine. In addition, a
pit toilet should be built at a reasonable safe distance from water sources in
order to avoid polluting ground water sources which increases the risk of
transmission of urinary schistosomiasis. A study on biosocial determinants of persistent schistosomiasis
among school children in Tanzania despite repeated treatment reported that
there is a remarkably high prevalence of Schistosoma
haematobium infection in children who do not use pit latrines regularly
compared to those who use regularly. (3) This study was in line with a study conducted
in Um‑Asher Area, Khartoum, Sudan where prevalence of urinary
schistosomiasis was 63.6% in individual with non-sanitary pit latrines and the
remainder 36.4% urinary schistosomiasis was in individual with sanitary
latrines. (14)
2.7 Uptake of praziquantel for prevention of urinary schistosomiasis
Annual mass drug administration with praziquantel
on school children remain the crucial control approach against urinary
schistosomiasis in Tanzania. (15) There is a significant association between uptake
of praziquantel and prevalence of urinary schistosomiasis, a study on
prevalence of urogenital schistosomiasis and risk factors for transmission
among primary school children in an endemic urban area of Kinondoni
municipality in Dar es Salaam, Tanzania revealed this association that, all of
the infected students self-reported never taking praziquantel drugs at school
during last round of MDA due to various reasons including parent’s refusal and
fear of side effects of praziquantel drugs. (16)
CHAPTER
03
3.0 METHODOLOGY
3.1 Study area
The
study was conducted at Lang’ata, Kilimanjaro. Lang’ata is the ward of Mwanga
District, one of the seven Districts of the Kilimanjaro Region of Tanzania.
Mwanga district is bordered to the northeast by Kenya, to the northwest by the
Moshi Rural District, to the southwest by the Manyara Region, and to the south
by Same District. Its administrative seat is the town of Mwanga. The district
has a total surface area of 2641 sq. km. Land area is 2,558.6 sq. km and water
area is 82.4 sq. km of which 56 sq. km is covered with water of Nyumba ya Mungu
Dam and 26.4 sq. km is covered with water of Lake Jipe. According to the 2012
Tanzania National Census, the population of Mwanga District was 131,442.
The
district is one of the semi-arid areas in Kilimanjaro region. It experiences
400-600mm of rainfall per annum in low lands and between 800-1,200mm in the
highlands. There are two distinct rain seasons. These are the short rains
(Vuli) and long (Masika) rain seasons. The district experiences some strong and
dry winds blowing normally from the East to the West. Temperature ranges
between an average of 14°C during June – July and 32°C usually during the month
of January. The land area is covered by shrubs of Acacia type especially in
both the Eastern and Western Lowlands. Short grass with interspersed trees
exists in the highlands.
The main economic activities performed by the
Mwanga community are agriculture, livestock keeping and fishing. Despite the
fact that rainfall is unreliable, coffee and banana is grown in the highland
area, irrigation in the Eastern, Northern and Western lowlands is popular for
Maize, Beans and Paddy production, there is a special type of irrigation in the
highlands popularly known as “Ndiva” (water catchments across the rivers and
valleys) in order to get water for irrigation. Main fishing activities is
carried out at Nyumba ya Mungu.
3.2 Study design
A
cross-sectional study was conducted between May and June, 2021 to determine the
prevalence of urinary schistosomiasis and associated transmission factors
whereby children at Kagongo and Bwawani primary schools in Lang’ata ward were
selected randomly. Urine samples were collected in appropriate urine containers
from children for processing. Demographic information and factors (awareness,
knowledge and practices) associated with exposure to Schistosoma haematobium infection were obtained by using a standard
structured an interview-based questionnaire.
3.3 Study
population
The
study population was school age children who live at Langa’ata ward enrolled in
Kagongo and Bwawani primary schools from standard (STD) 3 to 7.
3.4 Sample size
estimation
Based on previous study reported prevalence,
N=
required sample size
P=
previous reported prevalence
↋=
Margin of error, 5%
Z=
Level of confidence, 1.96
Then
N=1.96²×79× (100-79)
5²
Note,
the previous Mwanga prevalence is 79%
N= 1.96 × 1.96 ×79 × (100-79)
25
N= 6373.2144
25
Then, N= 254.9 = 255
Therefore, the required sample size
for this study was 255 school age children.
3.5 Sampling
technique and procedures
Random
sampling method was used to get 255 participants living in Lang’ata wards
attending Kagongo and Bwawani primary schools. Students with between 5 and 14
years old from standard 3 to 7 were randomly selected. Small uniform piece of
papers with written number, were folded and put in container. Each student from
each class were allowed to take out required lot in random manner from the
container. Those with number 4 and 8 were selected as participants.[LEM6] The two primary schools were
selected because of their closeness to Nyumba Ya Mungu dam which is the main
source of a number of transmission factors that may expose people living nearby
to getting infected.
3.6 Eligibility
criteria
3.6.1 Inclusion criteria
The
study was limited to children attending Kagongo and Bwawani primary schools age
between 5 to 14 years. In addition, the study included school age children who
agreed to participate and provide the urine sample.
3.6.2 Exclusion criteria
All
school age children who refused to provide their [LEM7] assent to participate were excluded
from this study.
3.7 Study variables
3.7.1 Dependent variables
Urinary
schistosomiasis was the dependent variable of this research study.
