Volume 87, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



There is a need for field-applicable markers to assess morbidity associated with intestinal schistosomiasis, especially in the context of preventive chemotherapy in young children. We investigated whether fecal occult blood (FOB) point-of-care tests could be used to assess intestinal pathology over a 12-month period in a cohort of 382 children (< 5 years of age). We found a strong association between egg-patent schistosomiasis and FOB at baseline (odds ratio [OR] = 3.1, < 0.0001), 6 months (OR = 3.4, < 0.0001), and 12 months (OR = 3.5, < 0.0001), despite repeated chemotherapy. There were tendencies for prevalence of FOB to decrease in children who became egg negative and increase in those who became egg positive. Our results demonstrate overt disease in children less than five years of age. We therefore propose that FOB is useful for assessing dynamics of intestinal morbidity in young children at the community level and monitoring changes in morbidity after mass chemotherapy.

[open-access] This is an Open Access article distributed under the terms of the American Society of Tropical Medicine and Hygiene's Re-use License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J, , 2006. Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 6: 411425.[Crossref] [Google Scholar]
  2. Gryseels B, Polman K, Clerinx J, Kestens L, , 2006. Human schistosomiasis. Lancet 368: 11061118.[Crossref] [Google Scholar]
  3. van der Werf MJ, de Vlas SJ, Brooker S, Looman CW, Nagelkerke NJ, Habbema JD, Engels D, , 2003. Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa. Acta Trop 86: 125139.[Crossref] [Google Scholar]
  4. El-Shabrawi MH, El Din ZE, Isa M, Kamal N, Hassanin F, El-Koofy N, El-Batran G, El-Makarem SA, El-Hennawy A, , 2011. Colorectal polyps: a frequently-missed cause of rectal bleeding in Egyptian children. Ann Trop Paediatr 31: 213218.[Crossref] [Google Scholar]
  5. King CH, Dickman K, Tisch DJ, , 2005. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 365: 15611569.[Crossref] [Google Scholar]
  6. Lamyman MJ, Noble DJ, Narang S, Dehalvi N, , 2006. Small bowel obstruction secondary to intestinal schistosomiasis. Trans R Soc Trop Med Hyg 100: 885887.[Crossref] [Google Scholar]
  7. Ongom VL, Bradley DJ, , 1972. The epidemiology and consequences of Schistosoma mansoni infection in West Nile, Uganda. I. Field studies of a community at Panyagoro. Trans R Soc Trop Med Hyg 66: 835851.[Crossref] [Google Scholar]
  8. Ongom VL, Owor R, Grundy R, Bradley DJ, , 1972. The epidemiology and consequences of Schistosoma mansoni infection in West Nile, Uganda. II. Hospital investigation of a sample from the Panyagoro community. Trans R Soc Trop Med Hyg 66: 852863.[Crossref] [Google Scholar]
  9. Owor R, Madda JP, , 1977. Schistosomiasis causing tumour-like lesions. East Afr Med J 54: 137141. [Google Scholar]
  10. von Lichtenberg F, Rollinson D, Simpson AJ, , 1987. Consequences of infections with schistosomes. , eds. The Biology of Schistosomes. From Genes to Latrines. London: Academic Press, Ltd., 185232. [Google Scholar]
  11. Fenwick A, Webster JP, Bosque-Oliva E, Blair L, Fleming FM, Zhang Y, Garba A, Stothard JR, Gabrielli AF, Clements AC, Kabatereine NB, Toure S, Dembele R, Nyandindi U, Mwansa J, Koukounari A, , 2009. The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002–2008. Parasitology 136: 17191730.[Crossref] [Google Scholar]
