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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 28  |  Issue : 3  |  Page : 211-217

A comparative study on the prevalence and intensity of urinary schistosomiasis among primary (formal) and almajiri (informal) school pupils in kura local government area of Kano State, Nigeria


1 Department of Paediatrics, Murtala Mohammad Specialist Hospital, Kano, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano/Bayero University Kano, Kano, Nigeria
3 Department of Child Health, Obafemi Awolowo University Teaching Hospital, Ife, Nigeria

Date of Submission03-Mar-2021
Date of Decision02-Jul-2021
Date of Acceptance17-Jul-2021
Date of Web Publication22-Oct-2021

Correspondence Address:
Dr. Safiya Gambo
Department of Paediatrics, Murtala Mohammad Specialist Hospital, P. O. X: 3200, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_605_21

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  Abstract 


Background: Urinary schistosomiasis remains one of the most prevalent neglected tropical diseases in the world today, particularly in developing countries including Nigeria. Chronic infection can affect the genitourinary system. School pupils, particularly the informal Almajiri school pupils are at increased risk of the infection. Study Objectives: The objective of this study was to determine and compare the prevalence and intensity of urinary schistosomiasis among primary and Almajiri school pupils in Kura Local Government Area (LGA) aged 5–15 years. We also aim to determine the presence of haematuria and proteinuria among these pupils. Subjects and Methods: It was a cross-sectional comparative study involving 200 primary and 200 Almajiri school pupils aged 5–15 years in Kura LGA who met the inclusion criteria. Urine samples were analysed by the dipstick urinalysis and microscopically examined for the egg S. haematobium. Results: The Almajiri school pupils had a significantly higher infection (55.5%) than the primary school pupils (43.0%). The infection was predominantly of light intensity in both school types (67%). The overall mean egg intensity was 51.6 ± 35 EPC. The infection was higher among boys and those aged 10 years and above. Majority of the pupils had microhaematuria (88.3%) and and proteinuria (71.1%), which were statistically significantly associated with the infection with P < 0.1 and P < 0.001, respectively. Conclusion: The prevalence of urinary schistosomiasis is higher among the Almajiri school pupils compared to the primary school pupils. Control programmes should focus on these Almajiri pupils in addition to the primary school pupils.

Keywords: Almajiri, school pupils, urinary schistosomiasis


How to cite this article:
Gambo S, Ibrahim M, Oyelami OA, Raymond B. A comparative study on the prevalence and intensity of urinary schistosomiasis among primary (formal) and almajiri (informal) school pupils in kura local government area of Kano State, Nigeria. Niger Postgrad Med J 2021;28:211-7

How to cite this URL:
Gambo S, Ibrahim M, Oyelami OA, Raymond B. A comparative study on the prevalence and intensity of urinary schistosomiasis among primary (formal) and almajiri (informal) school pupils in kura local government area of Kano State, Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2021 Dec 1];28:211-7. Available from: https://www.npmj.org/text.asp?2021/28/3/211/328777




  Introduction Top


Schistosomiasis is a parasitic disease that results from infestation by any of the five schistosomes, namely S. haematobium, S. intercalatum, S. japonicum, S. mansoni and S. mekogi.[1],[2],[3] It is the most prevalent tropical disease after hookworm infection.[1],[4] According to the WHO, 200 million people mainly in the rural agricultural and peri-urban areas are affected worldwide[1],[2],[4] Sub-Saharan Africa accounts for majority of those infected.[1],[4] Nigeria has a high burden of the disease[4],[5] estimated to be about 29 million cases.[4],[5],[6] Infection by S. haematobium which causes urinary schistosomiasis[2],[3] is the most common form of schistosomiasis in Nigeria. Chronic urinary schistosomiasis is of great public health importance as it can result in debilitating complications such as chronic kidney disease, cancer of the bladder and stunted growth.[2],[3],[7]

Infection of human occurs through contact with infested water, particularly in rural areas or urban slums where dams have been developed to meet human demands.[1],[2],[4],[8] School-aged children are usually the most readily and heavily affected by the infection.[1],[3],[4] This is because of their tendency to indulge in domestic activities, group swimming and fishing in snail infested water bodies usually after school hours. Most studies focused on primary school pupils. Studies on Almajiri school pupils have been limited. These are school-aged children that are enrolled in informal Quranic schools called 'tsangaya' under the tutelage of the Islamic scholar (Alaramma) away from their homes with the aim of studying the Holy Quran. They are usually socioeconomically deprived and usually engage in menial labour in search of alternative means to earn a living.[9],[10],[11] Being unsupervised, they may be more at risk of infections and infestations compared to primary school pupils.[10],[11] The presence of river Kano in Kura Local Government Area of Kano State predisposes the inhabitants to urinary schistosomiasis.