3.7.2 Independent variables
Environmental
sanitation, personal hygiene, habits of open field urination, source of
domestic water supply, education and occupation of parents, knowledge about
urinary schistosomiasis and uptake of praziquantel in the last round of MDA
were the independent variables of this research study.[LEM8]
3.8 Data collection and methods
3.8.1
Sample collection and investigation
Fresh
urine samples were collected using a sterile, labeled, clean, dry, wide mouthed
plastic containers. The school children were given the containers at school
between 10:00 am and 02:00 pm the time for peak egg production, with
instruction requesting to bring sufficient amount of urine sample. Once receipt
of the urine sample, each of the urine container were labelled with the
participant’s unique identification number. The collected urine samples were kept in
a cooler box but before that a few milliliter of 10% formalin was added to
preserve the parasite morphology before been transported to Multi-Purpose
Laboratory (MPL) at Muhimbili University of Health and Allied Science (MUHAS)
in Dar es Salaam[LEM9] . In the laboratory, the urine
samples were checked for identification number, quantity, and quality then were
processed and examined microscopically using urine centrifugation technique and
light microscope for detection of eggs of Schistosoma haematobium.
Macroscopic examination of urine for color, cloudiness or clarity was done. The
presence of blood in urine (hematuria) is the classic sign of urogenital
schistosomiasis.
3.8.2
Risk factors associated with urinary schistosomiasis among school age children
Structured
questionnaire was developed in English language and translated to Swahili
language. The school age children were interviewed using the already prepared questionnaire to obtain [LEM10] [E11] demographic information, source of
domestic water supply, occupation of parents or legal guardians, level of
knowledge and awareness about urinary schistosomiasis, habits and behaviors
that put them at risk of getting infected availability and use of toilets in
the community of participants and uptake of praziquantel in the last round of
MDA. Then, the responses were translated back into English.
3.9 Data management and analysis
3.9.1 Recruitment and training
of research assistants
Two research assistants with knowledge to collect data and two
microscopists with knowledge on morphology of Schistosoma haematobium eggs were recruited. Research assistants
were trained for four days to use questionnaire tool during interviews in the
field and also were trained on how to approach study participants during data
collection so as to obtain consent and on how to collect urine sample.
Experienced researcher was recruited to train research assistants theoretically
and practically so as to make sure they become competent in the field.
3.9.2 Pre-testing of data
collection tools
Questionnaire tool was be pre-tested before being used in the data
collection in the study so as to check the quality of the questionnaire tool to
be used in the study. The questionnaire tool was pre-tested by using 40 primary
school children out of the participants from Kagongo and Bwawani primary
schools. Research
assistants were involved in the pre-testing so as to get familiar with the
tool. Weaknesses of questionnaire tool that were observed during pre-testing
were corrected and modified so as to get best questionnaire tool to be used in
the study.
3.9.3 Data processing and analysis
Statistical Package
for Social Science (SPSS) software version 20 was used to analyze the collected
data. Descriptive statistics including percentages and frequency were needed to
be analyzed from data obtained in questionnaire. Chi-square test was be
performed to verify the possible association between prevalence of urinary
schistosomiasis and sociodemographic characteristics, behavioral factors,
hygienic practices and environmental sanitation factors by establishing the
statistical significance, whereby a p-value p≤0.05 was marked as statistically
significant. Frequencies and cross tabulation were calculated to
obtain prevalence of urinary schistosomiasis and also to obtain the proportion
and Chi squared tests for each of the study variables.
Associated
transmission factors for transmission of urinary schistosomiasis also were
presented in frequency and proportion. Association between transmission factors
and prevalence of urinary schistosomiasis were tested by using Chi squared
tests where p< 0.05 was considered statistically significant.
Knowledge level was presented as high knowledge, moderate knowledge and
poor knowledge, also association between knowledge and prevalence of urinary
schistosomiasis was tested by using Chi squared tests, where p< 0.05 was
considered as statistically significant.
3.10 Ethical consideration
Approval for the study was obtained from Muhimbili
University of Health and Allied Sciences through the head of Department of
Parasitology and Medical Entomology, Mwanga District Executive Director (DED)
and Mwanga District Education officer (DEO). Head teachers of both
primary schools provided consent for their school children to participate in
the study by signing informed consent form. All patients found to have urinary
schistosomiasis parasite were managed by clinicians according to the available
guidelines. Moreover, confidentiality of the information obtained from the
study was maintained.
3.11 Study
limitation and mitigation
The
fact that we collected only one sample of urine decreases the chances of
recovering Schistosoma haematobium, consequently it might have
underestimated the prevalence of urinary schistosomiasis in our study area.
Therefore, urine samples were collected between 10am and 2pm after encouraging
fluid intake and performing simple physical exercise in order to increase
chances of recovering eggs of Schistosoma haematobium in collected urine
samples.
Recall bias happened during questionnaire interviews as primary school
children came across difficulties to recall episodes or experience from the
past like how did they get symptoms of urinary schistosomiasis such as
hematuria. Adequate time was taken for them to recall correct answers so as to
reduce this bias.
Furthermore, the way questionnaire was used by researchers to collect
data might have led to different response between primary school students.
Giving enough training to research assistants mitigated this as they got enough
knowledge to use questionnaire to get required response from the participants.
CHAPTER
04
4.
RESULTS AND FINDINGS
4.1
Introduction
This
section presents
[LEM12] findings of the study on prevalence
and transmission factors for urinary schistosomiasis among school age children
in Lang’ata, Mwanga district. The assessment was done through gathering of
information from the selected participants (school age children) whereby
questionnaires were used.
In
attaining the objectives, 255 participants were chosen to be the
representatives of the whole population from the study area. Consequently, age,
sex, class and school of the students were considered in gathering the needed
information.
4.2 Socio-demographic information of the study participants
A
total of 255 primary school children attending Kagongo and Bwawani primary
schools, from class three, four, five and seven were recruited in this
study. Moreover, all 255 provided urine
samples and participated in the interview. Therefore, the rate of response was
100%. Of the 255 children who participated, 217 (85.1%) were from Kagongo
primary school and the remaining 38 (14.9%) were from Bwawani primary school.
