Home PARASITOLOGY AND ENTOMOLOGY PROJECT TOPICS AND MATERIALS EFFICACY OF ARTESUNATE IN THE TREATMENT OF URINARY SCHISTOSOMIASIS AT UMUIKWU- ANAM COMMUNITY IN ANAMBRA WEST LOCAL GOVERNMENT AREA OF ANAMBRA STATE, SOUTHEASTERN NIGERIA.

EFFICACY OF ARTESUNATE IN THE TREATMENT OF URINARY SCHISTOSOMIASIS AT UMUIKWU- ANAM COMMUNITY IN ANAMBRA WEST LOCAL GOVERNMENT AREA OF ANAMBRA STATE, SOUTHEASTERN NIGERIA.

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    ABSTRACT

    A study on the efficacy of artesunate in the treatment of urinary
    schistosomiasis at Umuikwu- Anam community, Anambra West Local
    Government area was carried out between November 2008 and
    June 2009. Urine samples from 471 primary school children were
    examined for ova of Schistosoma haematobium . Using filtration
    method, S. haematobium ova was recorded in the urine samples of
    72(15.3%) pupils. The prevalence of 34.4% and 28.2% were recorded
    in two primary schools with an overall egg output of 7.63 eggs/10mls
    urine (geometric mean). The prevalence was significantly higher in
    the males (18.2%) than in the females (11.3%) and among the 11-13
    years age group (25.6%; p<0.05). The intensity was also significantly
    higher among the males (48) and 5-10 years age group (39).
    Infected pupils who reported for treatment were divided into three
    groups ;oral doses of praziquantel (40mg/kg-single dose), artesunate
    (4mg/kg/day) once a day for 3 days and a combination of
    praziquantel and artesunate respectively. When the treated children
    were examined after 2weeks, praziquantel had the highest egg
    reduction rate of 92.63%, combined therapy of artesunate and
    praziquantel had egg reduction rate of 90.22% while artesunate had
    a 72.86% egg reduction rate. There was significant difference in the
    treatment regimen and all the treatments were significantly
    effective (P<0.50). All the treatment regimen were well tolerated.

    TABLE OF CONTENTS

    COVER
    PAGE……………………………………………………………….………………
    ……….i
    TITLE
    PAGE………………………………………………………………………………
    ….……….ii
    CERTIFICATION……………………………………………………………………
    ………..….….iii
    DEDICATION………………………………………………………………………
    …………………iv
    ACKNOWLEGMENT………………………………………………………………
    ……………….v
    TABLE OF
    CONTENTS……………………………………………………………………….…
    …vi
    LIST OF
    TABLES………………………………………………………………………………
    …….viii
    LIST OF
    FIGURE………………………………………………………………………………
    ……..ix

    LIST OF
    PLATES………………………………………………………………………………
    ………x
    ABSTRACT…………………………………………………………………………
    ……………………xi
    CHAPTER 1:
    INTRODUCTION………………………………………………………………….1
    CHAPTER 2: LITERATURE
    REVIEW………………………………………………………….. 4
    2.1 LIFE CYCLE OF
    S.HAEMATOBIUM………………………………………………………6
    2.2 TREATMENT OF URINARY
    SCHISTOSOMIASIS…………………………………..9
    2.3
    PRAZIQUANTEL……………………………………………………………………
    ……………9
    2.4
    ARTESUNATE………………………………………………………………………
    …..……….11
    2.5 COMBINATION CHEMOTHERAPY FOR
    SCHISTOSOMIASIS…………..…..12
    CHAPTER 3: MATERIALS AND
    METHODS……………………………………………..…14

    3.1 STUDY
    AREA………………………………………………………………………………
    ……..14
    3.2 STUDY
    POPULATION………………………………………………………………………
    …17
    3.3 ETHICAL
    CONSIDERATION…………………………………………………………………
    17
    3.4 SCHOOLS SELECTED FOR THE
    STUDY……………………………………………..…17
    3.5 SELECTION OF THE PUPILS FROM THE
    SCHOOLS………………………………18
    3.6 SAMPLE
    COLLECTION………………………………………………………………………
    ..18
    3.7 URINE
    EXAMINATION………………………………………………….…………………
    ….20
    3.8 TREATMENT OF INFECTED
    PUPILS……………………………….……………….…..24
    3.9 POST TREATMENT
    EXAMINATION……………………………………………………..27
    3.9.1 STATISTICAL
    ANALYSIS……………………………………………………………….….27

    CHAPTER 4:
    RESULTS………………………………………………………………….………….
    .28
    4.1 PRETREATMENT PREVALENCE OF S. HAEMATOBIUM
    AMONG THE PRIMARY SCHOOLS
    EXAMINED………………………………….28
    4.2 PRETREATMENT PREVALENCE OF S. HAEMATOBIUM BY SEX AMONG
    THE
    SCHOOLS…………………………………………………………………………
    ….…….30
    4.3 PRE AND POST-TREATMENT PREVALENCE OF S. HAEMATOBIUM BY
    AGE
    GROUP……………………………………………………………………………
    …………32
    4.4 PRETREATMENT EGG PRODUCTION STATUS OF S. HAMATOBIUM
    AMONG THE SEXES OF THE
    PUPILS……………………………………………………34
    4.5 TREATMENT OF S. HAEMATOBIUM INFECTED PUPILS WITH THE

