INFLUENCE OF LONG TERM EXPOSURE TO SCHISTOSOMIASIS ON

COGNITIVE AND REPRODUCTIVE FUNCTIONS AMONG THE MIDDLE AGE

WOMEN IN EBUTTE IGBOORO, YEWA NORTH LOCAL GOVERNMENT, OGUN
STATE.

BY

AKANBI, MORENIKEJI OLUWAFOLAKEMI

MATRIC NUMBER: H/ST/21/2083

DEPARTMENT OF SCIENCE LABORATORY TECHNOLOGY

SCHOOL OF PURE AND APPLIED SCIENCES

THE FEDERAL POLYTECHNIC ILARO, OGUN STATE.

NOVEMBER, 2023.

i
 INFLUENCE OF LONG TERM EXPOSURE TO SCHISTOSOMIASIS ON
COGNITIVE AND REPRODUCTIVE FUNCTIONS AMONG THE MIDDLE AGE
WOMEN IN EBUTTE IGBOORO, YEWA NORTH LOCAL GOVERNMENT, OGUN
STATE.

BY

AKANBI, MORENIKEJI OLUWAFOLAKEMI

MATRIC NUMBER: H/ST/21/2083

A PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE AWARD OF HIGHER DIPLOMA IN THE DEPARTMENT OF SCIENCE
LABORATORY TECHNOLOGY, THE FEDERAL POLYTECHNIC ILARO, OGUN
STATE.

NOVEMBER, 2023.

ii
 CERTIFICATION

This is to certify that the research work titled “Influence of long-term exposure to
Schistosomiasis on cognitive and reproductive functions among the middle age women in
Ebute Igbooro Yewa North, Ogun State” was carried out by AKANBI, MORENIKEJI
OLUWAFOLAKEMI, matric number; H/ST/21/2083 under the supervision of Mr. A
Adewole and Mrs. Popoola in the Department of Science Laboratory Technology.

__________________________

Mr. A. Adewole

Supervisor’s Signature and Date

__________________________

Mrs. Popoola

Co-Supervisor’s Signature and Date

__________________________

Dr. R.A. Amusa

Head of Department Signature and Date

iii
 DEDICATION

I dedicate this work to the Abba father who is faithful in all things and in whom all
achievement in life are made possible, and my parents who gave me the support to achieve
my dream at their expense. Without them, this project would not have been possible.

iv
 ACKNOWLEDGEMENTS
It is my pleasure to register my profound appreciation and gratitude for the moral, financial
support, advice and cooperation received from various people at different stages of this
research work and eventual completion of my course of study in this great citadel of learning.
Firstly, I express my sincere gratitude to my supervisor, Mr. Adewole Adekanmi and co-
supervisor Mrs. Popoola for their patience, enthusiasm, insightful comments and parental
advice in the course of carrying out the research work. Their knowledge and professional
expertise in research work has enabled me to complete this research work successfully.
I also express my sincere thanks to my parents Mr. and Mrs. Festus Akanbi, for their prayers,
love, care, and financial support throughout my academic pursuit; you will live long in good
health and wealth eat the fruits of your labor in Jesus name (Amen).
I would also be ungrateful if I did not acknowledge Dr Oyedeji, Mr. F.T Faparusi, Mrs. F.O
Abdulsalam, and all the lecturers for their impartation of knowledge.
I am also grateful to my friends; Yakub, Micheal, Ayobami, Esther, Aishat, Akorede,
Oreoluwa, John, to mention but a few, for their supports, love and care towards me.
Finally, I am extremely grateful to all Flakkie shiners and my siblings for their financial
support towards the success of this project. Thanks for all you do.
To God be the glory great things he has done.
Thank you all for everything!

v
 ABSTRACT

This research work is aimed at the assessment of the influence of long term exposure
to Schistosoma on cognitive and Reproductive functions among the middle age
woman in Ebute Igbooro, Yewa North, Ogun State. The study was descriptive and data
were collected from 50 participant using a purpose designed, and structured questionnaire to
assess their knowledge, perceptions, and practices, in relation to the disease on cognitive and
reproductive functions. Urine analysis was used to determine urinary schistosomiasis
infection. The association test carried out revealed a p-value higher than 0.05 between
how long and symptoms (x2=2.014, ₚ=0.156), thinking and symptoms (x 2=1.891,
ₚ=0.595), forget names and symptoms (x2=1.866, ₚ=0.760), how long and inflammation
(x2=1.043, ₚ=0.594), age and RDT test (x2=1.295, ₚ=0.730), age and microscopy
examination (x2=1.295, ₚ=0.730), blood urine and RDT test (x2=0.378, ₚ=0.539), (table
4.3-4.9). It was concluded that schistosomiasis is a serious public health problem that
has a negative impact on the cognitive and reproductive functions among humans and
must not be taken for granted. It was recommended that mass drug administration
(PRAZIQUANTEL), community mobilization and health education regarding the cause,
transmission and prevention of schistosomiasis and education about good personal and
sanitary hygiene practices should be considered in order to significantly reduce the
exposure and morbidity of infection within these communities.

