The Prevalence of Schistosomasis among People in Almatama locality River Nile State, Sudan

The discovery of Schistosoma parasites in humans was in 1851 by Dr. Theodor Bilharz in Cairo, and the demonstration of their life cycle by Dr. Robert T. Leiper in Egypt in 1915 ¹. The great interest of European archeologists and historians in Egypt and the relative neglect of other civilizations in Africa also contributed to the view that Schistosomasis and several other infectious diseases originated in the lower Nile valley ². Schistosomasis disease is widely prevalent among waterborne diseases and is considered next to malaria, affecting more than 74 countries and 200 million people with 600 million people being exposed to the infection ³. Urinary Schistosomasis is caused by Schistosomasis haematobium and intestinal Schistosomasis by any of the organisms S. intercalatum, S. mansoni, S. japonicum, and S. mekongi ⁴. Life cycle: Schistosomasis is a parasitic infection leads to chronic ill health. Infection is acquired from contaminated freshwater containing the larval forms (cercariae) of blood flukes, known as Schistosomasis. The centimeter long worms mature in the human bladder and intestines, laying eggs that can cause massive damage. Once released by the body in to water through feces and urine, the eggs hatch and their larvae (miracidia) penetrate suitable snail hosts. The cercariae emerge from the snail into water from where they penetrate a human host within seconds, thereby perpetuating the life cycle ⁵. Signs and symptoms: Disease due to schistosomiasis depends on the infecting species and the intensity of infection. Acute Schistosomasis occurs 2 to 12 weeks post infection and symptoms last for periods varying from 1 day to a month or more; recurrence of symptoms 2 or 3 weeks later is common. Between 40% and 95% of individuals not previously exposed to infection develop symptoms which include fever, malaise, headache, abdominal pain, diarrhea and urticaria. Many have eosinophilia. After the initial acute onset, most become asymptomatic, although those with S haematobium infections may develop microscopic or macroscopic haematuria. Rare complications result from ectopic deposition of eggs in the spinal cord and brain. Most travelers are only lightly infected and are therefore often asymptomatic and unlikely to develop the severe manifestations of chronic schistosomiasis. Severe disease occurs in patients with heavy and prolonged infection. Hepatosplenomegaly, portal hypertension, ascites and oesophageal varices may result from intestinal schistosomiasis, and frank haematuria with varying degrees of impairment of the urinary bladder and ureters may occur with S haematobium infections ⁶. Laboratory diagnosis is based on demonstrating the presence of parasite eggs in feces either by sedimentation techniques or by duodenal probe. Opisthorchis eggs are rather heavy and do not float readily in a saturated solution of sodium nitrate. of the immunologic tests, enzyme-linked immune sorbent assay (ELISA) is used most often. Assays to detect circulating antibodies for . Viverrini have shown moderately high sensitivity (91% to 92%), but specificity of opisthorchiasis 137 only 70% to 80%. viverrinimetabolic antigen in stool samples yielded slightly greater sensitivity than the observation of eggs in feces and proved to be capable of detecting infections on the basis of a single specimen ⁷. The prevalence, intensity of infection, and transmission intensity of schistosomiasis is determined by numerous factors including socio-economic, human behavior, ecology and biological factors which influence the interactions between human and animal hosts and life cycle stages of the parasites. Human water contact behaviors and transmission patterns .The various permanent and temporal water bodies existing in the country contribute significantly to the eco epidemiological transmission of schistosomiasis ⁸. The goal for the control of Schistosomasis of attaining a minimum target of regular administration of chemotherapy to at least 75% and up to 100% of all school-age children at risk of morbidity by 2010 . They have also indicated that WHO approach to combating should include “advocating new partnerships with organizations of the United Nations system, bilateral agencies, nongovernmental organizations and the private sector, and by continuing to provide international direction and coordination". January 2010 estimates indicate that less than 10%of the population at risk of morbidity receives praziquantel (PZQ) preventive chemotherapy ⁹. Prevention and Control of Schistosomasis and Soil-transmitted helminthiasis, can be prevented through the Creation of alternative, safe water sources to reduce infective water contact, proper disposal of feces and urine to prevent viable eggs from reaching bodies of water containing snail hosts, health education, information and communication to promote early care-seeking behavior, use of safe water and proper disposal of excreta, environmental management reduction of snail habitat and snail contact ¹⁰.

This is a descriptive cross sectional community based study in Almatama locality River Nile State Sudan 2017, the study included resident people in Almatam locality, and their number is 151889. Multistage cluster sampling was used, the sample size was drawn by the flowing equation n = z².p.q/d².def×2= 500 person.

The prevalence of Schistosoma haemetoium was 15% and mansoni was zero (Table 1, Table 2, Table 3, Table 4, Table 5)

In this research it was found that the prevalence of Schistosomasis haematobium was 15% and mansoni was zero because the intermediate host for mansoni (bimoplalria) was rarely found in the study area. This result agrees with study that was conducted in Shendi locality among children the prevalence was 33.3% (Omya, 2014)

The study found that the prevalence was high among males (with 10.8%) than females (with 4.2%), this may be the males had frequently contact with stagnant water and work in agricultural projects, this result agrees with the Study conducted in Elkriab primary school, near ELslait irrigation scheme Sudan. 97 children (64 male and 33 female) infected with S. haematobium (Elagba. et al, 2006) -The study found that the age group ( 15 to 25) had high prevalence of 5.8%, this result agrees with a study which was carried out about the prevalence of Schistosomasis among primary school children in Barakat (Gazira state) age group greater than 15 years with 26.1% infection (Elawad,2006), also agrees with (Elsevier, 2006)

The prevalence of Schistosomasis hematoupium was 15% while Schistosomasis mansoni was Zero in Almamtama locality, The prevalence was high in Tibha administration unit with (6.0%), In Almatama unit (5.2% ), The study found that there was strong relationship of Schistosomasis prevalence and gender, It was high among males (10.8%) than females (4.2%) with strong significant association (PV=0.001), The study showed there was strong relationship between Schistosomasis and age groups, the prevalence increased among age group (15 to 25 years) (5.8%) and ( PV: 0.025)

1. The Public health authorities at localities are conducted effective health education programs on Schistosomasis.

2. The ministry of health is recommended provide free treatment for infected persons.

3. Encourage people to early diagnosis and treatment, for Schistosomasis.

4. Health authority of locality recommended to establishing an effective surveillance system to monitor the disease.

5. Shendi University is recommended to and cooperative with health authorities to raise the awareness for prevention and control of the disease.

The authors wish to deeply thank all regional and local health authorities in Almatama locality for their work in Schistosomasis programs, we also thank, my Supervisor: Professor Abdel Gaffer Ali Adam professor of community medicine and international health

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