title: An extensive burden of giardiasis associated with intestinal schistosomiasis and anaemia in school children on the shoreline of Lake Albert, Uganda.
abstract: Water-borne parasitic diseases associated with poverty still blight the lives of African school children. In Uganda, intestinal schistosomiasis is still common along the shoreline of Lake Albert, despite ongoing control, and co-infection with giardiasis and malaria is poorly described. To shed light on putative interactions between diseases, a prospective cross-sectional parasitological survey was undertaken in five primary schools.
  
  
  
  Stool samples from 254 school children, aged 5-10 years, were examined by microscopy and rapid diagnostic tests (RDTs), with additional real-time PCR assays for detection of Giardia DNA. A finger-prick blood sample was also taken from each child and tested for malaria, and haemoblobin levels measured. Assocations between diseases and anaemia were assessed.
  
  
  
  Intestinal schistosomiasis (46.5%), giardiasis (41.6%) and malaria (56.2%) were common, and a quarter of children were anaemic (<115 g/L). Up to 87.0% of children were excreting Giardia DNA and the prevalence of heavy infection by real-time PCR (Ct≤19) was 19.5%, being positively associated with light, moderate and heavy egg-patent schistosomiasis, as well as with anaemia.
  
  
  
  In this setting, an extensive burden of giardiasis was revealed with heavy intensity infections associated with egg-patent intestinal schistosomiasis and anaemia. To improve child health, greater attention on giardiasis is needed along with exploring joined-up actions across diseases that promote better water hygiene and sanitation measures.
authors.affiliation: Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.|Ministry of Health, Asir District, Kingdom of Saudi Arabia.
authors.forename: Hajri
authors.initials: H
authors.lastname: Al-Shehri
authors.affiliation: Ministry of Health, Asir District, Kingdom of Saudi Arabia.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Stanton
authors.affiliation: Ministry of Health, Asir District, Kingdom of Saudi Arabia.
authors.forename: James E
authors.initials: JE
authors.lastname: LaCourse
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Aaron
authors.initials: A
authors.lastname: Atuhaire
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Arinaitwe
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Aida
authors.initials: A
authors.lastname: Wamboko
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Adriko
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.|Schistosomiasis Control Initiative, School of Public Health, Imperial College London, London W2 1PG, UK.
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.affiliation: Ministry of Health, Asir District, Kingdom of Saudi Arabia russell.stothard@lstmed.ac.uk.
authors.forename: J Russell
authors.initials: JR
authors.lastname: Stothard
mesh_terms: D000740:Anemia / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D000818:Animals; D002648:Child; D060085:Coinfection; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology*; D005260:Female; D005873:Giardiasis / Q000453:epidemiology* / Q000517:prevention & control; D015438:Health Behavior; D006801:Humans; D060106:Lakes / Q000469:parasitology; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012499:Sanitation / Q000592:standards*; D012555:Schistosomiasis mansoni / Q000453:epidemiology* / Q000517:prevention & control; D012572:School Health Services; D012574:Schools; D014454:Uganda / Q000453:epidemiology
keywords: Co-infection; Control; Epidemiology; Giardia; Plasmodium; Schistosoma