Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic.
BACKGROUND
Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis.


METHODS
Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data.


RESULTS
From 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value < 0.05) with increased probability of experiencing two or more lifetime episodes of UGIB in our study.


CONCLUSIONS
Upper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.
Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
Christopher Kenneth
CK
Opio
Bishop Stuart University, Public Health Department, P.O.Box 9, Mbarara, Uganda.
Francis
F
Kazibwe
Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
Ponsiano
P
Ocama
Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
Lalitha
L
Rejani
Kazan University, Russian Federation.
Elena Nikolaevna
EN
Belousova
Pakwach Health Centre IV, Ministry of Health, Pakwach, Uganda.
Paul
P
Ajal
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D003430:Cross-Sectional Studies; D019353:Endemic Diseases; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012424:Rural Population; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012552:Schistosomiasis / Q000150:complications / Q000453:epidemiology*
Sub-Saharan Africa; Upper gastrointestinal bleeding; hepatic schistososomiasis