vi
 TABLE OF CONTENTS

Title Page i - ii

Certification iii

Dedication iv

Acknowledgements v

Abstract vi

Table of Contents vii

List of Tables ix

CHAPTER ONE: INTRODUCTION

1.0 Introduction 1

1.1 Background to the Study 1

1.2 Statement of the Problem 4

1.3 Justification of the Study 4

1.4 Aims of the Study 5

1.5 Objectives of the Study 5

CHAPTER TWO

2.0 Literature Review 6

2.1 Pathology and Morbidity due to Schistosomiasis 6

2.1.1 Invasion stage 6

vii
2.1.2 Acute Schistomiasis 6

2.1.3 Early manifestation of S.haematobium 7

2.1.4 Late manifestation of S.haematobium

7

2.2 Meta Analysis on Cognitive 8

2.3 Female Urogenital in Woman of reproductive Age and Pregnant Women 8

2.3.1 Schistosomiasis Morbidity and Mortality in sub-saharan Africa 10

2.3.2 Factors determining the continuous transmission of Schistosomiasis

in sub-saharan of Africa 10

2.3.3 Praziquantel treatment and pregnancy 12

CHAPTER THREE

3.0 Materials and Methods 14

3.1 Study Area 14

3.1.2 Study design and Population 14

3.2 Materials 14

3.3 Methods 14

3.4 Anthropometric evaluation 14

3.4.1 Administration of questionnaires 15

3.4.2 Urine collection 15

3.5 Examination of urine for microheamaturia 15

3.5.1 Microscopic examination for Schistosoma haematobium 16

3.5.2 Treatment 16

3.5.3 Ethical Approval 16

CHAPTER FOUR

4.0 Result and Discussion 17

4.1 Results 17

4.2 Discussion 34

viii
CHAPTER FIVE

5.0 Conclusion and Recommendation 37

5.1 Conclusion 37

5.2 Recommendation 37

REFERENCES 38

APPENDIX 44

ix
 LIST OF TABLES

Table 4.1 Respondent' socio demographic characteristics 17

Table 4.2 Respondents association of age and symptoms 18

Table 4.3 Respondents association of how long and symptoms 20

Table 4.4 Respondents association of thinking and symptoms 22

Table 4.5 Respondents association of forget names and symptoms 24

Table 4.6 Respondents association of howlong and inflammation 26

Table 4.7 Respondents association of age and RDT test 28

Table 4.8 Respondents association of age and microscopy examination 30

Table 4.9 Respondents association of blood urine and RDT test 32

x
 CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Schistosomiasis is a snail-transmitted disease caused by digenetic trematodes of the genus

Schistosoma primarily infecting man. (Webbe, 1981). There are five (5) main species that

infect human being; S. haematobium, S. mansoni, S. intercalatum, S. mekongi. Other

schistosome species are parasites of animals and birds some of which occasionally hybridize

with human schistosomes (Webbe, 1981). The different species exhibits distinct difference

pertaining to size, the intermediate host and final location in the definitive host and the

number and morphological features of the eggs laid by the adult worms (Webbe, 1981).

Adult males and females of S. heamatobium reside in the venules of the pelvic plexus while

the other species S. mansoni, S. japonicum, S. intercalatum, S. mekongi are found in the

mesenteric veins.

Human Schistosomiasis otherwise called bilharzias, is a fresh water snail transmitted

intravascular debilitating disease resulting from infection by the parasitic dimorphic

Schistosoma trematode worms, which lives in the blood stream of human (Steinmann

et al., 2006). The World Health Organization (WHO) regards the disease as a neglected

tropical disease, with an estimated 732 million persons being vulnerable to infection

world – wide (WHO, 2004). Steinmann and co-workers documented that over 200

million individual from Africa, Asia and South – America are infected with this

disease (Steinmann et al., 2013). The World Health Organization (WHO) further

estimated that schistosome infections and geo-helminths account for over 40% of the

world tropical disease burden with the exclusive of malaria (Olve Du et al., 2013).

Human get infected with disease when they make contact with water contaminated

1
with the skin – penetrating cercariae (WHO, 2014). Approximately 120 million

individual in sub – Saharan Africa have Schistosomiasis – related symptoms while about

20 million undergo hardship as a result of chronic presentation of the disease

(Chitsulo et al., 2013).

Schistosomiasis has been successfully eliminated in Japan and Tunisia (Utzinger et

al., 2009). Morocco and some Caribbean Islands countries have made significant

progress on controlling the disease while Brazil, China and Egypt are taking steps

towards elimination of the disease (Utzinger et al., 2009). Schistosomiasis is more

rampant in poor rural communities especially place where fishing and agricultural

activities are dominant. Domestic activities such as washing clothes and fetching in

the infected water exposes woman and children to infection. Recreational activities

like swimming and poor hygiene also make children vulnerable to Schistosomiasis

(WHO, 2014).

The intermediate freshwater snail inhabit calm and slowly moving freshwater lakes,

rivers, ponds or steam. The rate of infection in human increases Subsequently, the

parasites eggs are released into the feaces or urine where they remain alive for about

seven (7) days. When get into fresh water, miracidium is released from the egg with

the aid of chemical stimuli and light, the miracidium seeks the fresh water snails

which is its intermediate host. On locating the snail, the miracidium penetrate it and

undergoes asexual reproduction to produce multicellular sporocytes which develops to

cercariae lava hatching embryonic suckers as well as two-branched tail (Aryseels et

al., 2006). After 4-6 weeks of infecting the snail, the cercariae leave the snail and

gyrate around for about 72 hours looking for the skin of a prospective host. Once

released from the snail the cercariae are investigated by light mainly during the day

2
time. On locating the human host skin, the cercariae burrow into it, migrate into the

blood through the liver and lungs and undergo transformation into Schistosomula also

called young worms (Aryseel et al., 2006).

withWith the duration spentduration inspent contaminatedin watercontaminated (water

(Aray et al., 2006). Microscopic examination of urine is the gold standard for

detection (diagnosis) of Schistosoma infection. The schistosome eggs are easily seen

and identified on microscope due to its peculiar size and shape, and possession of a

lateral or terminal spine (Aray et al., 2006).

1.1.2 Schistosomiasis in Women of Reproductiveof Reproductive Age

Female urogenital Schistosomiasis (FUS) is a lifetime disease acquired primarily in

childhood by exposure to S. haematobium, one of the two (2) main schistosomes

transmitted in Africa (WHO, 2009). Female urogenital Schistosomiasis is

predominantly caused by Schistosoma haematobium and has been estimated by the

World Health Organization (WHO) to affect up to 45 million woman living in sub-

Saharan Africa (WHO, 2009). Adult S. haematobium worms inhabits blood vessels

surrounding the urinary bladder and female genital tract and lay eggs that migrate

through tissue of proximate organs, causing, chronic granulomatous inflammation most

commonly in the urinary bladder cervix and vagina, vagina bleeding, pain during

sexual intercourse and modules in the vulva (WHO, 2009). There may be long-term

irreversible consequence, including infertility (WHO, 1998; 1999). Previous policy has

excluded pregnant and lactating women from the control of Schistosomiasis using

Praziquantel treatment (WHO, 1998; 1999) but this policy was rescinded following a

review in 2002 (WHO, 2022; Allen, 1998).

3
1.1.2 Schistosomiasis infection on the cognitive functions of preschool age
children.

