ABSTRACT
A study
on the efficacy of artesunate in the treatment of urinary schistosomiasis at
Umuikwu- Anam community, Anambra West Local Government area was carried out
between November 2008 and June 2009. Urine samples from 471 primary school
children were examined for ova of Schistosoma haematobium . Using
filtration method, S. haematobium ova was recorded in the urine samples
of 72(15.3%) pupils. The prevalence of 34.4% and 28.2% were recorded in two
primary schools with an overall egg output of 7.63 eggs/10mls urine (geometric
mean). The prevalence was significantly higher in the males (18.2%) than in the
females (11.3%) and among the 11-13 years age group (25.6%; p < 0.05).
The intensity was also significantly higher among the males (48) and 5-10 years
age group (39). Infected pupils who reported for treatment were divided into
three groups ;oral doses of praziquantel (40mg/kg-single dose), artesunate
(4mg/kg/day) once a day for 3 days and a combination of praziquantel and
artesunate respectively. When the treated children were examined after 2weeks,
praziquantel had the highest egg reduction rate of 92.63%, combined therapy of
artesunate and praziquantel had egg reduction rate of 90.22% while artesunate
had a 72.86% egg reduction rate. There was significant difference in the treatment regimen
and all the treatments were significantly effective (P < 0.50). All the
treatment regimen were well tolerated.
CHAPTER ONE
INTRODUCTION
Schistosomiasis, is
a disease caused by a blood fluke of the genus Schistosoma. It is a
serious debilitating and sometimes fatal parasitic disease. The disease is
endemic in about 74 countries in Africa, Asia and North America (WHO, 1999).
Adult schistosomes live in a mammalian host.
Schistosomiasis is
the second most prevalent tropical disease in Africa after malaria and is of
great public health and socio- economic importance in the developing world
(WHO, 2002). The first obvious symptom of the infection is blood in the urine.
Early signs of morbidity common to the infection and which manifest in school
age children are anaemia, impaired growth, and development, poor cognition and
substandard school performance (Cetron et al, 1996). The late and life
threatening consequences of schistosomiasis include bladder cancer or serious
kidney malfunction caused by S. haematobium, and severe complications of
the liver and spleen in the case of intestinal schistosomiasis (Cheesbrough,
2002).
Five major
species of schistosomes namely; S.mansoni, S. haematobium, S. intercalate,
S.japonicum and S. mekongi infect man. Schistosoma mansoni originated
in Africa, S. haematobium and S. intercalatum are confined to
Africa while S. japonicum and S. mekongi are found only in the
Far East, in China and the Phillipines (Cetron et al,1996).
Light infections
with schistosomiasis can be asymptomatic and many people may live their lives
without knowing they have ever been infected. Globally up to 120 million of
the estimated 200 million infected people are believed to be symptomatic and as
many as 20 million may well be suffering severe consequences of their
infection. The annual deaths associated with schistosomiasis are estimated at
20,000 while about 500-600 million people worldwide are at risk (WHO,2001),
There is yet no
vaccine available for the prevention of schistosomiasis. The current mainstay
of control is chemotherapy with praziquantel which is given as a single oral
dose against all human schistosome parasite (WHO, 2002). However, some
compounds exhibiting activities against the young developmental stages of the
parasites are relevant as praziquantel is ineffective in this area (Cioli,
2000). Recently, Borrman et al,(2001), Inyang- Etoh et al, (2004)
and Inyang- Etoh et al, (2005) have variously studied the efficacy of
the artemisinin derivatives for the treatment of all human schistosomiasis.
Significant advances have been made with artemether and artesunate (which are
already effectively used in the treatment of malaria) as having prophylactic
effect on schistosome (Xiao et al,2002). Artesunate has also been used
in human to obtain cure and egg count reduction against Schistosoma
species infection. Praziquantel and artemisinin derivatives display a broad-
spectrum anti- schistosomal activities and the susceptibilities of the
different stages to the two drugs are different. It had been suggested that the
use of these two compounds in combination might be beneficial for the treatment
of infections caused by all human schistosome species (Utzinger et al,
2003). Hence the use of the combination may increase the worm burden reductions
and as a consequence, augment cure and egg reduction rates (Utzinger et al,
2003). Reports on the efficacy of artesunate in the treatment of urinary
schistosomiasis is scarce especially in Nigeria and Anambra state in particular
where there is serious effort in
eradicating the disease. Such studies have never been done in the Anam area
where there is high prevalence rates in most of the communities.
OBJECTIVES
This study seeks to
determine the efficacy of artesunate in the treatment of urinary schistosomiasis
in 5-16 years old primary school children in Umuikwu Anam, Anambra West Local
Government area of Anambra state.
Specifically,
the study will:
1.Determine the
prevalence of S. haematobium infection among the primary school children
in Umuikwu- Anam.
2.Assess the
efficacy of artesunate on the parasite through determination of egg production
before and after administration
3.
Compare the
efficacy of artesunate with that of praziquantel (the drug of choice) on the
parasite through determination of egg production before and after drug
administration.
Assess the tolerability of the drugs in the
treatment of S. haematobium.
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