More than half (52.5%) were females, the majority (70.6%) were aged between 8
to 11 years. In addition, class 3 (27.5%) and class 5 (27.5%) provided majority
of the study participants. (Table 4.1)
Table 4.1 Socio-demographic characteristics of study participants, Lang’ata,
Mwanga, 2021 (N=255)
|
Variable |
Frequency
(n) |
Percentage
(%) |
95%
CI |
|
School Kagongo Bwawani |
217 38 |
85.1 14.9 |
80.2-89.6 10.4-19.8 |
|
Sex Males Females |
121 134 |
47.5 52.5 |
42.4-54.0 46.0-57.6 |
|
Age
group 8-11 12-15 |
180 75 |
70.6 29.4 |
64.9-76.1 23.9-35.1 |
|
Class Class
3 Class
4 Class
5 Class
7 |
70 67 70 48 |
27.5 26.3 27.5 18.8 |
22.4-33.3 20.8-31.7 22.1-32.5 14.5-23.9 |
4.3
Prevalence of urinary schistosomiasis among school age children
A total of 3 (1.2%) of the 255 primary school children examined had S. haematobium
eggs in their urine. The prevalence was higher in Kagongo primary school (1.2%)
than in Bwawani primary school (0%) but was not statistically significant
(p=0.466). The infection rate was higher in males (1.7%) than in females (0.7%)
but was not statistically significant (p=0.503). Children between the age group
of 12 to 15 years were more affected (2.7%) compared to 8 to 11 years age group
(0.6%) but was not statistically significant (p=0.154), in addition, the
prevalence of urinary schistosomiasis was higher among students in class 7
(2.1%) when compared to other classes. (Table 4.2)
Table 4.2 Prevalence of urinary schistosomiasis among study
participants, Lang’ata, Mwanga, 2021
|
Variable |
Total |
S. haematobium positive |
Chi-Square |
P-value |
|
Total |
255 |
3 (1.2) |
|
|
|
School Kagongo Bwawani |
217 38 |
3 (1.4) 0 (0) |
0.532
|
0.466 |
|
Sex Males Females |
121 134 |
2 (1.7) 1 (0.7) |
0.450 |
0.503 |
|
Age group 8-11 12-15 |
180 75 |
1 (0.6) 2 (2.7) |
2.029 |
0.154 |
|
Class Class 3 Class 4 Class 5 Class 7 |
70 67 70 48 |
1 (1.4) 0 (0.0) 1 (1.4) 1 (2.1) |
1.214 |
0.75 |
4.4 Level of knowledge and awareness about urinary schistosomiasis among
school age children
Almost three quarter (74.9%) of school age children
had heard about urinary schistosomiasis while the remaining quarter (25.1%) had
never heard about it. However, of 74.9% who had heard about urinary
schistosomiasis, almost half of them (47.1%) did not know about signs and
symptoms of it, the remaining (52.9%) population of school age children knew
the signs and symptoms of urinary schistosomiasis with painful urination
(10.2%) the leading known symptom among the school children who participated in
the study. (Table 4.3)
Table 4.4 shows that less than half of the participants had high knowledge about
the common symptoms of urinary schistosomiasis, but the majority (83.9%) had
low knowledge about the symptoms of the disease but was not statistically
significant (p=0.748). Moreover, 1.4% of the school age children who had low
level of knowledge about the disease were suffering from the disease but still
it was not statistically significant.
Table 4.3 Knowledge about urinary schistosomiasis among the
study participants, Lang’ata, Mwanga, 2021[LEM13] [E14]
|
Variable |
Frequency (n) |
Percentage (%) |
|
Heard about urinary schistosomiasis? Yes No |
191 64 |
74.9 25.1 |
|
Symptoms of urinary schistosomiasis? Blood in urine Blood in urine + Frequent urination Blood in urine + Painful urination Blood in urine + Poor appetite Painful urination + Fever + Fatigue Blood in urine + Fatigue + Frequent urination Blood in urine + Painful urination + Frequent
urination Painful urination + Malaise + Chills Blood in urine + Painful urination + Fever +
Fatigue + Malaise + Chills Painful urination Blood in urine + Painful urination + Frequent
urination + Poor appetite Blood in urine + Painful urination + Poor
appetite Blood in urine + Painful urination + Fever Blood in urine + Painful urination + Fever +
Frequent urination Blood in urine + Painful urination + Malaise +
Frequent urination Fatigue + Chills + Poor appetite Fever Fatigue Malaise Chills Frequent urination Poor appetite Don’t know
|
7 21 17 1 2 1 22 2
1 26
3 4 1
1
2 1 2 2 1 1 16 1 120 |
2.7 8.2 6.7 0.4 0.8 0.4 8.6 0.8
0.4 10.2
1.2 1.6 0.4
0.4
0.8 0.4 0.8 0.8 0.4 0.4 6.3 0.4 47.1 |
|
Do you know the name of the drug used in
treatment? Yes No |
0 191 |
0 100 |
Table 4.4 Knowledge level about urinary schistosomiasis
among the study participants, Lang’ata, Mwanga, 2021[LEM15] [E16]
|
Variable |
Frequency (n %) |
S. haematobium positive |
Chi-square |
P-value |
|
Level of knowledge of school age children. High level Moderate level Low level |
1 (4) 40 (15.7) 214 (83.9) |
0 (0.0) 0 (0.0) 3 (1.4) |
0.582 |
0.748 |
4.5 Water, sanitation, hygiene, and
other risk factors associated with the transmission of urinary schistosomiasis
among school age children
Out of 255 school age children from Kagongo and
Bwawani primary schools, more than three quarter of them were using river water
as a source of water for washing clothes and utensils at home (85.1%), [LEM17] for
drinking (54.5%), for bathing (83.5%). Moreover, more than three quarter
(85.9%) of school age children had habits of swimming. Of 83.5% who had habits
of swimming, 76.3% had habits of swimming sometimes and the remaining 23.7% had
habits of swimming regularly, in addition, of 83.5% who had habits of swimming,
more than half (61.2%) had habits of using more than thirty minutes for
swimming activities. Also, [LEM18] 95.3% of
participants in this study reported to have toilet facilities at home, 59.2%
reported pit latrines as type of toilet used at their home setting. (Table
4.5)
As shown in table 4.5, most of the school
age children father’s occupation was non fisherman (53.3%), but high prevalence
of urinary schistosomiasis (1.7%) was recorded in school age children whose
father’s occupation was fisherman, this also applies to those whose mother’s
occupation was fish monger (3.7%). Of
all the risk factors assessed, neither of them was statistically significant.