Children growing up in Schistosomiasis endemic areas have been disproportionately

affected by the disease for decade, as they account for 123 million of total global

burden of over 250 million people infected (Nelwan, 2019). Schistosomiasis affects

multiple body systems such as the Urogenital, gastrointestinal, respiratory and nervous

systems (Antiwi et al., 2014; de Cleve et al., 2004). The impact of the infection within

the nervous system has been linked to learning difficulties, poor school performance,

growth retardation and cognitive deficits (Development pfc, 2002; Ezeamama et al.,

2018). The majority of the Infected children resides in low-income countries

particularly in region that have poor water supply and sanitation facilities (Hotezp et

al., 2006).

According to the Canadian council on learning (2010); cognitive development in the

first five years of early childhood development is crucial as it has an impact on the

future success of the child in school, workspace as an adult, and many aspect of a

healthy fulfilling life. The first five years of childhood is characterized by rapid

growth and development of brain (Learning CCO, 2009-2010; Plos Negi, 2018). A

meta analysis conducted in 2018 reported on the negative association of

Schistosomiasis and cognitive deficits in school aged going children, particularly in

the educational, learning and memory domains (Ezeamama, et al., 2018).

1.2 Statement of the problem

Domestic activities such as washing clothes and fetching in the inflected water

exposes woman and children to infection. Recreation activities like swimming and

poor hygiene also make children vulnerable to Schistosomiasis (WHO, 2014).Long

4
time exposure to this infection has been known to have impacts on the cognitive functions in

endemic environment.

1.3 Justification of the study

Ebute Igbooro is endemic for the disease; therefore a study of this nature could provide a

pointer to long term effect of exposure to this parasite.

1.4 Aim of the study

This research work is aimed at the assessment of the influence of long term exposure

to Schistosoma on cognitive and Reproductive functions among the middle age woman

in Ebutte Igbooro.

1.5 Objective of the study

1) To determine the influence of long termlong term exposure to Schistosoma

2) To determine the effects of this on cognitive and reproductive function among the

middle age woman in Ebutte Igbooro.

5
 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Pathology and Morbidityand dueMorbidity todue Schistosomiasisto

Schistosomiasis

Schistosomiasis is a chronic disease with infection occurring in early childhood, while

due to continued water – contact activities, accumulation of worms may continue to

early adulthood. Survival of the mature worms normally ranges from 2.5 – 12years,

but there have been reported of woman living for up to 30years (Vermund, 1983).

Schistosomiasis is a granulomatous disease which may affect several organs in the

body including the Urinary System. (Smith andSmith Christineand Christine, 1986).

Noted that hydroureter usually precedes hydronephrosis and that Schistosoma hydro

nephrosis pases from progressive renal pelvic dilation to medullary atrophy and finally

to nearly total effacement of the medulla before cortical atrophy occurs.

2.1.1 Invasion stage

Shortly after penetration of the cercariae (within a few hours). A pruritic popular rash

can occur at the site of penetration. The skin manifestation mainly occurs in migrants

and tourists coming into contact with schistosomes for the first time.

2.1.2 Acute Schistosomiasis

6
Two to 10weeks after the initial infection, the katayama syndrome can develop

mainly in non – immune visitors to endemic areas and more severe after S.mansoni

infection (Zuidema, 1981; Visser, et al., 1995). Preventing symptomsPreventing

varysymptoms fromvary generalfrom malaisegeneral tomalaise serveto illnessserve

illness. The most common clinical findings are fever, anorexia, headache, abdominal

pains, myalgia, arthralgia, diarrhea, loss of weight, hepatomegaly, splenomegaly and

urticaria (Stuiver, 1984; Doherty et al., 1996).

2.1.3 Early manifestationEarly ofmanifestation S.haematobiumof S.haematobium

Pathology ofPathology S.haematobiumof infectedS.haematobium individualinfected

mostindividual frequentlymost frequently occurs in the bladder. In the active praise of

infection, the pathological changes observed in the bladder wall is duding among others

granulomas consisting of eggs and different type of inflammatory cell, sandy patches

as a result of dead and calcified eggs and polypoid lesions, the extent of which

depends on the intensity and duration of infection. This is more common in children

and young adults (Garba, et al., 2006). In highly endemic areas, bladder lesions can

be detected in up 89% of the population and major bladder lesion in 44% (Hatz et

al., 2001). The lesion produce the early symptoms (terminal) hematuria, dysuria,

urinary frequency and supra public pain. It has been suggested that loss of blood

causes Anemia (Farid et al., 1968). Hematuria is the most common signs of urinary

Schistosomiasis and it has been estimated that infected individual loose between 2.6

and 12.6 millimeters of blood per day. (Tarid et al., 1968). In a well-designed cross

sectional survey conducted in Tanzania, S.haematobium infection was related to both

decreased hemoglobin and decreased iron in adults, after adjusting for measure of

7
socio economic status, malaria and hook worm (Tatala et al., 1998). In school

children (aged 5 - 14years), adolescents and adult (aged > 15years) and the presence

of S.haematobium infection was related to increase risk of anemia (Beasley et al.,

1999).

2.1.4 Late2.1.4 manifestationLate ofmanifestation of S.haematobium

Eggs deposited in the tissue of the ureters can obstructive uropathy, thus hydroureter

and hydronephrosis, which can be visualized by ultrasonography. One study showed

that presence of lesion was related to the intensity of infection both on individual and

population level (Hatz, 2001). Eventually, a heavy and chronic S.haematobium

infection can lead to bladder cancer and kidney failure whereas chronic S.mansoni

infection can lead to hematemesis, and heavy S.japonicum infection to liver cirrhosis,

which is a risk factor for colon and liver cancer (Utzinger, et al., 2011).

2.2 Meta Analysis on Cognitive

A meta – analysis conducted in 2018 reported on the negative associations if

Schistosomiasis and cognitive deficits in school aged going children, particularly in

the educational, learning and memory domain (Ezeamama et al., 2018). However, to

date there is paucity of research that shows the direct and indirect health development

impact of Schistosomiasis on preschool age children (PSAC) including the benefit of

treatment in the age group. Although the mechanisms of how schistosomiasis cause

cognitive deficits is unknown, it has been suggested that inflammatory mediators could

be the cause of affecting working memory consolidation (Hennessy et al., 2017;

Vitkoviz et al., 2000; Miller, 2009; Monje, Toda & Palmer, 2003).

