Co-infection with Schistosoma haematobium and soil-transmitted helminths in rural South Africa

Mari Molvik; Elin Helland; Siphosenkosi G. Zulu; Elisabeth Kleppa; Kristine Lillebo; Svein G. Gundersen; Jane D. Kvalsvig; Myra Taylor; Eyrun F. Kjetland; Birgitte J. Vennervald

doi:10.17159/sajs.2017/20160251

Authors

Mari Molvik 1. Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark 2. Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway http://orcid.org/0000-0002-4567-678X
Elin Helland Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark http://orcid.org/0000-0002-0619-6265
Siphosenkosi G. Zulu Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa http://orcid.org/0000-0002-4996-8827
Elisabeth Kleppa 1. Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway 2. Faculty of Medicine, University of Oslo, Oslo, Norway http://orcid.org/0000-0002-7089-5343
Kristine Lillebo Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway http://orcid.org/0000-0002-4826-9071
Svein G. Gundersen 1. Research Department, Sorlandet Hospital, Kristiansand, Norway 2. Institute for Global Development and Planning, University of Agder, Kristiansand, Norway http://orcid.org/0000-0001-8474-6106
Jane D. Kvalsvig Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Myra Taylor Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa http://orcid.org/0000-0003-3087-2240
Eyrun F. Kjetland 1. Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases Ullevaal, Oslo University Hospital, Oslo, Norway 2. Discipline of Public Health Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa http://orcid.org/0000-0002-5552-1095
Birgitte J. Vennervald Parasitology and Aquatic Diseases, University of Copenhagen, Copenhagen, Denmark http://orcid.org/0000-0001-5721-3494

DOI:

https://doi.org/10.17159/sajs.2017/20160251

Keywords:

urogenital schistosomiasis, KwaZulu-Natal, Ascaris lumbricoides, Trichuris trichiura, schoolchildren

Abstract

Schistosomiasis and soil-transmitted helminthiasis are among the most prevalent neglected tropical diseases and may lead to severe consequences. We assessed the extent of co-infection between Schistosoma haematobium and the soil-transmitted helminths (STHs) Ascaris lumbricoides and Trichuris trichiura in schoolgirls in the rural areas of KwaZulu-Natal, South Africa. We also explored if S. haematobium can serve as a predictor for soil-transmitted helminths in this area. From 15 selected schools, 726 primary schoolgirls aged 10–12 years provided both urine and stool samples. The samples were examined for the presence of eggs using the urine sedimentation technique for S. haematobium and the Kato Katz technique for STHs. Pearson’s chi-square test was used to calculate the association and Spearman’s rank correlation was used for the correlation analysis. There was a highly significant correlation between S. haematobium and STHs at a school level (Spearman’s correlation coefficient =0.93; p<0.001). The prevalences were found to be 36.9% and 38.8% for S. haematobium and STHs, respectively. A significant association was found between S. haematobium and STHs (odds ratio =2.05; confidence interval =1.58–2.93; p<0.001). Indirect indicators of urogenital schistosomiasis (e.g. water contact and haematuria) were significantly associated with A. lumbricoides and T. trichiura infection. We have demonstrated a highly significant correlation and overall association between urogenital schistosomiasis and A. lumbricoides and T. trichiura. We cautiously suggest that all S. haematobium endemic areas should be treated for STH infections.

Significance:

The prevalences of urogenital schistosomiasis and soil-transmitted helminth infections were highly significantly correlated.
More than half (60%) of the investigated schools are in need of annual treatment for S. haematobium infection.
Almost half of the infected schoolgirls had a heavy intensity of S. haematobium infection.
Nearly all the schools investigated require treatment for soil-transmitted helminthiasis once or even twice per year.
This study can contribute to the epidemiological planning process of the deworming programme.