Table 4.5 Water,
sanitation and other risk factors associated with transmission of urinary
schistosomiasis among study participants, Lang’ata, Mwanga, 2021
|
Variable |
Frequency (n %) |
S. haematobium positive |
Chi-square |
P-value |
95% CI |
|
Toilet facilities at home Yes No |
243 (95.3) 12 (4.7) |
3 (1.2) 0 (0.0) |
0.150 |
0.699 |
92.7-97.6 2.4-7.3 |
|
Type of toilet used Pit latrine Ventilated latrine Other type No toilet |
151 (59.2) 60 (23.5) 32 (12.5) 12 (4.7) |
2 (1.3) 0 (0.0) 1 (3.1) 0 (0.0) |
1.916
|
0.590 |
53.3-65.7 18-28.6 9-16.7 2.4-7.3 |
|
Source of water for washing clothes and utensils at home Public piped water Open well River water Protected spring
|
14 (5.5) 22 (8.6) 217 (85.1) 2 (0.8)
|
0 (0.0) 0 (0.0) 3 (1.4) 0 (0.0)
|
0.532 |
0.912 |
2.9-8.5 5.1-12.2 80.4-89.4 0.0-2.0
|
|
Source of water for drinking Public piped water Open well River water Protected spring |
68 (26.7) 38 (14.9) 139 (54.5) 10 (3.9) |
0 (0.0) 0 (0.0) 3 (2.20 0 (0)
|
2.533 |
0.469 |
20.8-32.8 11.0-19.6 48.6-60.8 1.6-6.5 |
|
Source of water for bathing Public piped water Open well River water Protected spring |
23 (9) 16 (6.3) 213 (83.5) 3 (1.2) |
0 (0.0) 0 (0.0) 3 (1.4) 0 (0) |
0.599 |
0.897 |
5.3-12.8 3.5-9.4 78.287.8 0.0-2.6
|
|
Habits of swimming Yes No |
219 (85.9) 36 (14.1) |
3 (1.4) 0 (0) |
0.499 |
0.480 |
81.2-90.2 9.8-18.8 |
|
Frequency of swimming Sometimes Regularly |
167 (76.3) 52 (23.7) |
2 (1.2) 1 (1.9) |
0.679 |
0.712 |
59.6-71.8 15.5-24.9 |
|
Average duration of swimming Less than 30 minutes More than 30 minutes |
85 (61.2) 134 (38.8)
|
0 (0.0) 3 (2.2) |
2.741
|
0.254 |
27.2-39.2 46.8-59.2
|
|
Parent’s occupation Father’s occupation Fisherman Non fisherman Mother’s occupation Fishmonger Farmer Housewife Others |
119 (46.7) 136 (53.3)
54 (21.2) 33 (12.9) 72 (28.2) 96 (37.7) |
2 (1.7) 1 (0.7)
2 (3.7) 0 (0.0) 1 (1.4) 0 (0.0) |
0.488
4.530 |
0.485
0.210 |
40.4-54 46-59.6
16.2-26.3 9-16.9 23.1-34.6 32.3-44.0 |
4.6 The uptake of praziquantel among
school age children in the last round of mass drug administration (MDA)
Majority (83.9%) of school age children reported to
have participated in the last round of mass drug administration (MDA). For
children who did not participate in the last round of mass drug administration, the leading reasons were; bad smell taste (44%) and fear of side effects
(24.6%).
There was a statistically significant association
between prevalence of urinary schistosomiasis with children who had never
swallowed praziquantel in the last round of mass drug administration (p=0.000)
and reasons for not taking praziquantel in the last round (p=0.000). (Table
4.6)
Table 4.6 Self-reported uptake of praziquantel among study
participants in the last round of MDA, Lang’ata, Mwanga, 2021 [LEM21]
|
Variable |
N (%) |
S. haematobium
positive |
Chi-square |
P-value |
|
Swallowed
praziquantel in the last round of MDA? Yes No |
214
(83.9) 41
(16.1) |
0 (0.0) 3 (7.3) |
15.845 |
0.000 |
|
Reasons
for not taking praziquantel in the last round? Absent
from school Parent
did not allow Fear of
side effects Bad
smell taste |
9 (22) 4 (9.6) 10
(24.4) 18 (44) |
0 (0.0) 0 (0.0) 1
(33.3) 2
(66.7) |
24.679 |
0.000 |
CHAPTER 05
5. DISCUSSION OF THE RESULTS
5.1 Introduction
This
chapter discusses the findings presented in the previous chapter based on study
objectives and questions. Thus, the discussion in this chapter will also focus
discussing the findings in relation to research objectives or questions.
