الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Schistosomiasis is considered one of the neglected tropical diseases, affecting approximately 250 million people worldwide; about 90% of them live in Africa. Despite the communities implementing control measures, it is still one of several diseases that spread in conditions of poverty.
The overall prevalence of schistosomiasis in Egypt fell down to <3% as a consequence of effective control programs. However, there are still hot spot transmission foci. Kafr El-Sheikh is one of these high transmission areas. For optimal design of schistosomiasis control programs, and for evaluation of the programs progress, it is essential to gain baseline information on the true prevalence. Accurate diagnosis is the key for adequate patient management and for monitoring the control measures.
The present study was designed to evaluate the schistosomiasis-positive school children as indicators for the identification of positive family cases.
This study was conducted in Arab El-Mahder primary school, Motobus district and Abd ElAal Dekheil primary school, Fowa district, Kafr El-Sheikh governorate, Egypt. After obtaining the consent of school guardians and children’s parents, a total of 600 school children were invited to submit stool samples. Four hundred and sixteen complied and all stool samples were examined microscopically for S. mansoni by Kato-Katz. One hundred children negative by Kato-Katz submitted urine samples. Urine samples were collected in screw-cap vials. They were stored at -20°C until the CCA cassette test (American Trade Company) was performed. Families of children positive by Kato-Katz and an equal number of families of negative children submitted stool samples. All the stool samples of families were examined microscopically for S. mansoni by Kato-Katz. Among the studied cases, parasitological examination of feces by using Kato- Katz revealed that the overall percentage of S. mansoni infection among children of high prevalence school and low prevalence school was 15.3% and 1.6 % respectively. The highest infection rates of S. mansoni in this study were observed in the age group 6-<8 years old, but the difference in infection rate by age was not significant. Regarding gender, there was no significant difference in S. mansoni percentage between boys and girls.
In spite of the high prevalence, the majority of children had light S. mansoni infection intensity (65%) denoting persistence of transmission at a low potential.
The highest infection rate of S. mansoni in this study was detected by CCA test while the lowest infection rate was diagnosed by Kato-Katz. These results confirm the low sensitivity of Kato-Katz as compared to CCA. CCA test revealed much higher infection rates as compared to Kato-Katz.
Members of the families were examined only by Kato-Katz. All relatives of the low infection school children showed negative results, while those of the high infection children revealed 5% and 6% rate whether they were related to positive or negative children. It is most probable that their intensity of infection was below the level of Kato-Katz sensitivity and a good proportion was accordingly missed.
CCA cassette test proved to have significant advantages. It is rapid, easy to use and has also the potential to detect the early infection (before passing eggs). Simple urine sample collection makes it an attractive tool for screening of S. mansoni infections in control programs. Therefore, efforts to reduce the cost of CCA cassettes are required to permit its large scale.
Conclusions and Recommendations
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CONCLUSIONS AND RECOMMENDATIONS
from the present study, it could be concluded that:
• This study conforms to the WHO reporting that children aged 6-12 years are a sensitive index for schistosomiasis in their communities. Results of the present work denote that Schistosoma mansoni constitutes a real public health problem in Kafr-El-Sheikh governorate.
• Diagnosed by a sensitive and accurate technique as the CCA cassette test, schoolchildren pin pointed to a wide yet low and hidden potential of transmission.
• Although schoolchildren were a sensitive index of schistosomiasis in their communities, they were not indicators of infection in their particular families when the latter were diagnosed only by Kato-Katz.
It is recommended that:
• As adults are expected to have lower intensity of infection than children, the use of a sensitive technique may disclose some hidden cases among family members to confirm or reject the presence of a relation.
• Once schoolchildren display any load of infection (prevalence and intensity), continuous surveillance and treatment of cases passing ova is recommended to avoid re-emergence of the problem with its morbidity challenge.