2.3 Female Urogenital in Woman of reproductive Age and Pregnant Women.

8
Studies of S.haematobium epidemiology and denical manifestation have focused

predominantly on cognitive functions. Genital schistosomiasis has received less

attention, although, histopathogical studies have demonstrated that the female and male

internal genitals are sites of egg – induce granulomatous inflammation (Gelfand, 1971;

Wright, 1982). In a number of clinical studies of the woman living in the area where

S.haematobium in endemic Schistosoma eggs have often been observed to be associated

with characteristic sandy patch lesson in the cervix and in the virginal (Poggensee, 2000;

Poggensee, 2001; Kjetland, 2006). Egg have also been detected in ejaculated from

S.haematobium infected man (Mckenna, 1997; Leutscher, 2000; Durand, 2004). In

most area of endemicity, infection prevalence and intensity normally peak during the

second decade of life (Serieye, 1996; Kwriba, 2005). On the community level infected

individual may contribute to the burden of infection transmission, by transmission of

S.haematobium to the community through passage of egg in urine to the local water

bodies (Cohan, 1997; Chan, 2007). Chronic female genital – tract inflammation caused

by S.haematobium has been associated with Virginal itching and discharge, (Poggensce

et al., 2006, Kjetland, 2008) post – coital bleeding, (Poggensee, 2000) Genito pelvic

discomfort, (Lactschar, 2008), materials discord, (Kjetland 1996), and infertility

(Poggensee, 2001; Kjetland, 2006). Female urogenital Schistosomiasis in a

geographically dustered infection that disproportionately affect human younger that

30years of age (Jennifer et al., 2011). These young woman who also have the highest

risk of incident HIV infection and in whom genital lesions may be reversible if

treated early, should be the focus of public health interventions aimed to reduced the

prevalence of S.haematobium infection (Jennifer et al., 2011).

9
The health status of a woman before pregnancy is a crucial determinant of gestational

morbidity and pregnancy outcome. Poor nutritional status, deprived living environment

and higher rates of infection diseases contribute to maternal mortality, infant mortality

and low Birth Weight (WBW) (Kramer, 1987; Hasin et al., 1996; Kramer & Victoria,

2001) in Lesser – Developed Countries (LDCs). Woman who are under weight or

shout and those with anemia or infection are at increased risk of delivering

underweight infants (Steketee, 2003; Kramer, 2003) since, Schistosomiasis causes both

anemia (MC – garvey et al., 1996; Friedman et al., 2005; Leenstra, 2006) and under

nutrition (Stephenson, 1989; Friedman, 2005; Coutinho, 2005), maternal

Schistosomiasis could have deleterious consequences during pregnancy (Helling-

Giese et al., 1996). Treatment of high risk group would be beneficial to both the

mother and the unborn child.

2.3.1 SCHISTOSOMIASIS MORBIDITYSCHISTOSOMIASIS ANDMORBIDITY

MORTALITYAND INMORTALITY SUBIN SUB – SAHARAN AFRICA.

Population studies of Schistosomiasis infected children revealed that Schistosomiasis

can cause growth retardation, fatigue, weakness, impairment of memory and cognitive

reasoning and increased in anemia, leading to poor academic performance (Gray et

al., 2011). A study among Zimbabwean women showed that women with

S.haematobium egg in their pap smear had a risk three times higher of having HIV

(Kjetland et al., 2006).

Study on human subjects have establish adverse consequence of Schistosomiasis on

Pregnancy outcomes. S.haematobium infection has been linked to placental

inflammation, leading to poor birth – outcomes as a result of placental incompetency

(Friedman et al., 2007). Another study in Tanzania linked the delivery of Low Birth

10
Weight (LBW) babies to infection with parasitic disease including Schistosomiasis

during pregnancy (Dregfess et al., 2001).

2.3.2 FACTORS DETERMINING THE CONTINUOUS TRANSMISSION

SCHISTOSOMIASIS IN SUB – SAHARAN OF AFRICA.

The continuous transmission of Schistosomiasis in sub – Saharan Africa is attributable

to various environmental and socio – economic factors such as; Climatic changes

There is an established link between climatic changes and infectionsinfectious disease

whose local infection and geographical expansion is influenced by climatic change and

global warming (Mas–coma et al., 2009). Rainfall patterns also have an effect on the

transmission of Schistosomiasis; in Senegal, the snail specie Biomphalaria pfeifferi is

responsible for S.mansoni transmission during the raining season, while during the dry

season S.haematobium infection is transmitted by Bilunus globascus (Ernould and

Sellin ; 1999).

PROXIMITY TOPROXIMITY WATERTO SOURCESWATER SOURCES.

The schistosome parasite required an avenue where in there is direct contact between

the molluscan intermediate snail and the final human host for transmission of

Schistosomiasis to take place (Brooker, 2007). An estimated 76% of the sub-Saharan

population live close to various open water bodies which are infested with the

intermediate snail host necessary for the disease (Steinmann et al., 2006).

MAN-MADE ECOLOGICAL CHANGES

Ecological changes due to man-made construction of irrigation schemes, reservoir and

dams for agricultural purposes and electricity generation also are responsible for

continued transmission of Schistosomiasis in some sub-Saharan African countries

11
(Fenwick et al., 2009). Construction of dams led to remarkable increase in cases of

urinary Schistosomiasis as experienced in some sub-Saharan Africa countries such as

Senegal, Cote dIvoire, Ghana, Mali, Namibia, and Cameroon (Olveda et al., 2013).

Steinmann and co-workers estimated that 13.6% (106 million) of people vulnerable

to Schistosomiasis reside close to irrigation schemes and large dam reservoirs

(Steinmann et al., 2006)

A study carried out in Yewa North Local Government of Ogun State, Nigeria

buttressed the fact that schistosomiasis exists among pregnant women. The study

population consisted of pregnant women of age range 15–42 years. A prevalence of

20.8% of S. haematobium infection was observed, with the younger pregnant women

at greater risk of the infection, which is in consonance with a previous report from

Tanzania. It was also observed that the prevalence recorded within pregnant mothers

in Yewa North was obviously lower compared with earlier reports from similar

population groups due to a taboo in that part of the country restricting pregnant

women from visiting natural water bodies (Salawu and Odaibo; 2013).