5.2 Prevalence and associated transmission factors
of urinary schistosomiasis infections among school age children
Urinary
schistosomiasis remains as a major public health problem in Tanzania because of
extensive occurrence of ecological and socio-economic factors correlated with
the disease in many rural regions. (4)(17) This study confirmed the
presence of urinary schistosomiasis among school age children in Lang’ata,
Mwanga district, Kilimanjaro Tanzania with a prevalence of 1.2% in the study
area. This prevalence was low compared with previous study in the area, which
reported higher prevalence, 79.9%. (6) The decline in prevalence of the
disease discovered in the present study could be attributed to the effect of a
preventive praziquantel-treatment programme, initiated by the World Health
Organization in 2005, for school-aged children and high-risk groups in the
community. (2) This is similar to another study
done in 2020 in Kinondoni municipality in Dares Salaam, Tanzania, which
revealed a decline in prevalence of urogenital schistosomiasis among school
aged-children from 41.6% in 1992 to 1.2% in 2020. (16)
Finding
of this study revealed that urinary schistosomiasis did not significantly
associate with gender, although high prevalence of infection was reported in
males (1.7%) compared to females (0.7%), this is similar with other studies
such as that of K. Mohammed of Sokoto State Nigeria and Amaechi of Ebonyi
State. (7)(18) This shows that both male and
female sex are evenly exposed to the source of S. haematobium infection.
Moreover, the study found that, 12-15 age group had a higher prevalence of
infection (2.7%) when compared to 8-11 age group (0.6%), however statistically
was insignificant. The lack of significant association of urinary
schistosomiasis with age shows that regardless of age, all school age children
are equally exposed to cercariae contaminated water bodies.
5.3 Source of
domestic water supply
The study
revealed that majority of participants use river water as the main source of
water for washing clothes and utensils at home (85.1%), for drinking (54.5%)
and for bathing (83.5%). However, the findings
were not statistically significant (p>0.05). [LEM22] [E23] These findings are in contrast to the study on
biosocial determinants of persistent schistosomiasis among school children in
Tanzania despite repeated treatment, which reported that individual with access
to safe water had significantly lower odds of schistosomiasis. (3) In addition, the study done in
Bahi, Tanzania reported that, there was a huge chance of getting into contact
with unsafe water crowded with Bulinus species snail for those school
age children who use more than one source of water for domestic use, therefore
leading to continuity of Schistosoma haematobium infection. (2)
5.4 Knowledge
level about urinary schistosomiasis among school age children
Although
the majority (74.9%) of the study participants had heard about schistosomiasis,
the results showed that awareness about the symptoms among the participants was
generally poor. Majority of the study participants had heard about Schistosoma haematobium
infection because this study was conducted in an endemic area that is under
active control and prevention surveillance by the schistosomiasis national
control project. Nonetheless the majority of school children had heard about
schistosomiasis but the overall level of knowledge about urinary
schistosomiasis was low as more than three quarter (83.9%) of the study
participants had low level of knowledge. Our study revealed that all of the
infected children had low level of knowledge although not statistically
significant (p>0.05). This was
similar to findings of the study done in Kisumu City, Western Kenya. (11) Overall, these findings are not
in agreement with previous study from other schistosomiasis-endemic country,
Yemen. (19)
5.5 Occupation
of parent or legal guardian
The prevalence of urinary schistosomiasis was
higher among children whose parents were involved in fishing activities, as
shown in table 4.5 prevalence of 1.7% (40.4-54, 95% CI) was recorded to
school children whose fathers were fishermen and 3.7% (16.2-26.3, 95% CI) [LEM24] to
school age children whose mothers were buying and selling fish though the
results were not statistically significant (p>0.05). Children, especially
males tend to join their parents in their day-to-day activities and therefore
becoming exposed to Schistosoma haematobium infection as fishing
activities involve coming into contact with water. These findings are similar
to the findings of the study done in some rural communities in Southwestern
Nigeria. (8) Moreover, the findings are in contrast from the
study done in Cote d’ Ivoire where higher prevalence of infection was recorded
in study participants whose parents were farmers. (20)
5.6 Children habits and behaviors
The current study revealed that, majority (85.9%)
of the study participants had habits of swimming but it was intriguing to
notice high prevalence of Schistosoma haematobium infection among school
age children with the habit of swimming without significant association.
Similar results were reported in an earlier study in Kinondoni Municipality in
Dar es Salaam, Tanzania. (16) Regardless of the high prevalence of Schistosoma haematobium
infection with the habit of swimming, school age children swimming sometimes
but in longer duration of time reported for 76.3% while those swimming
regularly but in shorter duration of time reported for 23.7% of the current
total prevalence of urinary schistosomiasis. This finding shows that long
duration of hours to water contact was viewed as an important risk factor for
exposure to Schistosoma haematobium infection rather than frequency of
water contact, with similar results reported in Ethiopia. (9)
5.7 Availability and use of toilets in the
community
From the study, it was also found that most (95.3%)
of the study participants had toilet facilities at home. The study findings
revealed that, most of the affected school age children came from households
with pit latrine toilets. Possessing toilets at home did not prevent the study
participants from acquiring Schistosoma haematobium infection as there
are still other risk factors that expose them to infection. The current
findings are in conformity with other study findings in Tanzania and South
Africa, but there was no association with the disease. (16)(21)
5.8 Uptake of praziquantel for prevention of
urinary schistosomiasis
The uptake of praziquantel in the last round of
mass drug administration was statistically significantly associated with the
prevalence of Schistosoma haematobium infection among school age children.
(p=0.000). [LEM25] All of
the infected school age children self-reported not taking praziquantel in the
last round of mass drug administration with the leading reasons of not
participating being bad smell taste and absence from school during praziquantel
distribution. The side effects caused by praziquantel tends to affect
treatments coverage and treatment compliance (acceptance and swallowing) of
praziquantel during mass drug administration programs in endemic areas. (22) The current study findings are similar to the
study done in Tanzania and Ethiopia. (16)(23)
CHAPTER 06
6. CONCLUSION AND RECCOMENDATIONS
6.1 Conclusion
The current study showed the low prevalence of urinary
schistosomiasis among school age children in Lang’ata, Mwanga, Tanzania.
