Hymenolepis nana, commonly known as the dwarf tapeworm, affects 50 to 75 million people worldwide. To date, no studies have explored the disease burden of H. nana infection in Sudan. This study aimed to determine the national prevalence of H. nana across 189 districts and 18 states in Sudan and the number of individuals infected with H. nana who did not receive treatment during the mass drug administration (MDA) campaign targeting schistosomiasis. In addition, the study sought to evaluate the extent of co-infection of H. nana with schistosomiasis and soil-transmitted helminthiasis. This involved a secondary analysis of a nationwide survey conducted in 2017 in Sudan. Binomial family generalized linear models with a logarithmic link function were used to estimate the prevalence ratio of potential risk factors, including sex and water and sanitation conditions in schools and households. For the nationwide survey, a 2-stage sampling method was used, in which 105,167 students were selected from 1,772 schools. A total of 96,679 stool samples were collected, of which 4,706 (4.9%) tested positive for H. nana. Of these, fewer than 1% were co-infected with schistosomiasis (either Schistosoma haematobium or Schistosoma mansoni), and a mere 0.1% had co-infections with soil-transmitted helminths. At an 8% threshold for village-based MDA, approximately 1.1 million infected adults are ineligible to receive praziquantel from the village-based MDA. Children residing in households with improved latrines had a lower odds of H. nana infection than those without improved latrines did (adjusted odds ratio=0.87, 95% confidence interval=0.80–0.94, p=0.001). In countries where H. nana is endemic, such as Sudan, providers making MDA decisions should consider the prevalence of either H. nana or schistosomiasis, rather than focusing solely on the latter.
Global efforts to identify groups at high risk for schistosomiasis have mainly concentrated on identifying their geographical distribution. Investigations on the socioeconomic characteristics of high-risk groups are relatively scarce. This study aimed to explore the associations between schistosomiasis among students and their parents’ occupations. A nationwide cross-sectional survey was conducted targeting 105,167 students in 1,772 primary schools across Sudan in 2017. From these students, 100,726 urine and 96,634 stool samples were collected to test for Schistosoma haematobium and S. mansoni infection. A multi-level mixed effect analysis was used with age and sex as fixed factors, and school as a random factor. The odd ratios (ORs) of practicing open defecation among farmers’ children were almost 5 times higher than their counterparts whose parents were government officials (OR=4.97, 95% confidence intervals (CIs): 4.57-5.42, P<0.001). The ORs of contacting water bodies for watering livestock among farmers’ children were more than 4 times higher than those of children whose parents were government officials (OR=4.59, 95% CIs: 4.02-5.24, P<0.001). This study shows that schistosomiasis represents a disease of poverty and that farmers’ children constituted a high-risk group.
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We aimed to explore the population dynamics of snail in 3 sites of the White Nile in Sudan. More specifically, we aimed to investigate the annual patterns of snail populations that act as intermediate hosts of schistosomes and monthly snail infection rates and ecological characteristics presumably related to snail populations. We collected snails for 1 year monthly at 3 different shore sites in the vicinity of El Shajara along the White Nile river in Khartoum State, Sudan. In addition, we measured air and water temperatures, water turbidities, vegetation coverages, and water depths and current speeds. Most of the collected snails were Biomphalaria pfeifferi and Bulinus truncatus. The population densities of snails and their infection rates varied across survey sites. The collected snails liberated S. mansoni and S. haematobium cercariae as well as Amphistome and Echinostome cercariae. Infected snails were found during March-June. The ecological characteristics found to be associated with the absence of snails population were: high turbidity, deep water, low vegetation coverage (near absence of vegetation), high water temperature, and high current speed. To our knowledge, this is the first longitudinal study of the snail population and ecological characteristics in the main basin of the White Nile river.
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This study aimed to investigate whether mass drug administration (MDA) intervention has an equivalent effect on reducing the prevalence and intensity of Schistosoma haematobium infection regardless of the baseline values. A repeated cross-sectional survey was performed targeting students of 12 primary schools in Al Jabalain and El Salam districts of White Nile State, Sudan, at both 1 week before and 8 months after the MDA. Prior to the baseline survey, school-aged children in Al Jabalain had received MDA interventions twice in 4 years, while those in El Salam had not. The baseline prevalence was 9.1% in Al Jabalain and 35.2% in El Salam, which were reduced to 1.8% and 5.5% at 8 months after the MDA, respectively. The corresponding reduction rates were 80.3% and 84.4%, not significant difference between both districts. However, changes in the geometric mean intensity (GMI) of egg counts were significantly different between both districts. The baseline GMIs were 14.5 eggs per 10 ml of urine (EP10) in Al Jabalain and 18.5 EP10 in El Salam, which were reduced to 7.1 and 11.2 EP10 after treatment, respectively. The corresponding reduction rates were 51.0% and 39.5%. In conclusion, MDA interventions were found to bring about similar relative reduction in prevalence regardless of the baseline value; however, the relative reduction in infection intensity was more salient in the district with a low baseline value for both prevalence and intensity. This clearly points to the importance of repeated MDA interventions in endemic areas, which will eventually contribute to schistosomiasis elimination.
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There have been some reports on schistosomiasis of school children in Sudan’s Nile River basin area; however, information about the infection status of Schistosoma species and intestinal helminths among village residents of this area is very limited. Urine and stool samples were collected from the 1,138 residents of the Al Hidaib and Khour Ajwal villages of White Nile State, Sudan in 2014. The prevalence of overall schistosomiasis and intestinal helminthiasis was 36.3% and 7.7%, respectively. Egg positive rates were 35.6% for Schistosoma haematobium, 2.6% for S. mansoni, and 1.4% were mixed. The prevalence of schistosomiasis was significantly higher in men (45.6%) than in women (32.0%), in Khou Ajwal villagers (39.4%) than in Al Hidaib villagers (19.2%), and for age groups ≤15 years old (51.5%) than for age groups >15 years old (13.2%). The average number of eggs per 10 ml urine (EP10) of S. haematobium infections was 18.9, with 22.2 eggs in men vs 17.0 in women and 20.4 in Khou Ajwal villagers vs 8.1 in Al Hidaib villagers. In addition to S. mansoni eggs, 4 different species of intestinal helminths were found in the stool, including Hymenolepis nana (6.6%) and H. diminuta (1.0%). Collectively, urinary schistosomiasis is still prevalent among village residents in Sudan’s White Nile River basin and was especially high in men, children ≤15 years, and in the village without a clean water system. H. nana was the most frequently detected intestinal helminths in the 2 villages.
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