Surveillance and Monitoring component

A pilot study was conducted to assess a relationship between excreted urine-albumin and levels of morbidity associated with S. haematobium infection, as detected by ultrasound.

As part of the surveillance and monitoring component within the "Piga vita kichocho" programme, a pilot study was conducted to assess a relationship between excreted urine-albumin and levels of morbidity associated with S. haematobium infection, as detected by ultrasound. A collaborative study was conducted in Zanzibar with Dr Amadou Garba, SCI National Programme Co-ordinator, Niger, working together with Drs Russell Stothard and David Rollinson, Natural History Museum, U.K. in conjunction with the Helminth Control Laboratory Unguja field team.

The survey took place in 4 primary schools in northern Unguja: Mwera, Kilombero, Chaani and Kinyasini, where a total of 250 children were examined. Mass drug administration had taken place within these schools during 2004 and so intensity of infections was lighter than had been seen in 2003. Prevalence at both Chaani and Kinyasini, however, remained high and this clearly shows that transmission around these habitats has been stable and intense. As a consequence morbidity such as bladder-wall masses and ureter-irregularities could still be found.

To further investigate levels of morbidity within the adult community, a small walk-in cross-sectional survey of 60 adults took place at Chaani health dispensary. In many of the adults, moderate to severe bladder/kidney pathology could be seen, especially in those who had patent S. haematobium infections and no history of previous PZQ treatment. From a preliminary analysis of data, levels of excreted urine-albumin appeared to be a good proxy of lower urinary tract morbidity. The portable Hemocue urine-albumin photometer is a very good field-based assay and holds promise as a useful biochemical indicator of morbidity caused by urinary schistosomiasis.

The field study also provided a convenient platform for further hands-on experience and additional on-the-job training of 4 ultrasonographers from Unguja (Mr Khamis Adulrahman Simai and Mrs Salma Suleiman Seif) and Pemba (Mr Mahmoud Badru Ali and Mr Masoud Hassan Juma) who had previously attended the SCI ultrasound workshop in Mwanza earlier that year. Using the portable ultrasound machine on loan from the Tanzanian mainland, under the guidance of Dr Garba, a variety of typical upper and lower urinary tract morbidities were seen, assessed and recorded. It is hoped that ultrasound will play an important future role reassessing the morbidity burden of urinary schistosomiasis in Zanzibar.