Despite the low prevalence it’s an indication of the ongoing transmission of
the disease in that endemic setting. The small group of students who never
swallowed the praziquantel could oppose the on-going efforts of W.H.O
preventive chemotherapy through praziquantel mass drug administration towards
Schistosoma haematobium infection and serve as reservoir of the
infection. Consequently, there is a need to highlight health education to both
the parents and children, concentrating on the importance of praziquantel
treatment in order to increase treatment coverage and treatment compliance
among school age children and therefore ensuring that no children are left
behind during mass drug administration.
6.2
Recommendations
Community mobilization approaches need to be
strengthened in order to reach non-attending or non-enrolled school age
children.
Also, in order to accomplish eradication strategy
of schistosomiasis, a very high treatment scope and compliance of praziquantel
at national, regional and local level is vital and additional control measures
such as biological snail control and behavioral change interventions will need
to be considered in endemic settings.
Moreover, adequate information regarding
praziquantel side effects and benefits of praziquantel mass drug administration
should be understandably communicated to school age children in order to
increase treatment compliance and treatment coverage as benefits of
chemotherapy outweigh the side effects.
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http://dx.doi.org/10.1016/j.jiph.2017.09.012
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13. Person B,
Ali SM, Kadir FMA, Ali JN, Mohammed UA, Mohammed KA, et al. Community
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Muhajir AEMA, Eshag HA, Alfadel A, Nahied E, Dahab R, et al. Prevalence
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CHAPTER
06
APPENDIXES.
Appendix 1: Questionnaire English version.
PREVALENCE
OF URINARY SCHISTOSOMIASIS AND ASSOCIATED TRANSMISSION FACTORS AMONG SCHOOL AGE
CHILDREN IN MWANGA DISTRICT, KILIMANJARO,
TANZANIA.
SECTION A: DEMOGRAPHIC INFORMATION
Date [D/M/Y] ____/_____/_____
ID Number __________________
Questions
- Name
_______________________________
- Sex (M/F) ___________
- Age ______
- Name of school
____________________
- Class (STD) ______
- Where do you live?
___________________________
SECTION B:
- After visiting toilet what are
you likely do?
a) Dress and leave
b) Wash hands with water only
c) Wash hands with water and soap
d) Wipe hands with tissue paper
e) Others, specify
_______________________
- If you are out in the field and
have need to respond call of nature, what are you likely do?
a) Find secure bush nearby area and do
what you need
b) Hide behind or in tall grass and do
what you need
c) Move fast to the closest village and
ask to use a toilet
d) Others specify
________________________
- If you do field activities
involving touching contaminated water, what are likely to do when finish?
a) Wipe my hands-on ground or grasses
b) Get water and wash hands
c) Wipe hands on my clothes
d) Others specify
_________________________
- If you find fruit under tree or
buying from shop, what you normally do?
a) Peeling by knife and eat
b) Eat without peeling
c) Wash the fruit and eat
d) Wash the fruit, hands and eat
e) Others specify ________________________
- If you swim, where you normally
go for swimming?
a) River
b) Swimming pool
c) Ocean
d) Pond
e) Others specify
________________________
- Which source do you obtain your
drinking water?
a) Public piped water
b) Open well
c) River water
d) Protected spring
- Which Source of water do you
use for bathing?
a) Public piped water
b) Open well
c) River water
d) Protected spring
- Which source of water do you
use for washing clothes and utensils at home?
a) Public piped water
b) Open well
c) River water
d) Protected spring
- Swimming
habits: Sometimes [ ]
Regularly [ ]
Average duration of
swimming
(Minutes)
What
is your father occupation?
What
is your mother occupation?
SECTION C:
- Have
you ever heard about urinary schistosomiasis?
a) Yes [ ]
b)
No [ ]
- Can
you mention signs and symptoms of urinary schistosomiasis?
a)
Blood in the urine
b)
Painful urination
c)
Fever
d)
Fatigue
e)
Malaise
f)
Chills
g)
Frequent urination
h)
Poor appetite
i)
Others
j)
Don’t know
- Within
the past six months have you suffered from urinary schistosomiasis?
a)
Yes [ ]
b)
No [ ]
- Were
you taken to the hospital?
a)
Yes [ ]
b)
No [ ]
If
the answer is no explain why?- Were
you given praziquantel drugs?
a)
Yes [ ]
b)
No [ ]
If
the answer is yes, mention the name of the drugs that was given?
Appendix 2 Questionnaire Swahili version.
KUANGALIA
UWEPO WA MAAMBUKIZI YA VIMELEA VYA KICHOCHO CHA MKOJO NA TABIA HATARISHI
ZINAZOHUSIANA NA MAAMBUKIZI YA KICHOCHO CHA MKOJO
KIFUNGU A:
Tarehe ____/_____/_____
Namba ya utambulisho
__________________
Maswali
- Jina _______________________________
- Jinsia
(Mme/Mke) ___________
- Umri
______
- Jina
la shule ____________________
- Darasa
______
- Unaishi
wapi? ___________________________
KIFUNGU B:
- Nini
unafanya baada kumaliza kujisaidia chooni?
a) Navaa nguo na kuondoka
b) Nanawa mikono kwa maji matupu
c)
Nanawa mikono kwa maji na sabuni
d) Nafuta mikono na tishu
e) Nyenginezo _______________________
- Ukiwa
upo mbali, umeshikwa na haja na unahitaji kujisaidia, unafanyaje?
