Description

ABSTRACT

The efficacy of artesunate in the treatment of urinary schistosomiasis was assessed among school children aged 5-16 years. Urine samples from 367 primary school children were examined for ova of Schistosoma haematobium. Using standard parasitological procedures (filtration method), S. haematobium ova was found in the urine samples of 29(7.9%) pupils. High infection rates of 16.0% and 13.2% were recorded in two primary schools with an overall egg output of 10.55 eggs/10mls urine (geometric mean). The prevalence was higher in the males (10.10%) than in the females (5.0%) and among the 12-16 years age group (15.1; p<0.05). Infected pupils who reported for treatment were given oral dose of artesunate (4mg/kg/day) for 3 days. When the treated children were examined 2 weeks post treatment, the intensity reduced to 1.59eggs/10ml urine and the drug had an 85.12% egg reduction and efficacy rates. The treatment regimens were well tolerated. This study confirmed that the treatment of urinary schistosomiasis with artesunate is safe and effective but its widespread use for the treatment of schistosomiasis has to be considered carefully so that it does not compromise the efficacy of the drug as an anti-malaria and thereby increasing the risk of resistance developing in local Plasmodium.

Keywords: Urinary schistosomiasis, school children, artesunate

CHAPTER ONE

1.0                                                                   INTRODUCTION

1.1                                                     BACKGROUND OF THE STUDY

Schistosomiasis is a serious debilitating, sometimes fatal parasitic disease. It is the second most prevalent tropical disease in Africa after malaria and of great public health and socio- economic importance in the developing world (WHO, 2002). The first obvious symptom of the infection is blood in the urine. Early signs of morbidity common to the infection and which manifest in school age children are anaemia, impaired growth, and development, poor cognition and substandard school performance (Cetron et al., 1996). The late and life threatening consequences of schistosomiasis include bladder cancer or serious kidney malfunction caused by S. haematobium, and severe complications of the liver and spleen in the case of intestinal schistosomiasis (Cheesbrough, 2002).

Globally up to 120 million of the estimated 200 million infected people are believed to be symptomatic and as many as 20 million may well be suffering severe consequences of this infection. The annual deaths associated with schistosomiasis are estimated at 20,000 while about 500-600 million people worldwide are at risk (WHO, 2001). Nigeria is one of the countries known to be highly endemic where it is reported to affect all the 36 states of the country including Abuja.

There is yet no vaccine available for the prevention of schistosomiasis. The current mainstay of control is chemotherapy with praziquantel which is given as a single oral dose against all human schistosome parasite (WHO, 2002). Recently, Borrman et al (2001), Inyang- Etoh et al (2004) and Inyang- Etoh et al (2005) have variously studied the efficacy of the artemisinin derivatives (well known for its anti-malarial properties) for the treatment of all human schistosomiasis. Some compounds exhibiting activities against the young developmental stages of the parasites are relevant as praziquantel is ineffective in this area (Cioli, 2000).

Artesunate has also been used in human to obtain cure and egg count reduction against Schistosoma species infection. Report on the efficacy of artesunate in the treatment of urinary schistosomiasis is scarce especially in Nigeria and Anambra state in particular.

1.2                                                           PROBLEM STATEMENT

Schistosomiasis is one of the most prevalent helminthic infections in the world. In mid-2003, the population at risk was estimated to be 779 million individuals, and more than 200 million people were infected.1 This parasitosis affects people living in tropical and subtropical areas of Africa – Nigeria. Schistosomiasis is acquired through the skin by contact with cercariae while bathing or wading in fresh water. Chronic infection in endemic areas is associated with liver and intestinal disease (Schistosoma mansoni, Schistosoma intercalatum, Schistosoma japonicum, and Schistosoma mekongi) or kidney and bladder dysfunction (Schistosoma haematobium).

Urinary schistosomiasis is an important cause of morbidity in Africa. It is normally acquired during childhood and up to 60% of schoolchildren have been found to be infected in some settings, even an 80% prevalence has been reported, indicating that schoolchildren is one of the most, if not the most affected group by chronic urinary schistosomiasis (Ahmed et al., 2019). Chronic infection can lead to chronic anemia, undernutrition, reduced exercise tolerance, and loss of performance (King et al., 2015). Schistosomiasis was responsible for the loss of at least 13–15 million disability-adjusted-life-years in 2004 (King et al., 2010). Moreover, squamous cell carcinoma of the bladder is a well-known complication and has been reported as the most frequent cancer in endemic areas (Mostafa et al, 2019).There are many Urinary schistosomiasis treatment. It would be more cost-effective to treat urinary schistosomiasis with artesunate. The potential efficacy of artesunate derivatives led us to study the role of these drugs in the treatment of urinary schistosomiasis.

1.3                                              AIM AND OBJECTIVES OF THE STUDY

The main aim of this work is to access the efficacy and tolerability of oral artesunate for the treatment of urinary schistosomiasis was assessed among. The objectives of this study:

1. To determine the effectiveness of artesunate in treatment of urinary schistosomiasis
2. To study the chemical composition of artesunate

• To determine the prevalence of urinary schistosomiasis among children.

1.4                                                     SIGNIFICANCE OF THE STUDY

This study will bring a clear understanding of the efficacy of artesunate in the treatment of urinary schistosomiasis to drug distributor, producers and consumers. This study will serve as a means of promoting the general use of artesunate.

1.5                                                            RESEARCH QUESTION

1. What are the symptoms of urinary schistosomiasis?
2. How do one get urinary schistosomiasis?

• If artesunate in the treatment of urinary schistosomiasis effective?

1. Can you see schistosomiasis in urine?
2. Can urinary schistosomiasis be cured with artesunate?

 

1.6                                               SCOPE / LIMITATION OF THE STUDY

There are many means and different drugs for the treatment of treatment of urinary schistosomiasis. However, this work covers the efficacy of artesunate urinary schistosomiasis at MUBI South Adamawa State. From the study, Urine samples from primary school children were examined for ova of Schistosoma haematobium. Using standard parasitological procedures (filtration method).