2.3.3 PRAZIQUANTEL TREATMENTPRAZIQUANTEL ANDTREATMENT

PREGNANCYAND PREGNANCY

Praziquantel (P2Q) was made available in 1997 and has been the minister of

Schistosomiasis control program for decades (Davis et al., 1981). Praziquantel has not

been studies in pregnant or lactating women (middle age women) and was therefore,

designated as a ‘pregnancy class B’ drug. Federal Drug Administration

(FDA:http//www.fda.gov) class B drugs are presumed to be safe based on animal

studies but lack safety data from studies in pregnant woman. In practice, this has led

to withholding of treatment for pregnant and lactating women in most schistosomiasis

12
– endemic countries. This is important in that woman aged 18-25years who live in

schistosomiasis – endemic region might spend almost 25% of their reproductive life

pregnant and 60% of their reproductive time lactating – delay in treatment of more

than one year results in significant morbidity among non-pregnant women (Coutinho,

2006; been Stra, 2006) and such morbidity could be further exacerbated in pregnant

woman who have increased micro and macro nutrient requirements.

World Health Organization in 2002 in an informal conference held in Geneva

indicated that all Schistosome – infected pregnant and lactating (middle aged) women

should be considered a high – risk group and Allen, 2002 suggested treatment be

offered individual or during treatment campaigns. The WHO recommendation based

the cost of withholding treatment on the expected morbidity that would be suffered

by non pregnantnon-pregnant women of reproductive who might be left untreated

during long periods of pregnancy and lactating. In the cost benefit analysis, an

emphasis was placed in examining the morbidity that woman would be expected to

experience, specially Schistosomiasis induced organ damaged, which can progress over

relatively short periods of time, anemia and pathologies that are largely reversible

when treated early, such as hepatomegaly and urinary tract pathology. Despite this

informal recommendation, the ministries of health of many endemic countries have

not adopted this policy because of a lack of pregnancy safety data that had been

rigorously collected (Friedman, 2007).

13
 CHAPTER THREE

3.0 MATERIALS3.0 MATERIALS AND METHODSAND METHODS

3.1 STUDY3.1 AREASTUDY AREA

The study was conducted in Ebute Igbooro village which is located in Yewa North,

Ogun State, its geographical coordinates are 6 54 ‘0’ East and its Original name

(with diacritics) is Ebute igbooro. It is located at an elevation of 37 above sea level

and its population amount to 17,672.

3.1.2 STUDY DESIGNSTUDY DESIGN AND POPULATIONAND POPULATION

The case control study was conducted among the middle aged women who are

matched according to age at baseline to investigate the influence of long term of

Schistosomiasis on cognitive and reproductive function among the middle aged

women. A case was determined as a middle aged women who had at least one egg in

their Urine sample following screening with the Urine filtration techniques and

microscopy (Mott’k et al., 1982) and the sampling method was purposive making use

of 50 respondent.

3.2 MATERIALS3.2 MATERIALS

Hand gloves, Hand sanitizer, Sterile urine bottle, Urine samples, Nose cover,

Centrifuge machine, Microscope, Hematocrit test strips, Urine filtration techniques,

Questionnaire, Scale, Test tubes.

3.3 METHODS3.3 METHODS

3.4 ANTHROPOMETRIC EVALUATIONANTHROPOMETRIC EVALUATION

The anthropometric measurements were carried out according to Weiner and Laurice

(Weiner & Laurice, 1969). The respondents measurements were measured with scales

of 100kg capacities and the weights were recorded.

14
3.4.1 ADMINISTRATION OF QUESTIONNAIRES

Structured questionnaires were administered to the respondent middle age women before

collecting their urine samples. The women were interviewed and the questionnaires were

filled on behalf of the respondent for proper record of the data. Demographic data

obtained were sex, age, occupation, house number, community, weight, their place of

birth, stay outside the community sometimes, how long they have been in the

community, their experience on blood in urine.

3.4.2 URINE3.4.2 COLLECTIONURINE COLLECTION

Transparent, capped, sterile, plastic, universal containers also known as urine bottles,

were labeled and was given to the middle age women to collect their urine samples.

This was donewas betweendone thebetween hoursthe ofhours 10.00amof to10.00am

2.00pmto 2.00pm. The urine collected was taken immediately to the laboratory for

analysis and the ones that were not allowed to be taken away were tested

immediately with the hematocrit urine test strip to check for the presence of blood,

by comparing the strip with the producers urine color chart.

3.5 EXAMINATION3.5 OFEXAMINATION URINEOF FORURINE

MICROHEAMATURIAFOR MICROHEAMATURIA

A reagent strip (Urine- 10 parameters, Cypress Diagnostic (DUS 10 and Uro dip 10)

was carefully dipped into the universal sterile bottle containing the urine for 5

seconds. The resulting change in color of the strip were compared with the

manufacturers color chat to estimate the amount of blood in the urine and also to

know the protein level of the urine.

15
3.5.1 MICROSCOPIC EXAMINATION FOR SCHISTOSOMIASIS
HAEMATOBIUMSCHISTOSOMIASIS HAEMATOBIUM

10ml of the urine samples were spined with the centrifuge machine at 500rpm for 5

minutes. The supernatant was then discarded to leave the sediment which was then

transferred to the center of a sterile, clean microscope slide to which cover slip were

added. It was then placed or mounted on a light microscope which was examined at

x40 objective to identify Schistosoma haematobium ova which is characterized with a

terminal spine. The eggs in infected urine will show a cylindrical shaped with two

endings which indicate the presence of Schistosoma haematobium is counted and

recorded as eggs/10ml of urine.

3.5.2 TREATMENT

Treatment of all infected member will follow the baseline survey and all infected

middle age women will receive a single dose of 40mg/kg of praziquantel drugs.

3.5.3 ETHICAL APPROVAL

Provincial Permission was granted by the Medical Research Council of the Federal

Polytechnic Ilaro, and District Medical Directors and the king of the Ebutte Igbooro

where the participants( middle age women) resides. The study goals and methodology

were explained in the local language( Yoruba) to the king and the participants. The

king instructed his town crier to make an awareness to the community on our behalf

for the recruitment of the middle age women to participate during the study.

Recruitment of participantsof wasparticipants onwas aon voluntarya basisvoluntary

basis.

16
 CHAPTER FOUR

4.0 RESULTS4.0 ANDRESULTS DISCUSSIONAND DISCUSSION

4.1 RESULTS4.1 RESULTS

A total number of 50 middle aged women were enrolled using purposive sampling.
Questionaires wereQuestionnaires usedwere toused obtainto obtain data fromdata
allfrom respondentsall respondents.

