Efficacy, Adverse Effects and Acceptability of Praziquantel in the Treatment of Schistosoma Haematobiumin Pre-School Age Children: A Study of Selected Early Childhood Development Centres of Kwale County Kenya

Abstract

The recommended strategy for control of schistosomiasis is preventive chemotherapy with praziquantel (PZQ). Pre-school age children (PSAC) are excluded from population treatment programs. In high endemic areas, these children are also at risk, and require treatment with PZQ. The Government of Kenya initiated the National School-Based Deworming Programme (NSBDP) where PSAC in Early Childhood Development (ECD) Centres are only eligible for treatment with albendazole (ABZ) but not with PZQ. Four hundred PSAC were enrolled, from 10 randomly selected ECD Centers in Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with fruit juice, at a single dose of 40 mg/kg. Treatment efficacy was assessed by examining urine samples for Schistosoma haematobium eggs in the 5 weeks’ post-treatment follow-up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group’s geometric mean egg counts per 10 ml of urine) following treatment, expressed as a proportion of the pre-treatment infection intensity. Twenty-four hours’ post-treatment, adverse effects were assessed through questionnaires administered to the parents or guardians.Treatment acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment.Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4 - 24.2%). Of these, 41 (51.3%) had infections of heavy intensity while the rest (48.7%) were of light intensity. Five weeks’ post-treatment, 10 children who had heavy intensity infection were diagnosed with S. haematobium (prevalence: 2.5% (95% CI 1.5 - 4. 9%). Infection intensities decreased significantly from 45.9% (95% CI: 31.0 - 68.0) eggs/ 10 ml urine to1.4% (95% CI: 1.1 - 1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The ERR was 96.9%. 330 out of the 400 children recruited inthe study were assessed for AEs 24 hours post treatment. One experienced dizziness, one experienced a headache, four had abdominal pain/discomfort, two had nausea and two experienced itching. None of the children vomited. While six respondents took no action when their child experienced an adverse event, one gave food, two gave milk and the other one made the child to rest. Treatment tolerability among the 400 children was high as none of the children spat and/ or vomited as observed in this study. The study revealed that crushed PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age group. The study recommends the Government of Kenya to consider having the PSAC children treated with PZQ as they have a high S. haematobium burden.