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
LIST OF TABLES
Table 1: Pretreatment prevalence of S. haematobium among the
p’;rimary
schools examined.
Table 2: Pretreatment prevalence of S. haematobium by sex
among the
schools.
Table 3: Sex infection-status cross tabulation
Table 4: Pretreatment prevalence of S.haematobium by age
group
Table 5: Post- treatment prevalence of S.haematobium by age
group
Table 6: Pretreatment sex of the pupils and egg production status
of
S.haematobium
Table 7: Treatment of S. haematobium infected pupils with
artesunate,
praziquantel or combined therapy of praziquantel and
artesunate.
Table 8: Intensity of S.haematobium infection before and after
treatment
with the drugs
Table 9: Intensity of S. haematobium infection before and after
treatment
with the drugs in the schools studied
LIST OF FIGURE
FIG 1 : Map of Anambra State showing the study area
LIST OF PLATES
PLATE 1: Some sections of Umuikwu-Anam community.
PLATE 2: Urine samples to be examined
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.
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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