  12. Bundy DA, Shaeffer S, Jukes M, Beegle K, Gillespie A, Drake L, Lee SF, Hoffman AM, Jones J, Mitchell A, Wright C, Barcelona D, Camara B, Golmar C, Savioli L, Takeuchi T, Sembene M, Jamison D, Claeson M, Breman J, Meacham A, , 2005. School-based health and nutrition programs. , eds. Disease Control Priorities in Developing Countries. New York: Oxford University Press, 10911108. [Google Scholar]
  13. Sousa-Figueiredo JC, Pleasant J, Day M, Betson M, Rollinson D, Montresor A, Kazibwe F, Kabatereine NB, Stothard JR, , 2010. Treatment of intestinal schistosomiasis in Ugandan preschool children: best diagnosis, treatment efficacy and side-effects, and an extended praziquantel dosing pole. In Health 2: 103113.[Crossref] [Google Scholar]
  14. Stothard JR, Sousa-Figueiredo JC, Betson M, Green HK, Seto EY, Garba A, Sacko M, Mutapi F, Vaz Nery S, Amin MA, Mutumba-Nakalembe M, Navaratnam A, Fenwick A, Kabatereine NB, Gabrielli AF, Montresor A, , 2011. Closing the praziquantel treatment gap: new steps in epidemiological monitoring and control of schistosomiasis in African infants and preschool-aged children. Parasitology 138: 15931606.[Crossref] [Google Scholar]
  15. Hewitson P, Glasziou P, Watson E, Towler B, Irwig L, , 2008. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update. Am J Gastroenterol 103: 15411549.[Crossref] [Google Scholar]
  16. Kanzaria HK, Acosta LP, Langdon GC, Manalo DL, Olveda RM, McGarvey ST, Kurtis JD, Friedman JF, , 2005. Schistosoma japonicum and occult blood loss in endemic villages in Leyte, the Philippines. Am J Trop Med Hyg 72: 115118. [Google Scholar]
  17. Lehman JS, Jr Mott KE, Morrow RH, Jr Muniz TM, Boyer MH, , 1976. The intensity and effects of infection with Schistosoma mansoni in a rural community in northeast Brazil. Am J Trop Med Hyg 25: 285294. [Google Scholar]
  18. Ndamba J, Makaza N, Kaondera KC, Munjoma M, , 1991. Morbidity due to Schistosoma mansoni among sugar-cane cutters in Zimbabwe. Int J Epidemiol 20: 787795.[Crossref] [Google Scholar]
  19. Betson M, Sousa-Figueiredo JC, Rowell C, Kabatereine NB, Stothard JR, , 2010. Intestinal schistosomiasis in mothers and young children in Uganda: investigation of field-applicable markers of bowel morbidity. Am J Trop Med Hyg 83: 10481055.[Crossref] [Google Scholar]
  20. Green HK, Sousa-Figueiredo JC, Basanez MG, Betson M, Kabatereine NB, Fenwick A, Stothard JR, , 2011. Anaemia in Ugandan preschool-aged children: the relative contribution of intestinal parasites and malaria. Parasitology 138: 15341545.[Crossref] [Google Scholar]
  21. Montresor A, Crompton DW, Hall A, Bundy DA, Savioli L, , 1998. Guidelines for the Evaluation of Soil-Transmitted Helminthiasis and Schistosomiasis at Community Level. A Guide for Managers of Control Programmes. Geneva: World Health Organization, 145. [Google Scholar]
  22. Katz N, Chaves A, Pellegrino J, , 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14: 397400. [Google Scholar]
  23. Sousa-Figueiredo JC, Oguttu D, Adriko M, Besigye F, Nankasi A, Arinaitwe M, Namukuta A, Betson M, Kabatereine NB, Stothard JR, , 2010. Investigating portable fluorescent microscopy (CyScope) as an alternative rapid diagnostic test for malaria in children and women of child-bearing age. Malar J 9: 245.[Crossref] [Google Scholar]