This study hypothesised that there may not be any significant difference in the prevalence and intensity of urinary schistosomiasis between primary (formal) and Almajiri (informal) school pupils in Kura LGA. The objectives of the study were to determine and compare the prevalence and intensity of urinary schistosomiasis among primary (formal) and Almajiri (informal) school pupils aged 5–15 years in Kura local government Area of Kano State. It also aimed to determine the presence of haematuria and proteinuria among these pupils. The findings of this study will provide a database for the Almajiri pupils and will guide policy-makers with regards to target groups in control programmes.


  Subjects and Methods Top


The present study was conducted in Kura, one of the 44 LGAs in Kano state, Nigeria,[12] located on longitude 11°46' North and latitude 8°26' in the southern part of the state. Furthermore, about 30 km from the state capital (Kano city) along Kano-Kaduna express way.[13] The local government area has an estimated population of 164,654.[13] It has a total of 10 political wards, namely Dalili, Danhassan, Dukawa, S. Kura, Karfi, Butulawa, Gun dutse, Kosawa, Imawa and Rugar duka.[13] It is inhabited predominantly by Hausa and Fulani ethnic groups who are mainly farmers. The agricultural activities are mainly during the rainy season (between April and November) with the dry season irrigation farming (between December and March).[13] This is possible due to the presence of river Kano which provides uninterrupted water supply for irrigation. The local Government has 222 Almajiri schools with a total of 18,744 Almajiri school pupils[14] and 96 primary schools with a total of 12,524 primary school pupils.[15]

Study design and Sample size determination

The present study was a comparative, descriptive study carried out among primary (formal) school and Almajiri (informal) school pupils in Kura LGA of Kano state. The sample size was calculated using the formula for comparing two proportions.[16] The prevalence of 18.6% and 6.1% was used as P1 and P2 being the prevalence of urinary schistosomiasis reported among pupils of Local Education Authority primary school in Hanwa, Zaria and Islamic school Rafin Sidi, Zaria,[17] respectively. A sample size of 112 was obtained after adding 10% for contingency. This was approximated to 200 to increase the precision of the study. A total of 200 primary school pupils and 200 Almajiri school pupils were recruited for the study.

Ethical approval

Ethical clearance for the conduct of the study was obtained from Kura Local Government Authorities (reference number-URLG/MH/HEU/V.I/35) and the research and ethics committee of Aminu Kano Teaching Hospital (reference number-NHREC/21/08/2008/AKTH/EC/877).

Written informed consent signed or thumb printed was obtained from parents, guardians or Alaramma. Older pupils aged 7 years above gave their assent.

Recruitment of the study participants

The inclusion criteria included primary and Almajiri school pupils aged 5–15 years, registered in the selected schools, who had given informed consent for participation in the study. Only pupils resident in Kura LGA for more than 3 months at the time of the study were included.

The exclusion criteria included pupils who were resident in Kura LGA for <3 months at the time of the study and who had not given informed consent for their participation.

A multistage sampling technique was used to select 200 primary and 200 Almajiri school pupils from the LGA. Due to a large population size, 5 wards (50%) were randomly selected out of the 10 wards in the LGA by balloting. They were Karfi, Dalili, Kosawa, Dukawa and Gun Dutse. The ratio of the total number of primary schools to the total number of Almajiri schools in the wards selected was 1:2. Therefore, 1 primary school and 2 Almajiri schools were randomly selected by balloting from each of the wards selected. A proportionate sampling technique was used to select the 200 primary and 200 Almajiri pupils from each of the selected primary and Almajiri schools.