a) Najisaidia katika kichaka kilichopo
karibu
b)
Najisaidia kwa kujificha katika majani
marefu
c)
Nakimbilia kijiji kilichopo karibu na
kuomba choo kujisaidia
d) Nyenginezo ________________________
- Ukicheza
michezo inayohusisha kuchezea maji machafu unafanya nini ukimaliza?
a)
Nafuta mikono katika majani au chini
b) Nanawa mikono
c) Nafuta mikono katika nguo
d) Nyenginezo _________________________
- Ukiokota tunda (embe) chini ya mti
au ukinunua, unafanyaje?
a) Namenya na kisu nakula
b) Nakula na maganda yake
c) Naosha kwanza kisha namenya nakula
d)
Nakosha tunda, nanawa mikono kisha
nakula
e) Nyenginezo ________________________
- Ukitaka
kuogelea, unaogelea wapi?
a) Mtoni
b) Swimingi puli
c) Baharini
d) Madimbwi
e) Nyenginezo ________________________
- Je maji ya kunywa mnapata kutoka
katika chanzo gani?
a) Bomba la jumuiya (mferejini)
b) Kisima
c) Mito
d) Chemchem
- Maji
katika chanzo gani unatumia kuogea?
a)
Bomba
la jumuiya (mferejini)
b)
Kisima
c)
Mito
d)
Chemchem
- Maji katika chanzo gani
mnatumia kuoshea nguo na vyombo?
a) Bomba la jumuiya (mferejini)
b) Kisima
c) Mito
d) Chemchem
- Tabia za
kuogelea: Mara kadhaa
[ ]
Mara kwa mara [
]
16.
Wastani wa muda wa kuogelea (Dakika)
Baba anafanya kazi gani?
Mama anafanya kazi gani?
SECTION C:
- Je ulishawahi kusikia ugonjwa
wa kichocho cha mkojo?
a)
Ndio [ ]
b)
Hapana [ ]
- Je waweza taja dalili za ugonjwa wa kichocho cha mkojo?
a)
Damu kwenye mkojo
b)
Maumivu wakati wa kukojoa
c)
Homa
d)
Kuchoka kwa mwili
e)
Unyonge
f)
Baridi
g)
Kukojoa mara kwa mara
h)
Kukosa hamu ya kula
i)
Nyenginezo
j)
Sijui
- Je ndani ya miezi sita
iliyopita, ulishawahi ugua kichocho cha mkojo?
a)
Ndio [ ]
b)
Hapana [ ]
- Je ulipelekwa hospitali?
a)
Ndio [ ]
b)
Hapana [ ]
Kama jibu ni hapana eleza kwanini!!- Je ulipata dawa za kuzuia kichocho cha mkojo?
a)
Ndio [ ]
b)
Hapana [ ]
Kama jibu ni
ndiyo taja jina la dawa ulipatiwa
Appendix 3: Consent form English
version.
MUHIMBILI UNIVERSITY OF HEALTH AND
ALLIED SCIENCES
DIRECTORATE OF RESEARCH AND
PUBLICATION
INFORMED CONSENT FORM
ID-NO: ………………………….
Consent to participate
in Study.
Greetings!
I’m Erick Innocent Kakore, the investigator of this research project which aim
to investigate the Prevalence of urinary schistosomiasis
and associated transmission factors among the school age children in Mwanga
District, Kilimanjaro, Tanzania.
Purpose of the study.
The
study is intended to collect information about the Prevalence of urinary
schistosomiasis and associated transmission factors among the school age
children in Mwanga District, Kilimanjaro, Tanzania.
What participation
involves.
Participation
in this study is voluntary and will involve answering of some questions and
taking a urine sample from your child to test for presence of schistosoma
haematobium infections. If the child fails to continue answering the questions,
he/she will be allowed to stop from participation. Failure to participate will
not interfere with any right of children in the school.
Confidentiality.
All
information provided will be kept confidential. Names of participants will not
be used in order to ensure the privacy and reliability of result.
Rights to Withdraw and
Alternatives.
You
have a choice to participate in the study and you can withdraw from
participating at any time even if you have already given your consent. Refusal
to participate or withdraw from the study will not involve penalty or rights to
get healthcare and school services.
Benefits.
The result will help children to
know their health on schistosoma haematobium infections and those infected will
be referred for treatment. Moreover, the findings will help to inform the
school health programs which will help in fighting against schistosoma
haematobium infections among school age children.
Who to Contact?
Any questions about this study you
may contact the principle investigator Erick Innocent Kakore, Tel +255 694
020802 or you may call Dr. Lwidiko Edward, Supervisor of this research, Tel
+255 712 865206.
Do you agree?
Yes………. No………..
I………………………………………………………have
read/listened the contents in this form. My questions have been answered. I
agree to participate in this study with my child.
Signature of participant………………………….
Date of signed consent………………………………….
Appendix 4: Swahili version of consent form.
CHUO KIKUU CHA AFYA NA SAYANSI
SHIRIKISHI MUHIMBILI
KURUGEZI YA UTAFITI NA MACHAPISHO
FOMU YA RIDHAA.
NAMBA
YA UTAMBULISHO: ……………………………
Ridhaa ya Ushiriki katika Utafiti.
Habari! Mimi ni Erick Innocent
Kakore ni mwanafunzi wa shahada ya kwanza ya utaalamu wa sayansi ya afya ya
maabara katika chuo kikuu cha afya na sayansi shirikishi Muhimbili. Ninafanya
utafiti kuhusu maambukizi ya kichocho cha mkojo. Vile kuangalia tabia hatarishi
zinazohusiana na maambukizi ya kichocho cha mkojo.
Dhumuni la utafiti
Utafiti huu umelenga kukusanya
taarifa kuangalia maambukizi na tabia hatarishi zinazohusiana na maambuzi ya
kichocho cha mkojo.