  24. Kirkwood BR, Sterne JA, , 2003. Essential Medical Statistics. Oxford, UK: Blackwell Science. [Google Scholar]
  25. Fisher RA, , 1922. On the interpretation of chi-square from contingency tables and the calculation of P. JR Stat Soc 85: 8794. [Google Scholar]
  26. Armitage P, Berry G, , 1994. Statistical Methods in Medical Research. Oxford, UK: Blackwell Scientific. [Google Scholar]
  27. Harper R, Reeves B, , 1999. Reporting of precision of estimates for diagnostic accuracy: a review. BMJ 318: 13221323.[Crossref] [Google Scholar]
  28. Zweig MH, Campbell G, , 1993. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 39: 561577. [Google Scholar]
  29. Webster JP, Koukounari A, Lamberton PH, Stothard JR, Fenwick A, , 2009. Evaluation and application of potential schistosome-associated morbidity markers within large-scale mass chemotherapy programmes. Parasitology 136: 17891799.[Crossref] [Google Scholar]
  30. Lengeler C, Utzinger J, Tanner M, , 2002. Questionnaires for rapid screening of schistosomiasis in sub-Saharan Africa. Bull World Health Organ 80: 235242. [Google Scholar]
  31. Sousa-Figueiredo JC, Day M, Betson M, Rowell C, Wamboko A, Arinaitwe M, Kazibwe F, Kabatereine NB, Stothard JR, , 2011. Field survey for strongyloidiasis in eastern Uganda with observations on efficacy of preventive chemotherapy and co-occurrence of soil-transmitted helminthiasis/intestinal schistosomiasis. J Helminthol 85: 325333.[Crossref] [Google Scholar]
  32. Legros D, Ochola D, Lwanga N, Guma G, , 1998. Antibiotic sensitivity of endemic Shigella in Mbarara, Uganda. East Afr Med J 75: 160161. [Google Scholar]
  33. Brooks JT, Shapiro RL, Kumar L, Wells JG, Phillips-Howard PA, Shi YP, Vulule JM, Hoekstra RM, Mintz E, Slutsker L, , 2003. Epidemiology of sporadic bloody diarrhea in rural western Kenya. Am J Trop Med Hyg 68: 671677. [Google Scholar]
  34. Majalija S, Segal H, Ejobi F, Elisha BG, , 2008. Shiga toxin gene-containing Escherichia coli from cattle and diarrheic children in the pastoral systems of southwestern Uganda. J Clin Microbiol 46: 352354.[Crossref] [Google Scholar]
  35. Kaddu-Mulindw DH, Aisu T, Gleier K, Zimmermann S, Beutin L, , 2001. Occurrence of Shiga toxin-producing Escherichia coli in fecal samples from children with diarrhea and from healthy zebu cattle in Uganda. Int J Food Microbiol 66: 95101.[Crossref] [Google Scholar]
  36. Kabatereine NB, Kemijumbi J, Kazibwe F, Onapa AW, , 1997. Human intestinal parasites in primary school children in Kampala, Uganda. East Afr Med J 74: 311314. [Google Scholar]
  37. Johnston AR, Gillespie TR, Rwego IB, McLachlan TL, Kent AD, Goldberg TL, , 2010. Molecular epidemiology of cross-species Giardia duodenalis transmission in western Uganda. PLoS Negl Trop Dis 4: e683.[Crossref] [Google Scholar]
  38. Stothard JR, Sousa-Figuereido JC, Betson M, Adriko M, Arinaitwe M, Rowell C, Besiyge F, Kabatereine NB, , 2011. Schistosoma mansoni infections in young children: when are schistosome antigens in urine, eggs in stool and antibodies to eggs first detectable? PLoS Negl Trop Dis 5: e938.[Crossref] [Google Scholar]
  39. Pearce EJ, MacDonald AS, , 2002. The immunobiology of schistosomiasis. Nat Rev Immunol 2: 499511.[Crossref] [Google Scholar]

Data & Media loading...

Supplementary PDF

  • Received : 25 Jan 2012
  • Accepted : 29 May 2012
  • Published online : 03 Oct 2012

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error