Factors Influencing Burden of Schistosoma Haematobium Infection and the Influencing Factors among Pregnant Women in Kwale County, Kenya

Abstract

Schistosomiasis is a disease of global public health importance among populations residing in Schistosoma-infection prone areas. Global interventions have not succeeded yet in control, elimination nor eradication of the burden with 40 million women of reproductive age still affected. About 250 million people in 78 Countries in Africa are at risk. The Kenyan Coast is endemic to Schistosoma haematobium infections. Preventive measures and mass treatment of infected populations can reduce or possibly eliminate schistosomiasis. In Kenya, pregnancy is a contraindication to praziquantel (PZQ) treatment while World Health Organisation (WHO) recommends its’ use in pregnancy; effects of bilharzia in pregnancy and unborn child are known to be disastrous. Pregnant women in Kwale County remain at high risk together with the unborn child. This study aimed at investigating factors that influence Schistosoma haematobium (S.haematobium) infection among pregnant women in Kwale County. This was analytical cross-sectional study; quantitative and qualitative methods were used. The study was done in Kwale County in March through August 2016 within four Sub Counties; Matuga, Kinango, Msambweni and Lunga Lunga. Sample size was 368 pregnant women. Quantitative analysis used Stata version 12.0, qualitative data used N- Vivo version 8. Thematic analysis used six steps and themes were generated and clarified. Fisher’s exact tests were used for parity vs schistosomiasis comparisons with p value of 0.05 for significance. Odds ratios were used with 0.05 p value and 95% confidence interval to analyse Knowledge, Practice and Attitude factors significance as an association to Schistosomiasis infection. Structured questionnaires were used for quantitative data; in-depth interview guide was used on Key Informants for qualitative data. Clinical investigations were done to detect Schistosoma infection. Quantification of Schistosoma eggs using Kato-Katz technique was done. Pregnancy test was done to confirm pregnancy. Obstetric history was taken to assess previous deliveries and rule out abnormalities. The prevalence of S.haematobium infection among pregnant women in kwale County was 12.2%. Kinango Sub County reported highest prevalence 14.1%. Rice farming was a significant predisposing factor. Among the participants 36.7% utilize river waters and 14% use water pans. Among the participants 29% did not use toilets. Regarding knowledge of bilharziasis; 96.7% knew what bilharzia was and 84.8% were aware of the causal agent as parasite. Intensity of S.haematobium among pregnant mothers in Kwale County is low. Majority of the participants had no formal education which is known to increase the risk. Practices and attitude of the mothers had little significance to the infection. Rice farming was a risk factor, but the areas with highest prevalence are none rice growers. Bathing in rivers and use of untreated water increased the risk of infection. The county government together with ministry of health should integrate routine screening and treatment for S. haematobium disease into antenatal care services in affected areas like Kwale County. Mass drug administration campaigns to focus more on all women of reproductive age to lower community reservoir and cut the chain of reinfection which could reduce possible infections before they conceive thus alleviating gestational burden of schistosomiasis. water, sanitation and Hygiene Initiatives (WASH) to be expanded with more focus on bilharzia high prevalent areas to increase access to clean safe water sources to the community. The County government with ministry of health should increase sensitization health talks with emphasis on behaviour change to the population on xvii water hygiene practices, safe farming practices with emphasising on proper use of protective personal equipment to limit exposure to new infections and reinfections.