Advocacy visits were conducted to the local government authorities, traditional rulers in the community, Headmasters/Headmistresses and Alaramma of all the primary and Almajiri schools selected. An interviewer administered questionnaire method was used to fill the questionnaire. This contained questions on bio data, knowledge of the disease, symptoms, treatment and water contact activities. From each pupil about 15 ml of terminal urine was collected in a clean designated specimen bottle from 10 am to 2 pm corresponding to the time of highest egg shedding.[18] This was followed by macroscopic examination of each urine specimen for visible blood in urine. The examination of the urine for micro haematuria and proteinuria was done within 30 min of collection using the combi 9 (Boehringer Mannheim, Johannesburg®). The strip was dipped into each urine sample and then withdrawn after 5–10 s.[19],[20] Result was read according to the corresponding colour code. Haematuria was recorded as +, ++ and +++ corresponding to red blood cell concentration of 10 rbc/ul, 50 rbc/ul and 250 rbc/ul, respectively.[19] The presence of proteinuria was recorded by the strip as +, ++ and +++ corresponding to protein concentration of 30 mg/dl, 100 mg/dl and 500 mg/dl, respectively. The universal clean container, containing the urine sample was then tightly closed and placed inside a dark polythene bag. This was to prevent the eggs from hatching.[19],[20] These containers were then transported to the microbiology and parasitology laboratory of the Aminu Kano Teaching Hospital about 30 km drive from the point of collection.

In the laboratory, 10 ml of each urine sample was transferred into a conical tube. This was then placed into a centrifuge machine and was centrifuged at 3000 rpm for 3 min. The supernatant was then discarded and the sediment was stirred and transferred to a clean glass slide, with a cover slip. This was microscopically examined under ×40 objective.[19] The egg of S. haematobium appeared as pale yellow brown oval shaped with the characteristic small terminal spine.[19],[20] All eggs were counted per high power field, and the entire sediment was counted for all subjects. The intensity of infection was expressed per 10 ml of urine.[19] It was classified as light infection when there were <50 eggs/10 ml of urine and heavy infection in the presence of 50 eggs/10 ml of urine or more.[19]

Data analysis

Data were entered into the computer and were analysed using the Statistical package for the social sciences (SPSS) software version 16 (Chicago IL, U.S.A) for the data analysis. Intensity of infection (number of eggs/10 ml of urine) was analysed using the mean and standard deviation. The Pearson Chi-square test and Fisher's exact test were used to assess the associations between the demographic characteristics of study participants and other findings of the study. Student's t-test was also used to compare the differences between light and heavy infections. P < 0.05 was considered statistically significant.


  Results Top


A total of 400 pupils comprising of 200 primary school and 200 Almajiri school pupils were studied. The age ranged from 5 years to 15 years in both groups with a mean age of 10.3 ± 3.1 years and 10.7 ± 2.7 years in the primary and Almajiri pupils, respectively. A significantly higher proportion of the primary school pupils were boys 146 (77%) with a male-to-female ratio of 2.7:1. Majority of both the primary 116 (58%) and Almajiri 129 (64.5%) school pupils were aged 10 years and above. Most of the parents of both the primary 123 (61.5%) and the Almajiri 124 (62.0%) school pupils were farmers. There was a lack of formal education among most of the parents of the Almajiri school pupils 142 (71.0%). These differences in gender, parental occupation and parental educational status between the primary and Almajiri school pupils were found to be statistically significant (P < 0.05). A summary of the sociodemographic characteristics is shown in [Table 1].
Table 1: Sociodemographic features of the pupils studied

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Prevalence of urinary schistosomiasis

The overall prevalence of urinary schistosomiasis among school pupils in Kura LGA was 197 (49.2%). Specifically, the prevalence was 86 (43%) among primary school pupils and 111 (55.5%) among Almajiri school pupils. This difference in prevalence was observed to be statistically significant (χ2 = 6.25, df = 1, P < 0.05), as shown in [Table 2].
Table 2: Prevalence of urinary schistosomiasis amongst primary and Almajiri school pupils

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Intensity of urinary schistosomiasis