TABLE 4.1: Showing the Influence of long term to Schistosomiasis in relation to socio
demographics of middle age women exposure

Variables Frequency percentage

SEX
Male 0 0
Female 50 100

AGE
25-30 31 62

31-35 8 16
36-40 10 20
41-50 1 2

OCCUPATION
Farming 21 42
Fishing 6 12
Trading 15 30
Others 8 16

TABLE 4.1: Shows the demography variable of the respondent, where the female is the only
sex who responded while (62%) of the age group 25-30 years has the highest and the lowest
is (2%) of 41-50 year.

17
18
Table 2: shows the respondents associationrespondents association of AGE and
SYMPTOM

symptoms Total

yes no

age 25-30 Count 7 24 31

% within 22.6% 77.4% 100.0%

age

31-35 Count 3 5 8

% within 37.5% 62.5% 100.0%

age

40-45 Count 2 8 10

% within 20.0% 80.0% 100.0%

age

46-50 Count 0 1 1

% within 0.0% 100.0% 100.0%

age

Total Count 12 38 50

% within 24.0% 76.0% 100.0%

age

This table shows a non-significant, that means no effect was observed between age and
symptoms.

19
A bar chart showing the relationship between AGE AND SYMPTOMS

20
Table 4.3: showing the Influence of long-term exposure to Schistosomiasis in relation to
reproductive functions among the middle age women respondents using their
relationship between HOW LONG and SYMPTOMS

Response SYMPTOMS Test of

significant
Yes No

How
long
YES 18.9% 81.1% x2=2.014

NO 38.5% 61.5% ₚ=0.156

Total 24.0% 76.0% 100.0%

This table shows a non-significant, that means no effect was observed between how long and
symptoms.

21
A bar chart showing the relationship between HOWLONG AND SYMPTOMS

22
Table 4.4: showing the Influence of long-term exposure to Schistosomiasis in relation to
cognitive functions among the middle age women respondents using their relationship
between THINKING and SYMPTOMS

symptoms Test of significant

yes no

thinki Never 0 2
ng

Occasi 0 3 x2=1.891
onally

Quite 1 4 ₚ=0.595
often

Very 11 29
often

Total 12 38 50

This table shows a non-significant, that means no effect was observed between thinking and
symptoms

23
A bar chart showing the relationship between THINKING AND SYMPTOMS

24
Table 4.5: showing the Influence of long term exposure to Schistosomiasis in relation to
cognitive functions among the middle age women respondents using their relationship
between FORGET NAMES and SYMPTOMS

Response symptoms Test of significant

Yes No

Never 1 3 x2=1.866

Very rarely 1 4 ₚ=0.760

Occasionally 2 8

Quite often 0 4

Very often 8 19

Total 12 38 50

This table shows that at p value of 0.05, there is a non-significant, that means no effect was
observed between forget name and symptoms.

25
A bar chart showing the relationship between FORGET NAME AND SYMPTOMS

26
Table 6: showing the Influence of long term exposure to Schistosomiasis in relation to
cognitive functions among the middle age women respondents using their relationship
between HOWLONG and INFLAMMATION

Response Inflammation Test of

significant
0 yes no

How
long
YES 2.7% 64.9% 32.4% x2=1.043

NO 0.0% 53.8% 46.2% ₚ=0.594

Total 2.0% 62.0% 36.0% 100.0%

This table shows a non-significant, that means no effect was observed between how long and
inflammation.

27
A bar chart showing the relationship between HOWLONG AND INFLAMMATION

28
Table 4.7: showing the Influence of long term exposure to Schistosomiasis in relation to
cognitive and reproductive functions among the middle age women respondents using
their relationship between AGE and RDT TEST

RDT Test of
Variable +VE -VE significant
age 25-30 3 28 x2=1.295
31-35 1 7 ₚ=0.730
36-40 0 10
41-45 0 1
Total 4 46
Table 7 shows a non-significant association between AGE and RDT TEST

29
A bar chart showing the relationship between AGE and RDT test

30
Table 4.8: showing the Influence of long term exposure to Schistosomiasis in relation to
cognitive and reproductive functions among the middle age women respondents using
their relationship between AGE and MICROSCOPY EXAMINATION.

MICROSCOPY Test of
Variable +VE -VE significant
age 25-30 3 28 x2=1.295
31-35 1 7 ₚ=0.730
36-40 0 10
41-45 0 1
Total 4 46
Table 8 shows a non-significant between AGE and MICROSCOPY EXAMINATION

31
A bar chart showing the relationship between AGE and MICROSCOPY
EXAMINATION.

32
Table 4.9: showing the Influence of long-term exposure to Schistosomiasis in relation to
cognitive and reproductive functions among the middle age women respondents using
their relationship between BLOOD URINE and RDT test

RDT Test of
Variable +VE -VE significant
bloodu
4 x2=0.378
rine yes 0
no 4 42 ₚ=0.539

Total 4 46
Table 9 shows a non-significant between BLOOD URINE and RDT test

33
A bar chart showing the relationship between BLOOD URINE and RDT test

4.2 Discussion
34
Schistosomiasis is more rampant in poor rural communities especially place where

fishing and agricultural activities are dominant. Domestic activities such as washing

clothes and fetching in the infected water exposes woman and children to infection.

Recreational activities like swimming and poor hygiene also make children vulnerable

to Schistosomiasis (WHO, 2014). Human get infected with disease when they make

contact with water contaminated with the skin – penetrating cercariae (WHO, 2014).

Approximately 120 million individual in sub – Saharan Africa have Schistosomiasis –

related symptoms while about 20 million undergo hardship as a result of chronic

presentation of the disease (Chitsulo et al., 2013). This research work is aimed at the

assessment of the influence of long term exposure to Schistosoma on cognitive and

Reproductive functions among the middle age woman in Ebutte Igbooro. 50

respondents50 wererespondents selectedwere throughselected purposivethrough

samplingpurposive sampling. Table 4.1Table showed4.1 theshowed socialthe social-

demographic characteristicdemographic ofcharacteristic respondentsof respondents.

