Journal of Helminthology

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Review Article

Urinary schistosomiasis on Zanzibar: application of two novel assays for the detection of excreted albumin and haemoglobin in urine

D. Rollinsona1 c1, E.V. Klingera2, A.F. Mgenia3, I.S. Khamisa3 and J.R. Stotharda1a4

a1 Wolfson Wellcome Biomedical Laboratories, Department of Zoology, Natural History Museum, Cromwell Road, London, SW7 5BD, UK

a2 Department of Population and International Health, Harvard School of Public Health, Cambridge, MA 02138, USA

a3 Helminth Control Laboratory Unguja, Helminth Control Programme, Ministry of Health and Social Welfare, Zanzibar, Tanzania

a4 Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, London W2 1PG, UK

Article author query

Rollinson D [PubMed]  [Google Scholar]
Klinger EV [PubMed]  [Google Scholar]
Mgeni AF [PubMed]  [Google Scholar]
Khamis IS [PubMed]  [Google Scholar]
Stothard JR [PubMed]  [Google Scholar]


As part of a urinary schistosomiasis control programme on Zanzibar, an aged cross-sectional survey of 305 children from three schools on Unguja was conducted to investigate the relationships between levels of excreted albumin and haemoglobin in urine and Schistosoma haematobium infection status. Diagnosis was determined by standard parasitological methods, dipstick reagents for microhaematuria, visual inspection for macrohaematuria as well as collection of case-history questionnaire data for self-diagnosis. Prevalence of infection as determined by parasitology was 53.9% and approximately, one quarter of the children examined were anaemic (<11 g dl−1). A statistically significant negative association of blood haemoglobin levels of boys and S. haematobium infection intensity status was observed (rs=−0.23, P=0.005). Through sensitivity analysis of urine-albumin values it was determined that a concentration of above >40 mg l−1, as measured with the HemoCue urine-albumin photometer, had sensitivity, specificity, positive and negative predictive values of 0.90, 0.83, 0.86 and 0.89 respectively against ‘gold-standard’ parasitology. There was a clear association of reported pain upon micturition for children with elevated urine-albumin levels, with an odds ratio of 20 to 1. Levels of excreted blood in urine were quantified with the HemoCue Plasma/Low Hb photometer. However, dipsticks remain the method of choice for urine-haemoglobin of 0.1 g l−1 and below. Urine parameters over a 24-h period were assessed in a small sub-sample. Reductions in both albumin and haemoglobin excretion were observed in 11 children 54 days after praziquantel treatment. It was concluded that these rapid, high-through-put, portable HemoCue assays could play a role in better describing and monitoring the occurrence, severity and evolution of urinary schistosomiasis disease. The urine-albumin assay has particular promise as a biochemical marker of S. haematobium induced kidney- and upper urinary tract-morbidity.

(Accepted June 14 2005)


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