The intensity of infection was predominantly light among both the primary 58 (67.4%) and Almajiri 74 (66.7%) school pupils (excreting <50 eggs/10 ml of urine). Out of the 197 pupils infected, only 65 (33.0%) had heavy infection. The mean egg intensity of infection was observed to be 50.3 ± 33.8 and 52.8 ± 36.7 eggs among the primary and Almajiri school pupils, respectively, with an overall mean egg intensity of 51.6 ± 35.3 eggs, as shown in [Table 3].
Table 3: Intensity of urinary schistosomiasis amongst the infected primary and Almajiri school pupils

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By age group, the infection was higher among pupils aged 10 years and above in both the primary school pupils 59 (68.6%) and the Almajiri school pupils 73 (65.8%). This higher prevalence of the infection among the older Almajiri pupils aged 10 years and above compared to those aged <10 was found to be statistically significant. This is illustrated in [Table 4].
Table 4: Distribution of infection by age group

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Infection by gender and age group

[Figure 1] is a bar chart showing the distribution of infection among the infected primary and Almajiri pupils by gender. Majority of the infected primary school pupils were boys 68 (79.1%) while all the infected Almajiri school pupils were boys 111 (100%) as all the Almajiri pupils studied were boys. The infection was predominantly light in intensity. The difference in the intensity between the primary school boys and girls was not significant (χ2 = 3.15, df = 1, P > 0.05).
Figure 1: A bar chart showing the distribution of light and heavy infection by gender in the infected primary and Almajiri pupils

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Dipstick urinalysis findings

Dipstick urinalysis revealed that majority of the pupils 332 (83.0%) had micro haematuria. It was more common among those infected with urinary schistosomiasis 174 (43.5%) than those uninfected 158 (39.5%). Similarly, majority of the pupils had proteinuria 217 (54.3%). It was more common among those infected with urinary schistosomiasis 140 (35.0%) than those uninfected 77 (19.3%). Both micro haematuria and proteinuria were observed to be significantly associated with the infection (P = 0.01 and P = 0.001 respectively) as shown in [Table 5].
Table 5: Micro haematuria and proteinuria amongst the study population

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[Figure 2] shows an evaluation of the intensity of micro haematuria among those infected with urinary schistosomiasis. Majority had a significantly higher ++ level of micro haematuria 105 (60.4%). In the same vein, [Figure 3] shows that those infected with urinary schistosomiasis had a significantly higher ++ level of proteinuria 79 (56.4%) than +27 (19.3%) or +++34 (24.3%).
Figure 2: Intensity of micro haematuria among the pupils with urinary schistosomiasis. A = + level of microhaematuria corresponding to 10 rbc/ul. B = ++ level of microhaematuria corresponding to 50 rbc/ul. C = +++ level of micro haematuria corresponding to 250 rbc/ul

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Figure 3: Intensity of proteinuria among those with urinary schistosomiasis. A = + level of proteinuria corresponding to 30 mg/dl. B = ++ level of proteinuria corresponding to 100 mg/dl. C = +++ level of proteinuria corresponding to 500 mg/dl

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  Discussion Top


Our study observed that the prevalence of urinary schistosomiasis among formal and informal school pupils in Kura local Government Area of Kano state was high. The overall prevalence of 49.2% is comparable to that reported by Duwa et al. (44.2%)[21] in Minjibir, Kano state but higher than the figure (2.5%) observed by Belonwu[22] in Katagun, Bauchi state in Northern Nigeria and that (18%) reported by Ogbonna et al.[23] in Enugu state, South-east Nigeria. The high prevalence could be attributable to considerable water contact activities, pollution of the water bodies with eggs of S. haematobium and dependence on river and dams (such as river Kano and Minjibir Dam, respectively) for household water observed in this study and in Minjibir LGA. However, the lower prevalence in Katagun was attributed to the dry months during which the study was conducted which resulted in the dessication and death of the vector snails. In contrast, the prevalence of 57.5% observed by Adeyeba and Ojeaga[24] in Ibadan western Nigeria was higher than that observed in this study. Their bias in the sampling of only schools situated near a stream may have oversampled pupils at highest risk of the disease, thereby resulting in higher prevalence in Ibadan.