Ushiriki unahusisha nini
Ushiriki katika utafiti huu ni hiari
na utahusisha kujibu baadhi ya maswali na kuchukua sampuli ya mkojo kutoka kwa
mwanao kwaajili ya kupima ili kugundua uwepo wa minyoo. Kama mwanao atashindwa
kuendelea kujibu maswali, anaruhusiwa kuacha ushiriki wake katika utafiti huu.
Kutoshiriki kwake katika utafiti huu hakuwezi kuingilia na kugandamiza haki
zake za msingi hapa shuleni.
Usiri.
Taarifa zote utakazotoa katika
utafiti huu zitakuwa siri na majina ya mshiriki hayatatumika ili kuhakikisha
usiri wa taarifa zake badala yake itatumika namba ili kuhakikisha usiri wa
taarifa zote binafsi zitakazo tolewa.
Haki ya kujitoa na mambo mbadala.
Ushiriki wako
katika utafiti huu ni wa hiari, hivyo unayo haki ya kuacha kushiriki muda
wowote hatakama utakuwa umekubaliana na ridhaa ya ushiriki. Kukataa kushiriki
au kujibu swali lolote
hatakama
utakuwa umekubaliana na ridhaa ya ushiriki. Kukataa kushiriki au kujibu swali
lolote
hakuna adhabu
yoyote wala hautapoteza haki zako kama mshiriki na katika kupata huduma za afya
na za kishule pia.
Faida.
Majibu ya
vipimo vitakavyo chukuliwa yatarejeshwa kwa wanafunzi husika hivyo wanafunzi
wataweza kufahamu hali zao za kiafya kuhusiana na kichocho cha mkojo kwa
matibabu zaidi. Zaidi ya hayo utafiti huu utasaidia mradi wa afya mashuleni
kupambana na tatizo la kichocho mashuleni.
Mawasiliano.
Endapo utakuwa
na swali lolote kuhusu utafiti huu tafadhali wasiliana na mtafiti mkuu Erick
Innocent kakore namba ya simu 0694020802, au unaweza kuwasiliana na Dk. Lwidiko
Edward, msimamizi wa utafiti huu namba ya simu 0712865206.
Unakubali kushiriki?
Ndiyo………… Hapana……………
Mimi………………………………………………………..nimesoma/nimesikia
na kuyaelewa vizuri maelezo yaliyomo katika fomu hii. Maswali yangu yamejibiwa.
Ninakubali kushiriki katika utafiti huu pamoja na mtoto wangu.
Sahihi ya
mshiriki………………………..
Sahihi ya
Mtafiti………………………….
Tarehe ya
kusaini fomu ya ridhaa…………………………………………
Appendix 5: Sample collection form.
Date……………………………………………..
Participant
name…………………………………..............................
Participant
ID………………………………………………………...
Sample collected? YES [ ]
NO [ ]
Type of sample collected…………………………
Laboratory
Scientist Name……………………….
Signature………………….
Date………………………….
Appendix 6: Laboratory
form.
- Date……………..
- Sample number……………
- Sex………
- Age………
- Address ………………………
SAMPLE
ANALYSIS
Macroscopic……………………..
Microscopic: 1. Negative [ ] 2.
Positive [ ]
3. Parasites
seen ……………………………………….
Laboratory Scientist
Name…………………………………
Signature…………………… Date………………………
[LEM2]Its
actually undergraduate, graduate starts from masters and above.
[LEM3]Yu
should add also add results on the Related transmission factors, associations.
[LEM4]You
have not included prevalence of Schsito in your specific objectives.
[LEM5]You
may want to add year, when was this prevalence described?
[LEM6]Add
more details on selection of the schools.
[LEM7]Why
Oral ?
[LEM8]You
have not included knowledge ion your variables
[LEM9]This
seems rather impractical. You were sending samples every day ? for how long?
[LEM10]Were
the children given this questionnaire as self administered ama as interview?
Who filled the questionnaire, parents of children ?
[E11]As
interview Dr.
[LEM12]You
don’t discuss in the results section. Here you only present the results
[LEM13]Are
these three the only questions you asked about knowledge? I think there will be a problem especially
with the symptoms question. When you want to measure the level of knowledge, it
must be clear that there is a wrong and right answer. With this questions
response on symptoms of schisto seems to not have a clear cut between the wrong
and right answers, making it hard to gauge knowledge adequately
[E14]During
data collection of signs and symptoms, children circled the answers that they
know from ten possible correct alternatives and after that I measured their
level of knowledge from the knowledge SCORE scored by the student (though its
TRUE that my QN regarding knowledge were FEW) by designing knowledge SCORE
intervals (0-2 low level, 3-5 moderate level and 6-10 high level of knowledge)
[LEM15]Its
not clear how you measured and gauged knowledge
about schisto among participants.
[E16]It
is through the concept of knowledge SCORE interval that I explained in the
previous comment Dr.
[LEM17]This
is more than half, but also it is waaay more than half, 85% is very high, so
you may need to rephrase this sentence.
[LEM18]If
you say three quarters, it implies about 75%, but this Is 5% shy of 100%,
so rephrase that.
[LEM19]Whats
the P-value for these data?
[E20]I
tried to explain the concept of p value more in discussion of the results while
in results and findings section, I highlighted some few things that are found
in my tables of result.
[LEM21]Re
organize this table, the figures are not aligned
[LEM22]What
do you mean they were not statistically significant? Were you comparing
different groups?
[E23]Yes
Dr.
Comparison btn those who use unsafe source of water
(river water) Vs. those who use safe water sources.
[LEM24]Add
confidence internvals
[LEM25]Put
an actual P value
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