Table 4.1Table shows4.1 theshows socialthe social-demographic

characteristicsdemographic ofcharacteristics respondentsof respondents. The age group

showed 25-30 years were 31(62%), 31-35 years were 8 (16%), 36-40 years were 10

(20%), while 41-50 was the least year in the study with 1(2%). The demography

variable of the respondent, where the female is the only sex who responded while (62%) of

the age group 25-30 years has the highest and the lowest is (2%) of 41-50 year is similar to

Jennifer, et al., (2011). All of them the were female 50 (100%). The influence of long

exposure among the middle age women on reproductive functions is in line with the

study of WHO, (1994). The respondents occupation showed farming 21(42%), fishing

6(12%), trading 15(30%), while others were 8(16%). Table 4.2 shows respondents

association of age and symptoms where age 25-30years 7(22.6%) can describe the

35
symptoms while 24(77.4%) can not describe the symptoms, 31-35years 3(37.5%) can

described the symptoms while 5(62.5%) cannot describe the symptoms, 40-45years

2(20.0%) can described the symptoms while 8(80.0%) cannot described the symptoms,

46-50years 0(0.0%) can described the symptoms while 1(100.0%) cannot described

the symptoms. Table 4.3 shows respondents association to how long and symptoms

where 24.0% can described the symptoms while 76.0% cannot described the

symptoms. Table 4.4 shows respondent’s association to thinking and symptoms

where 12(24%) do read something and find they have not been thinking about it

and must read it again, while 38(76%) do read something and find they have been

thinking about it and must not read it again. Table 4.5 shows respondent’s

association to forget names and symptoms where 12(24%) do forget people’s names

while 38(76%) do not forget people’s names. Table 4.6 shows respondent’s

association to how long and inflammation where 1(2.0%) have no experience of

inflammation of the genital 31(62.0%) have experienced inflammation of the genital

18(36.0%) have never experience inflammation of the genital. Table 4.7 reveals

respondent’s association to Age and RDT test where 25-30years has 3(+ve) and 28(-

ve), 31-35years has 1(+ve) and 7(-ve), 36-40years has 0(+ve) with 10(-ve), while age

41-45years has the least RDT test significant of 0(+ve) with 1(-ve). Table 4.8 reveals

respondent’s association to Age and Microscopy examination where 25-30years has

3(+ve) and 28(-ve), 31-35years has 1(+ve) and 7(-ve), 36-40years has 0(+ve) with

10(-ve), while age 41-45years has the least microscopy examination of 0(+ve) with 1(-

ve). Table 4.9 reveals the respondent’s association to blood urine and RDT test where

4(+ve) are present and 46(-ve) to the test. A recent intervention program and drug

administration for the infection was active at the time of the study and such influence

as the one gotten in this study is expected to reduce drastically as the intervention

36
program persists. The major problem in this study is attributed to the living pattern

and mentality of the respondents in this study that majorly exposed themselves to

predisposing factors that expose them to the disease. The various study of Betson, et

al., have reported on the prevalence of schistosome infections on primary school age

children, yet the impact on early childhood development has not yet been realized

and quantified. The association test carried out revealed a p-value higher than 0.05

between how long and symptoms (x 2=2.014, ₚ=0.156), thinking and symptoms

(x2=1.891, ₚ=0.595), forget names and symptoms (x2=1.866, ₚ=0.760), how long and

inflammation (x2=1.043, ₚ=0.594), age and RDT test (x2=1.295, ₚ=0.730), age and

microscopy examination (x2=1.295, ₚ=0.730), blood urine and RDT test (x2=0.378,

ₚ=0.539), (table 4.3-4.9).

37
 CHAPTER FIVE

5.0 CONCLUSION AND RECOMMENDATION

5.1 Conclusion

In conclusion, long term exposure to schistosomiasis is still having influence on the

reproductive and cognitive functions among the middle age women of Ebutte Igbooro

community of Nigeria and the participants knowledge about the disease is poor. This

study reveals that knowledge about the cause, transmission, symptoms, and prevention

of schistosomiasis among the rural population in Ebutte was inadequate and that this

could be a challenging obstacle to the elimination of schistosomiasis in these

communities.

It is also concluded that schistosomiasis is a serious public health problem that has a

negative impact on the cognitive and reproductive functions among humans and must

not be taken for granted.

5.2 Recommendation

Therefore, mass drug administration (PRAZIQUANTEL), community mobilization and

health education regarding the cause, transmission and prevention of schistosomiasis

and education about good personal and sanitary hygiene practices should be

considered in order to significantly reduce the exposure and morbidity of infection

within these communities.

38
Also, portable water should be provided in the community with other basic amenities

to promote the level of good living in the rural communities, therefore avoiding the

use of ponds, river and stream water.

39
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 APPENDIX

Dear sir/ma,

Am carrying out a research on the INFLUENCE OF LONG TERM EXPOSURE TO

SCHISTOSOMIASIS ON COGNITIVE AND REPRODUCTIVE FUNCTIONS
AMONG THE MIDDLE AGE WOMEN IN EBUTTE IGBOORO YEWA NORTH
OGUN STATE.

I solemnly assure you that every piece of information supplied will be treated
confidentially for academic purpose only.

QUESTIONNAIRE

Thanks for your cooperation. Date……………………

SOCIO-DEMOGRAPHY

1. Sex: M [ ] F[ ]
2. Age: 25-30years ( ) 31-35years ( ) 36-40years ( ) 41-50years ( ) 50&above ( )
3. Occupation: (a) Farming (b) Fishing (c) Trading (d) Others
4. House Number: …………………………..
5. Community: ……………….………..
6. Weight: …………………….