The prevalence of 55.5% observed among Almajiri pupils is lower than that (71%) observed by Ahmed et al.[25] among quranic school pupils (khalwas) in Sudan. The abundance of irrigation canals surrounding the study area in Sudan suggests that these pupils are probably surrounded by more water bodies compared to the pupils in our study area. This may have resulted in more regular contact with infested water thereby resulting in a higher infection. Moreover, the recruitment of pupils from only two schools in the Sudan study compared to the proportionate sampling of pupils from ten schools in our study may have attributed to this difference in prevalence.

The higher prevalence of infection observed among the Almajiri pupils in this study is probably because they are usually deprived and unsupervised and so engage in more water contact activities compared to the primary school pupils. Furthermore, the constitution of only boys in Almajiri schools, who by nature are more mobile and adventurous, and more likely to become in contact with infected water bodies could explain the higher infection.

The majority of the infected pupils had a light intensity of infection (67.0%). This concurs with the findings by Amuta and Houmsou[26] among school-aged children in Guma LGA of Benue state. The possible development of acquired immunity among the pupils resulting in lower egg burden may have accounted for the predominant light intensity of infection.[2],[27] The lack of significance in the difference in the intensity of infection between the primary and Almajiri pupils in this study is probably due to daily variability in excretion of eggs of S. haematobium.[19] The observed 33% of infected pupils with heavy infection is worrisome because this indicates the presence of morbidity at individual level.[28]

The observed higher prevalence of urinary schistosomiasis in children aged 10 years and older among pupils in primary school (68.6%) and Almajiri school (65.8%) in this study is comparable to that of earlier works.[24],[25],[27],[29],[30] For instance, Sarkinfada et al.[31] and Ugbomoiko et al.[29] also observed that children aged 10–14 years had the highest infection and attributed it to increased water contact activities in this age group. Nevertheless, this contrasts with the findings of Ekwunife et al.[30] where primary school children aged 5–9 years were observed to have higher infection as compared to those aged 10–14 years. Although the authors attributed this to the fact that the 5–9 years pupils fell within the age group more at risk of the disease (5–14 years), differences in the sampling technique used between their study and our study may be responsible for this.[30] Convenient sampling of the same number of pupils in each school in their study may have resulted in selection bias.[30] Similarly, Nale et al.[17] observed a peak infection among 20–24 years old males in contrast to the findings of this study. They attributed this to late exposure among immigrants from non-endemic areas.[17]

This study also found a higher prevalence of infection in boys in both school types (79.1%). This is in agreement with what was observed by other authors.[6],[7],[21],[26],[31] Boys engage more in water contact activities while girls are socially restricted to domestic chores within the home environment and therefore have less contact with infectious sources. Females are also culturally restricted from swimming naked in streams. Furthermore, the over representation of boys in this study which resulted from the lack of girls in Almajiri schools[14],[25] as well as the poor enrolment of girls in primary schools[15] in the study area may also have contributed to this observation. In contrast, Nkegbe[32] in Ghana reported a higher infection among female pupils which they attributed to more contact of females with infectious source due to unavoidable household chores. However, this is only possible if the girls engage in more swimming, fishing and farming in addition to household chores compared to the boys. Similarly, White et al.[33] observed a higher infection in females in Sierra Leone due to more female involvement in fishing. The high prevalence of hematuria[34],[35],[36] and proteinuria[6],[34] among those infected is in keeping to what had been previously reported. The statistically significant association between urinary schistosomiasis with both micro haematuria and proteinuria may signify the presence of nephropathy in patients infected with urinary schistosomiasis. Although chronic urinary schistosomiasis has been known to cause nephropathy, this is however, beyond the scope of this study. Future studies should aim at establishing the presence of nephropathy in patients infected with urinary schistosomiasis.


  Conclusion and Recommendations Top


We conclude that the prevalence of urinary schistosomiasis in Kura Local Government Area of Kano state was higher among Almajiri School pupils compared to primary school pupils. Similarly, most of the infection in both school types is of light intensity. Furthermore, micro haematuria and proteinuria is common among the pupils. We recommend that control programmes should target more on Almajiri school pupils in addition to the primary school pupils.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
Subjects and Methods
Results
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