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Open Access Research article

A comparison of urinary tract pathology and morbidity in adult populations from endemic and non-endemic zones for urinary schistosomiasis on Unguja Island, Zanzibar

Beatrice Lyons1, Russel Stothard2, David Rollinson2, Simba Khamis3, Khamis A Simai4 and Paul R Hunter1*

Author Affiliations

1 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

2 Wolfson Wellcome Biomedical Laboratories, Zoology Dept, The Natural History Museum, London, UK

3 Helminth Control Laboratory Unguja, Ministry of Health and Social Welfare, Zanzibar, Tanzania

4 Mnazi Moja Hospital, of Health and Social Welfare, Zanzibar, Tanzania

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BMC Infectious Diseases 2009, 9:189  doi:10.1186/1471-2334-9-189

Published: 29 November 2009

Abstract

Background

Renal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. The aim of this study was to assess the burden of urinary tract pathology and morbidity due to schistosomiasis in Zanzibar and identify reliable clinical predictors of schistosomiasis associated renal disease.

Methods

A cross-sectional comparison of Ungujan men and women living within either high or low endemic areas for urinary schistosomiasis was conducted. Using urine analysis with reagent strips, parasitological egg counts, portable ultrasonography and a qualitative case-history questionnaire. Data analysis used single and multiple predictor variable logistic regression.

Results

One hundred and sixty people were examined in the high endemic area (63% women and 37% men), and 101 people in the low endemic area (61% women and 39% men). In the high endemic area, egg-patent schistosomiasis and urinary tract pathology were much more common (p = 1 × 10-3, 8 × 10-6, respectively) in comparison with the low endemic area. Self-reported frothy urine, self-reported haematuria, dysuria and urgency to urinate were associated with urinary tract pathology (p = 1.8 × 10-2, p = 1.1 × 10-4, p = 1.3 × 10-6, p = 1.1 × 10-7, respectively) as assessed by ultrasonography. In a multi-variable logistic regression model, self-reporting of schistosomiasis in the past year, self-reporting of urgency to urinate and having an egg-positive urine sample were all independently associated with detectable urinary tract abnormality, consistent with schistosomiasis-specific disease. Having two or more of these features was moderately sensitive (70%) as a predictor for urinary tract abnormality with high specificity (92%).

Conclusion

Having two out of urgency to urinate, self reporting of previous infections and detection of eggs in the urine were good proxy predictors of urinary tract abnormality as detected by ultrasound.