title: Schistosoma haematobium and soil-transmitted Helminths in Tana Delta District of Kenya: infection and morbidity patterns in primary schoolchildren from two isolated villages.
abstract: BACKGROUND
  Schistosomes and soil-transmitted helminths (STH) (hookworm, Trichuris trichiura and Ascaris lumbricoides) are widely distributed in developing countries where they infect over 230 million and 1.5 billion people, respectively. The parasites are frequently co-endemic and many individuals are co-infected with two or more of the species, but information on how the parasites interact in co-infected individuals is scarce. The present study assessed Schistosoma haematobium and STH infection and morbidity patterns among school children in a hyper-endemic focus in the Tana River delta of coastal Kenya.
  
  
  METHODS
  Two hundred and sixty-two children aged 5-12 years from two primary schools were enrolled in the study. For each child, urine was examined for S. haematobium eggs and haematuria, stool was examined for STH eggs, peripheral blood was examined for eosinophilia and haemoglobin level, the urinary tract was ultrasound-examined for S. haematobium-related pathology, and the height and weight was measured and used to calculate the body mass index (BMI).
  
  
  RESULTS
  Prevalences of S. haematobium, hookworm, T. trichiura and A. lumbricoides infection were 94, 81, 88 and 46 %, respectively. There was no significant association between S. haematobium and STH infection but intensity of hookworm infection significantly increased with that of T. trichiura. Lower BMI scores were associated with high intensity of S. haematobium (difference =-0.48, p > 0.05) and A. lumbricoides (difference =-0.67, p < 0.05). Haematuria (both macro and micro) was common and associated with S. haematobium infection, while anaemia was associated with high intensity of S. haematobium (OR = 2.08, p < 0.05) and high hookworm infections OR = 4.75; p < 0.001). The majority of children had eosinophilia, which was significantly associated with high intensity of hookworm infection (OR = 5.34, p < 0.05). Overall 38 % of the children had ultrasound-detectable urinary tract morbidity, which was associated with high intensity of S. haematobium infection (OR = 3.13, p < 0.05).
  
  
  CONCLUSIONS
  Prevalences of S. haematobium and STH infections among the primary school children were high and the parasites were responsible for significant morbidity. A clear synergistic interaction was observed between hookworm and T. trichiura infections. Increased coverage in administration of praziquantel and albendazole in the area is recommended to control morbidity due to these infections.
authors: Department of Medical Microbiology, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya. kn@uonbi.ac.ke.
authors: Kariuki H
authors: KH
authors: Njaanake
authors: Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark. bjv@sund.ku.dk.
authors: Birgitte J
authors: BJ
authors: Vennervald
authors: Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark. pesi@sund.ku.dk.
authors: Paul E
authors: PE
authors: Simonsen
authors: Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark. hmad@sund.ku.dk.
authors: Henry
authors: H
authors: Madsen
authors: Division of Vector Borne & Neglected Tropical Diseases, Ministry of Public Health & Sanitation, P.O. Box 54840-00202, Nairobi, Kenya. Dunstan.Mukoko29@gmail.com.
authors: Dunstan A
authors: DA
authors: Mukoko
authors: Centre for Biotechnology Research & Development, Kenya Medical Research Institute, P. O. Box 54840-00200, Nairobi, Kenya. kgachuhi@kemri.org.
authors: Gachuhi
authors: G
authors: Kimani
authors: Department of Medical Microbiology, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya. Wjaoko@kaviuon.org.
authors: Walter G
authors: WG
authors: Jaoko
authors: Jaramogi Oginga Odinga University of Science and Technology, P. O. Box 210-40601, Bondo, Kenya. bestambale@uonbi.ac.ke.
authors: Benson B
authors: BB
authors: Estambale
mesh_terms: D015766:Albendazole / Q000627:therapeutic use; D000723:Ancylostomatoidea / Q000302:isolation & purification; D000740:Anemia; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D017164:Ascaris lumbricoides / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D005243:Feces / Q000469:parasitology; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use; D015995:Prevalence; D012548:Schistosoma haematobium / Q000302:isolation & purification*; D012553:Schistosomiasis haematobia / Q000188:drug therapy / Q000453:epidemiology*; D012574:Schools; D012987:Soil / Q000469:parasitology; D014258:Trichuris / Q000302:isolation & purification
chemical_list: D000871:Anthelmintics; D012987:Soil; D011223:Praziquantel; D015766:Albendazole