Abstract:
The recommended strategy for control of schistosomiasis is preventive chemotherapy
with praziquantel (PZQ). Pre-school age children (PSAC) are excluded from population
treatment programs. In high endemic areas, these children are also at risk, and require
treatment with PZQ. The Government of Kenya initiated the National School-Based
Deworming Programme (NSBDP) where PSAC in Early Childhood Development
(ECD) Centres are only eligible for treatment with albendazole (ABZ) but not with
PZQ. Four hundred PSAC were enrolled, from 10 randomly selected ECD Centers in
Kwale County, Kenya where children were treated with crushed PZQ tablets mixed with
fruit juice, at a single dose of 40 mg/kg. Treatment efficacy was assessed by examining
urine samples for Schistosoma haematobium eggs in the 5 weeks’ post-treatment follow up. Children testing negative for S. haematobium during the follow-up were considered cured. Egg reduction rate (ERR) was calculated as the decrement in the infection intensity (group’s geometric mean egg counts per 10 ml of urine) following treatment, expressed as a proportion of the pre-treatment infection intensity. Twenty-four hours’ post-treatment, adverse effects were assessed through questionnaires administered to the parents or guardians.Treatment acceptability was determined by observing if the child spat and/ or vomited all or part of the PZQ dose immediately after treatment.Before treatment, 80 out of the 400 children enrolled in the study tested positive for S. haematobium (20.0% (95% confidence interval (CI) 16.4 - 24.2%). Of these, 41 (51.3%) had infections of heavy intensity while the rest (48.7%) were of light intensity. Five
weeks’ post-treatment, 10 children who had heavy intensity infection were diagnosed
with S. haematobium (prevalence: 2.5% (95% CI 1.5 - 4. 9%). Infection intensities
decreased significantly from 45.9% (95% CI: 31.0 - 68.0) eggs/ 10 ml urine to1.4%
(95% CI: 1.1 - 1.7) eggs/ 10 ml urine during pre-and post-treatment respectively. The
ERR was 96.9%. 330 out of the 400 children recruited inthe study were assessed for
AEs 24 hours post treatment. One experienced dizziness, one experienced a headache,
four had abdominal pain/discomfort, two had nausea and two experienced itching. None
of the children vomited. While six respondents took no action when their child
experienced an adverse event, one gave food, two gave milk and the other one made the
child to rest. Treatment tolerability among the 400 children was high as none of the
children spat and/ or vomited as observed in this study. The study revealed that crushed
PZQ is safe and effective in the treatment of urogenital schistosomiasis in this age
group. The study recommends the Government of Kenya to consider having the PSAC
children treated with PZQ as they have a high S. haematobium burden.
