Uganda: 1 year follow-up in Hoima & Mayuge districts completed and preliminary analysis of data from all districtsAt the end of July, the first round of 1 year post-treatment follow-up was completed in Hoima and Mayuge districts, marking the successful end of fieldwork operations for longitudinal monitoring for the period 2003/2004.
Hoima: Lake Albert
For those children & adults examined, there were many positive changes associated with treatment. Indeed compliance with a 2nd treatment was excellent and side-effects were now minimal. Whilst in Hoima, Russell & Poppy also collected miracidia of S. mansoni from several people for subsequent DNA characterization by PCR. Mayuge district: Lake Victoria
Initial analytical findings from 8 districtsA total of 4354 children across 37 schools which are acting as sentinel locations for the evaluation of treatment on morbidity and general health indicators have been examined at baseline, and 65% of them 1 year post-treatment. The children have been given a 2nd round of anthelmintic treatment and will again be re-examined in 1 year - starting again in October 2004 in Masindi, Nebbi, Arua, Moyo districts. From initial inspection of the data there is much to be pleased with: we have seen a tangible improvement in the awareness of Bilharzia in nearly all schools visited, a reduction in the levels of severe anemia and organomegaly, liver ultrasound measures associated with pathology and more importantly good reductions in faecal egg counts of ‘individuals’ as well as within ‘means’ calculated by sex, ageclass, schools & districts as well as reductions in point prevalences.
By basing our data collection on an individual basis we can quickly pinpoint any anomalies in our data for either biometric scores or faecal egg counts. For example, we can identify the children in our database whose faecal egg count appears to have increased after one year and contrary to expectation. By having a detailed record of the children who experienced side-effects e.g. vomiting, as well as markers of ‘unsafe’ water contact we can quickly resolve such ambiguities.
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After
splitting from Iganga, the newly created Mayuge district has extensive
shoreline on Lake Victoria and work continued in 5 schools and 2 adult
communities during July. Whilst the lakeshore is less dramatic than Lake
Albert, the conditions along are no less impoverished and schistosomiasis
continues to be a major scourge of the local population. During this survey
the VCD team was also accompanied by Russell and Poppy as well as two M.Sc.
research students from the London School of Hygiene and Tropical Medicine,
Ms Emily Robinson and Sarah Odogwu, as part of their degree.
Over
the two weeks while the main team was in Mayuge, Emily and Poppy performed a
detailed study of the dynamics of S. mansoni egg clearance following
from anthelmintic treatment and longevity of S. mansoni miracidia in
known titrations of praziquantel. While this was ongoing Russell and Sarah
investigated the occurrence of S. mansoni infections in pre-school
age children at two locations, Bwondha & Bogoto, along the lake. Owing to
the peculiarities of the shoreline of Bugoto where sanitation was very
poor, the lake very shallow (< 10cms) and Biomphalaria in great
abundance, patent S. mansoni infections were found in children as
young as 9 months old. On the other hand none was seen at Bowndha where the
transmission was perhaps less conducive.
