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Assessing the WHO 50% Prevalence Threshold in School-Aged Children as Indication for Treatment of Urogenital Schistosomiasis in Adults in Central Nigeria
Preventive chemotherapy with praziquantel is recommended in adults by the World Health Organization when prevalence of schistosomiasis in school-aged children (SAC) is ≥ 50%. This study ascertained the value of this threshold in predicting prevalence and intensity of Schistosoma hematobium (SH) infection in adults in central Nigeria. We evaluated urogenital schistosomiasis prevalence in 1,164 adults: 659 adults in 12 communities where mean hematuria among SAC in 2008 was 26.6% and 505 adults in 7 communities where the mean hematuria among SAC in 2008 was 70.4%. No statistically significant differences were found between the two groups of adults in prevalence of hematuria, prevalence of SH eggs, or intensity of infections. We conclude that, in this setting, the SAC threshold is not useful for treatment decisions in adults. Given the increased risk of subtle morbidity or urogenital schistosomiasis as a risk factor for human immunodeficiency virus (HIV), more liberal treatment of adults with praziquantel is warranted.
Author Notes
Financial support: Mass drug administration was carried out with support from The Bill & Melinda Gates Foundation and the World Health Organization. Praziquantel is donated in Plateau and Nasarawa by E-Merck. The Carter Center works in close collaboration with Federal and State Ministries of Health of Nigeria.
Authors' addresses: Darin S. Evans, The Carter Center, Atlanta, GA, E-mail: dsevans@emory.edu. Jonathan D. King and Frank O. Richards, The Carter Center—Health Programs, Atlanta, GA, E-mails: jdking@emory.edu and frich01@emory.edu. Abel Eigege, John Umaru, William Adamani, Kal Alphonsus, Yohanna Sambo, and Emmanuel S. Miri, The Carter Center—Nigeria, Jos, Nigeria, E-mails: eigegea@yahoo.com, umaruja@yahoo.com, williamadamani@yahoo.com, kalalphonsus@yahoo.com, yohannachusang@yahoo.com, and emmamiri@yahoo.com. Danjuma Goshit, Plateau Ministry of Health—Nigeria, Jos, Nigeria, E-mail: goshitdam@yahoo.com. Gladys Ogah, Nasarawa Ministry of Health—Nigeria, Lafia, Nigeria, E-mail: gladyseogar@yahoo.com.