… Studies reveal high prevalence of schistosomiasis in women, worms in children

By Chioma Obinna

Researchers at the Nigerian Institute of Medical Research, NIMR, have called for greater awareness and intervention on the prevalence and impact of Neglected Tropical Diseases, NTDs, in Nigeria.

This call follows recent concerning findings about the prevalence and impact of NTDs such as Female Genital Schistosomiasis (FGS), soil-transmitted helminthiases (STHs), and Buruli ulcer across the country.

Speaking to journalists during the Institute’s monthly media briefing in Lagos, a Professor of Parasitology and immediate past Deputy Director-General of NIMR, Prof. Olaoluwa Pheabian Akinwale, emphasised the urgent need for increased awareness, robust interventions, and sustained funding to combat these debilitating illnesses.

Akinwale, who also serves as the Director of NTD Research at NIMR and is affiliated with numerous international health organisations, including the WHO Strategic and Technical Advisory Group for NTDs, expressed concern over their studies’ findings.

A particular focus was on the high prevalence of urinary schistosomiasis among women of childbearing age and its potential link to female genital schistosomiasis (FGS).

She said: “Our study revealed that almost half of the women screened in endemic communities were infected with urinary schistosomiasis. Furthermore, photo-colposcopy indicated that about half of these infected women showed signs suggestive of FGS, a gender-specific manifestation that has been largely understudied.”

She emphasised the need for greater attention to women’s health in endemic areas and advocated for more measures to improve the health of women, especially those living in schistosomiasis-endemic communities.

The research also indicated abnormal cervical manifestations in these women, prompting a strong recommendation for follow-up studies with larger sample sizes to monitor potential progression to malignant lesions.

“Of particular concern were the findings from photo-colposcopy, which showed that approximately 50 per cent of the infected women exhibited signs of female genital schistosomiasis, including abnormal blood vessels, grainy sandy patches, and rubbery papules—symptoms that could lead to long-term health issues if left untreated,” Akinwale explained.

The study, funded by grants from the Royal Society of Tropical Medicine and Hygiene and the National Institute for Health Research in the UK and conducted in some communities in Ogun State, was “eye-opening,” she added.

“What we discovered is that schistosomiasis is not just a disease of the urinary system; it can also have debilitating effects on women’s reproductive organs, increasing the risk of infertility and other complications.”

Schistosomiasis, a parasitic disease caused by the Schistosoma worm, affects millions in Sub-Saharan Africa. However, the gender-specific manifestation of this disease, female genital schistosomiasis, has been largely overlooked in public health efforts.

“Schistosomiasis is often seen as a disease that primarily affects men, but women, especially those of reproductive age, are at significant risk due to their frequent exposure to contaminated water during domestic chores,” Akinwale explained.

“Our research aims to bring attention to female genital schistosomiasis, a condition that can lead to severe reproductive health complications.”

On their findings on Buruli ulcer, Akinwale highlighted the significant achievement of establishing the Buruli ulcer Reference Laboratory at NIMR in 2016, which has become a crucial member of the WHO African Region’s Skin NTD Laboratory Network.

 “The establishment of the BU Reference Laboratory has been a game-changer for Nigeria’s response to this debilitating skin disease. It has significantly reduced the turnaround time for PCR confirmation, leading to timelier diagnoses and improved treatment outcomes for patients,” she stated.

While recent PCR results indicate a low prevalence of Buruli ulcer in Nigeria, Professor Akinwale cautioned against complacency, recommending further screening for other skin NTDs in PCR-negative cases and advocating for increased government sensitization and active case searches.

Speaking on soil-transmitted helminthiases (STHs), particularly among children, a Senior Research Fellow, Public Health and Epidemiology Dept, NIMR, Dr Vincent Gyang who presented alarming data from a recent study in an urban slum in Lagos State noted that the overall prevalence of STH infections among the school-aged children they studied was nearly 90 per cent, with roundworm being the most common.  “Like in our study in an urban slum here in Lagos, the children were screened. And over 90 per cent were positive with intestinal parasites. Of those 90 per cent, about 50 per cent had multiple infections. Some had two worms, some had three worms, which exhibited different morbidities in the children.” 

The study revealed that 39.1 per cent of the children had polyparasitism, with 36.1 percent having double intestinal parasites and 2.9 per cent having triple parasites. Those with single parasitic infection constituted 46.4 per cent. The result suggested a highly contaminated nature of the Makoko settlement. The researchers emphasised that polyparasitism can lead to multiple morbidities due to the presence of different parasite species.

“We found that among the risk factors for infection, which included playing with soil, drinking untreated water, and consuming raw vegetables, there was only a significant association between drinking unsafe water and infection, as shown in the multivariate analysis,” he noted. The location of Makoko in Lagos was a significant concern, as the movement of people and goods, such as fish and vegetables, from such highly contaminated environments to other parts of the city exposes the entire city to the risk of infections by various intestinal parasites.

He stressed the profound impact of these infections on children’s health and development, linking them to poor growth, vitamin deficiencies, anaemia, and impaired educational performance. “Our findings underscore the urgent need for regular mass deworming programs, improved health education in schools, and ensuring access to safe water and proper sanitation facilities. We advocated for the complete stoppage of open defecation. Since the root of infection is the oral faecal route and you pick it from what you eat.”

Further, Professor Akinwale stressed the profound impact of these infections on children’s health and development, linking them to poor growth, vitamin deficiencies, anaemia, and impaired educational performance. “Our findings underscore the urgent need for regular mass deworming programmes, improved health education in schools, and ensuring access to safe water and proper sanitation facilities,” she urged.

Lamenting the persistent challenges hindering NTD research and control efforts in Nigeria despite their efforts, she stated, “Limited funding and the high cost of research tools and consumables remain major obstacles.”

To overcome these hurdles, she proposed exploring additional grant opportunities, training more early-career researchers in grantsmanship, and building local capacity for the development of diagnostic tools.

Akinwale stressed the need for interconnectedness of research, policy, and public health interventions in tackling NTDs.