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.