Urogenital Schistosomiasis in Pre-school Children in Mutoko District

Abstract

Prevalence of schistosomiasis is high among children in Zimbabwe, but not so much defined among children under five years. Schistosomiasis control efforts over time have included periodic mass treatments in endemic areas for adults and school going children aged 6 years and above. This study explores risk factors associated with schistosomiasis infection among pre-school aged children aged 2 - 6 years. A matched case-control study design was employed. A mixed approach with both quantitative and qualitative approaches components was conducted using a structured questionnaire to conduct in-depth interviews with 62 caregivers of children aged 2 - 6 years who had been screened for schistosomiasis in a clinical trial between October and December 2020. Prevalence was calculated using secondary data from the screening registers which were used in the main clinical trial. The study was conducted in Mutoko District, Mashonaland Central in Zimbabwe. It is one of the areas known to have high prevalence of schistosomiasis. Data were anonymized, captured into Epi-info form and analyzed using Epi-info. Based on the urine filtration and microscopy technique, there was an overall schistosomiasis prevalence of 4.6%, [95% CI (4.22-4.98)], (4.96 % in males and 4.12% in females) among preschool children aged between 2 – 6 years for the period October to December 2020 in Mutoko District. There were equal number of male and female participants with median and modal age being 4 years. Caregiver lack of knowledge about schistosomiasis scientifically proved to be the major risk factor with an odds ratio of 10.9 (1.73-68.54) and p-value; 0.01, among those who showed to lack of any correct information about the disease. Some caregivers concurrently had mixed right and wrong information. The children in this study could have contracted schistosomiasis through the contact with infested water during activities such as gardening (OR: 1.8, p-value 0.5), bathing (OR: 3.2, p-value 0.21) and recreational activities (OR: 4, p-value 0.14). 88.7% of the children were reported to be frequently visiting the open water bodies accompanied by adults or elder siblings (80.6%) and sometimes alone (8.1%) especially the older pre-school aged children. The study revealed that staying near the dams/river was also a risk factor for schistosomiasis infection. There was an odds ratio of 1.4, among children who use dam or river water for bathing compared to 0.12 among those who used water from protected wells. No scientific evidence was observed to link type of sanitary facilities type of toilet and sharing of toilets with schistosomiasis infection. Based on the urine filtration and microscopy technique, there was a moderate prevalence of schistosomiasis infection among pre-school aged children. Pre-school children age 2 - 6 years were at a high risk of exposure to schistosomiasis although it might be lower than in other groups as the latest national survey results indicated prevalence of 22.7% among school going children and adults. There is need for prevention interventions to target children in their early stages of life to control schistosomiasis in this vulnerable population.