Schistosoma haematobium Infection in School Children and Women of Reproductive Age: the Effect on Anaemia, Blood Patho-physiological Changes in Selected Parts of Kwale, Kilifi and Birth Weight Outcomes in Tana River, County, Coast Province, Kenya

Abstract

In Kenya Schistosoma haematobium is predominantly prevalent in Coastal region. In the present study, comparing diagnosis of Schistosoma haematobium using blood in urine questionnaire and urine filtration (egg counts) revealed prevalence by both methods of between 0 and 91.3% in school children in Coastal region of Kenya. Using a threshold of 30% reported blood in urine to identify high (>50%) schools, yielded a sensitivity of 90.0% (95% CIs: 54.4–99.7%) and a specificity of 97.1% (95% CIs: 85.1–100%). The prevalence of S. haematobium in school children informed the present study on where to conduct further research of this infection in women of reproductive age. Two Counties (Tana River and Kwale) were selected to investigate schistosomiasis infection, anaemia, blood patho-physiological changes and birth weight outcomes in pregnant and Nonpregnant women. Pregnant women in Kwale County had a higher prevalence of infection with urinary schistosomiasis than non-pregnant 36.9% and 30.0%, they also had a higher intensity of infection 51.1 eggs/10mls and 40.9 eggs/10ml of urine respectively. Younger women aged between 16 and 26 years, had higher infection rates and intensity 37.6% and 56 e/10mls respectively. Out of two hundred and fifty (250) samples analysed for serum urea and creatinine as a proxy for kidney function; none had significant levels of pathology, either in pregnant or non-pregnant women. Fifty percent (50%) of the women had S. haematobium infection; among them 50% were suffering from anaemia (Hb less than 11g/dl and RBC count of less than 4.2 x 106 μl) and other haematological conditions. The study has shown that there is elevated eosinophil counts in women who are infected with S. haematobium and equally high in pregnant women than non-pregnant women. This study reports decreased levels of thrombocytes (platelets) (thrombopenia) among pregnant women infected with S. haematobium. Using peripheral blood film examination and haematological indices analysis, 20.3% of the women, were diagnosed with Normocytic Normochromic Anemia (NNA) while 50% were diagnosed with Macrocytic Anaemia (MA) (Macrocytosis). The possibility of women infected with S. haematobium delivering under-weight children was also investigated in 32 pregnant women in 5 villages in Hola, Tana River. One third of the pregnant women infected with S. haematobium delivered underweight children who were less than 2.5Kgs after full term (5/19=26.3%). In this study, preterm deliveries were not investigated since this was a quasi-longitudinal study. The study has established that, school children in parts of coastal region have high infection of S. haematobium. In conclusion, the study demonstrates high prevalence and intensity of S. haematobium infection in women of reproductive age in Kwale and Tana River County. The study also reports the different anemia conditions diagnosed in women of reproductive age in parts of Tana River County. It is thus, rcommended that clinician be encouraged to investigate these specific anemia conditions, for proper management of anemia in pregnant women. Women in endemic areas spend a very large part of their reproductive lives involved in activities that expose them to infection and their treatment during gestation will not only improve on their health but alleviate their already poornutritional status and birth weight outcomes.