1 year follow-up in Hoima & Mayuge

At the end of July, the first round of 1 year post-treatment follow-up was completed in Hoima and Mayuge districts, marking the successful end of fieldwork operations for longitudinal monitoring for the period 2003/2004.

At the end of July, the first round of 1 year post-treatment follow-up was completed in Hoima and Mayuge districts, marking the successful end of fieldwork operations for longitudinal monitoring for the period 2003/2004.

Image: Children with their SCI treatment cards given to them the previous year

Hoima: Lake Albert

During June a total of 5 primary schools and 2 adult communities were visited along the shoreline of Lake Albert. To enable the 1 year follow-up take place in Tonya primary school, SCI would like to acknowledge the help of the Hoima District Medical Office by provision of their launch which ferried the 24 person VCD team, together with Dr Russell Stothard and Ms Poppy Lamberton, from the lakeside camp at Kibiiro. With its immediate proximity to the lake, and associated water meadows harboring numerous Biomphalaria, Tonya is a village hardest hit by schistosomaisis making it one of the severest locations for transmission of S. mansoni in Uganda.

The remote and beautiful nature of this lakeside plain does little to hide the associated morbidity of schistosomiasis, often commonly seen in young children with obvious hepatosplenomegaly. Daily life along this shoreline is replete with impoverishment and itinerancy, yet many families continue to survive and coalesce upon the Lake Albert fishery. The low recovery of the original 2002/2003 below the escarpment is best interpreted in light of this whole families move in search of fish. Above the escarpment cohort recoveries were higher likely attributable to the greater expanse of cultivated crops which better ‘binds’ people to the land.

For those children & adults examined, there were many positive changes associated with treatment. Indeed compliance with a 2nd treatment was excellent and side-effects were now minimal. Whilst in Hoima, Russell & Poppy also collected miracidia of S. mansoni from several people for subsequent DNA characterization by PCR.

Mayuge district: Lake Victoria

After splitting from Iganga, the newly created Mayuge district has extensive shoreline on Lake Victoria and work continued in 5 schools and 2 adult communities during July. Whilst the lakeshore is less dramatic than Lake Albert, the conditions along are no less impoverished and schistosomiasis continues to be a major scourge of the local population. During this survey the VCD team was also accompanied by Russell and Poppy as well as two M.Sc. research students from the London School of Hygiene and Tropical Medicine, Ms Emily Robinson and Sarah Odogwu, as part of their degree.

Over the two weeks while the main team was in Mayuge, Emily and Poppy performed a detailed study of the dynamics of S. mansoni egg clearance following from anthelmintic treatment and longevity of S. mansoni miracidia in known titrations of praziquantel. While this was ongoing Russell and Sarah investigated the occurrence of S. mansoni infections in pre-school age children at two locations, Bwondha & Bogoto, along the lake. Owing to the peculiarities of the shoreline of Bugoto where sanitation was very poor, the lake very shallow (< 10cms) and Biomphalaria in great abundance, patent S. mansoni infections were found in children as young as 9 months old. On the other hand none was seen at Bowndha where the transmission was perhaps less conducive.

Initial analytical findings from 8 districts

A total of 4354 children across 37 schools which are acting as sentinel locations for the evaluation of treatment on morbidity and general health indicators have been examined at baseline, and 65% of them 1 year post-treatment. The children have been given a 2nd round of anthelmintic treatment and will again be re-examined in 1 year - starting again in October 2004 in Masindi, Nebbi, Arua, Moyo districts.

From initial inspection of the data there is much to be pleased with: we have seen a tangible improvement in the awareness of Bilharzia in nearly all schools visited, a reduction in the levels of severe anemia and organomegaly, liver ultrasound measures associated with pathology and more importantly good reductions in faecal egg counts of ‘individuals’ as well as within ‘means’ calculated by sex, ageclass, schools & districts as well as reductions in point prevalences.

By basing our data collection on an individual basis we can quickly pinpoint any anomalies in our data for either biometric scores or faecal egg counts. For example, we can identify the children in our database whose faecal egg count appears to have increased after one year and contrary to expectation. By having a detailed record of the children who experienced side-effects e.g. vomiting, as well as markers of ‘unsafe’ water contact we can quickly resolve such ambiguities.