    DRUGS………………………………………………………………………………
    ..………….….35
    4.6 INTENSITY OF S. HAMATOBIUM INFECTION AMONG THE GROUPS
    BEFORE AND AFTER TREATMENT WITH THE
    DRUGS……………………………36
    4.7 INTENSITY OF S. HAEMATOBIUM INFECTION IN THE SCHOOLS

    BEFORE AND AFTER TREATMENT WITH THE
    DRUGS……………………….….37
    CHAPTER 5: DISCUSSION
    ……………………………………………………………………….…39
    5.1 CONCLUSIONS AND
    RECOMMENDATIONS…………………………………………43
    REFERENCES………………………………………………………………………
    …………….………47
    APPENDICES………………………………………………………………………
    …………………….62

    CHAPTER ONE

    INTRODUCTION
    Schistosomiasis, is a disease caused by a blood fluke of the genus Schistosoma. It
    is a serious debilitating and sometimes fatal parasitic disease. The disease is
    endemic in about 74 countries in Africa, Asia and North America (WHO, 1999).
    Adult schistosomes live in a mammalian host.
    Schistosomiasis is the second most prevalent tropical disease in Africa after
    malaria and is of great public health and socio- economic importance in the
    developing world (WHO, 2002). The first obvious symptom of the infection is
    blood in the urine. Early signs of morbidity common to the infection and which
    manifest in school age children are anaemia, impaired growth, and development,
    poor cognition and substandard school performance (Cetron et al, 1996). The late
    and life threatening consequences of schistosomiasis include bladder cancer or
    serious kidney malfunction caused by S. haematobium, and severe complications
    of the liver and spleen in the case of intestinal schistosomiasis (Cheesbrough,
    2002).
    Five major species of schistosomes namely; S.mansoni, S. haematobium, S.
    intercalate, S.japonicum and S. mekongi infect man. Schistosoma mansoni
    originated in Africa, S. haematobium and S. intercalatum are confined to Africa
    while S. japonicum and S. mekongi are found only in the Far East, in China and the
    Phillipines (Cetron et al,1996).
    Light infections with schistosomiasis can be asymptomatic and many people may
    live their lives without knowing they have ever been infected. Globally up to 120

    million of the estimated 200 million infected people are believed to be
    symptomatic and as many as 20 million may well be suffering severe
    consequences of their infection. The annual deaths associated with schistosomiasis
    are estimated at 20,000 while about 500-600 million people worldwide are at risk
    (WHO,2001),
    There is yet no vaccine available for the prevention of schistosomiasis. The
    current mainstay of control is chemotherapy with praziquantel which is given as a
    single oral dose against all human schistosome parasite (WHO, 2002). However,
    some compounds exhibiting activities against the young developmental stages of
    the parasites are relevant as praziquantel is ineffective in this area (Cioli, 2000).
    Recently, Borrman et al,(2001), Inyang- Etoh et al, (2004) and Inyang- Etoh et al,
    (2005) have variously studied the efficacy of the artemisinin derivatives for the
    treatment of all human schistosomiasis. Significant advances have been made with
    artemether and artesunate (which are already effectively used in the treatment of
    malaria) as having prophylactic effect on schistosome (Xiao et al,2002).
    Artesunate has also been used in human to obtain cure and egg count reduction
    against Schistosoma species infection. Praziquantel and artemisinin derivatives
    display a broad- spectrum anti- schistosomal activities and the susceptibilities of
    the different stages to the two drugs are different. It had been suggested that the
    use of these two compounds in combination might be beneficial for the treatment
    of infections caused by all human schistosome species (Utzinger et al, 2003).
    Hence the use of the combination may increase the worm burden reductions and as
    a consequence, augment cure and egg reduction rates (Utzinger et al, 2003).
    Reports on the efficacy of artesunate in the treatment of urinary schistosomiasis is
    scarce especially in Nigeria and Anambra state in particular where there is serious

    effort in eradicating the disease. Such studies have never been done in the Anam
    area where there is high prevalence rates in most of the communities.
    OBJECTIVES
    This study seeks to determine the efficacy of artesunate in the treatment of urinary
    schistosomiasis in 5-16 years old primary school children in Umuikwu Anam,
    Anambra West Local Government area of Anambra state.
    Specifically, the study will:
    1.Determine the prevalence of S. haematobium infection among the primary school
    children in Umuikwu- Anam.
    2.Assess the efficacy of artesunate on the parasite through determination of egg
    production before and after administration
    3. Compare the efficacy of artesunate with that of praziquantel (the drug of choice)
    on the parasite through determination of egg production before and after drug
    administration.
    4. Assess the tolerability of the drugs in the treatment of S. haematobium.

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