46
SECTION B: QUESTIONNAIRE ON SCHISTOSOMIASIS

1. Do you stay outside this community sometimes? Yes [ ] No [ ]

2. How long have you been in this village? Less than 5 years Yes [ ] No
[ ]
3. Are you born here? Yes [ ] No [ ]
4. Have you ever been to the hospital for skin disease? Yes [ ] No [ ]
5. If yes, can you describe the symptoms? Yes [ ] No [ ]
6. Do you experience blood in urine before? Yes [ ] No [ ]

SECTION C: THE REPRODUCTIVE ASSESSMENT QUESTIONNAIRE

7. Do you experience abdominal and pelvic pain? Yes [ ] No [ ]

8. Do you experience pain and difficulty urinating? Yes [ ] No [ ]
9. Have you ever or do you use to have pain and bleeding from intercourse and
contact [ e.g. Examination VirginalExamination BleedingVirginal Bleeding]? Yes
[ ] No [ ]
10. Have youHave everyou ever experience inflammation of the genital? Yes [ ]
No [ ]

SECTION DSECTION D: THE COGNITIVETHE ASSESSMENTCOGNITIVE

QUESTIONNAIREASSESSMENT QUESTIONNAIRE

The following questions are about minor mistakes, which everyone makes from time
to time, but some of which happen more often than others. We want to know how
often these things have happened to you in the past 6 months. Please selectPlease
theselect appropriatethe answerappropriate fromanswer thefrom the option below:

4= VERY OFTEN, 3= QUITE OFTEN, 2= OCCASIONALLY, 1= VERY RARELY

AND 0= NEVER

QUESTIONS 4 3 2 1 0
11 Do you read something and find you have
not been thinking about it and must it read it
again?

not been thinking about it and must read

it

again?
12 Do you fail to notice sign posts on the
road?

47
13 Do you find you confuse right and left
when giving directions?

giving directions?
14 Do you bump into people?
15 Do you find you forget whether you have
turned off light or a fire or locked the door?

turned off light or a fire or locked the

door?
16 Do fail to hear people speaking to you
when you are doing something else?

you are doing something else?

17 Do you loose your temper and regret it?
18 Do you find you forget appointments?
19 Do you find you accidentally throw away
the things you want and keep what meant
to throw away [ e.g. throwing away money
and keeping and putting the waste paper in
your pocket]?
20 Do you forget people’s names?
21 Do you start doing one thing at home and
get distracted into doing something else
(unintentionally) ?

48
INFLUENCE OF LONGTERM EXPOSURE TO SCHISTOSOMIASIS ON COGNITIVE
AND REPRODUCTIVE FUNCTIONS AMONG THE MIDDLE AGE WOMEN IN
EBUTTE IGBOORO, YEWA NORTH LOCAL GOVERNMENT, OGUN STATE.

BY

49
 AKANBI, MORENIKEJI OLUWAFOLAKEMI

MATRIC NUMBER: H/ST/21/2083

DEPARTMENT OF SCIENCE LABORATORY TECHNOLOGY

SCHOOL OF PURE AND APPLIED SCIENCES

THE FEDERAL POLYTECHNIC ILARO, OGUN STATE.

NOVEMBER, 2023.

50
INFLUENCE OF LONGTERM EXPOSURE TO SCHISTOSOMIASIS ON COGNITIVE
AND REPRODUCTIVE FUNCTIONS AMONG THE MIDDLE AGE WOMEN IN
EBUTTE IGBOORO, YEWA NORTH LOCAL GOVERNMENT. OGUN STATE.

BY

AKANBI, MORENIKEJI OLUWAFOLAKEMI

MATRIC NUMBER: H/ST/21/2083

A PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

THE AWARD OF HIGHER DIPLOMA IN THE DEPARTMENT OF SCIENCE
LABORATORY TECHNOLOGY, THE FEDERAL POLYTECHNIC ILARO, OGUN
STATE.

NOVEMBER, 2023.

51
52
 CERTIFICATION

This is to certify that the research work titled “Influence of long-term exposure to
Schistosomiasis on cognitive and reproductive functions among the middle age women in
Ebute Igbooro Yewa North, Ogun State” was carried out by AKANBI, MORENIKEJI
OLUWAFOLAKEMI, matric number; H/ST/21/2083 under the supervision of Mr. A
Adewole and Mrs Popoola in the Department of Science Laboratory Technology.

Mr A Adewole

Supervisor signature and Date

Mrs Popoola

Co-Supervisor signature and Date

Dr. R.A Amusa

Head of Department signature and Date

53
 DEDICATION

I dedicate this work to the Abba father who is faithful in all things and in whom all
achievement in life are made possible, and my parents who gave me the support to achieve
my dream at their expense. Without them, this project would not have been possible.

54
 ACKNOWLEDGEMENTS

It is my pleasure to register my profound appreciation and gratitude for the moral, financial
support, advice and cooperation received from various people at different stages of this
research work and eventual completion of my course of study in this great citadel of learning.

Firstly, I express my sincere gratitude to my supervisor, Mr Adewole Adekanmi and co-

supervisor Mrs Popoola for their patience, enthusiasm, insightful comments and parental
advice in the course of carrying out the research work. their knowledge and professional
expertise in research work has enabled me to complete this research work successfully.

I also express my sincere thanks to my parents Mr and Mrs Festus Akanbi, for their prayers,
love, care, and financial support throughout my academic pursuit; you will live long in good
health and wealth eat the fruits of your labor in Jesus name (Amen).

I would also be ungrateful if I did not acknowledge Dr Oyedeji, Mr F.T Faparusi, Mrs F.O
Abdulsalam, and all the lecturers for their impartation of knowledge.

I am also grateful to my friends; Yakub, Micheal, Ayobami, Esther, Aishat, Akorede,

Oreoluwa, John, to mention but a few, for their supports, love and care towards me.

Finally, I am extremely grateful to all Flakkie shiners and my siblings for their financial
support toward the success of this project. Thanks for all you do.

To God be the glory great things he has done.

Thank you all for everything!

55
 ABSTRACT

Schistosomiasis is a snail-transmitted disease caused by digenetic trematodes of the

genus Schistosoma primarily infecting man. Schistosomiasis has profound negative effects
on child development, outcome of pregnancy, and menta health. This research work is
aimed at the assessment of the influence of long term exposure to Schistosoma on
cognitive and Reproductive functions among the middle age woman in Ebute Igbooro,
yewa north. Ogun state. The study was conducted in Ebute. The study was descriptive and
data were collected from 50 participant using a purpose designed, and structured
questionnaire to assess their knowledge, perceptions, and practices, in relation to the disease
on cognitive and reproductive functions. Urine analysis was used to determine urinary
schistosomiasis infection.

56
 TABLE OF CONTENTS

Title Page i

Certification ii

Dedication iii

Acknowledgements iv

Abstract v

Table of Contents vi

List of tables vii

CHAPTER ONE: INTRODUCTION

2.0[1.0] Introduction 1

1.1 Background to the study 1

1.2 Statement of the problem 4

1.3 Justification of the study 4

1.4 Aims of the study 4

1.5 Objectives 5

CHAPTER TWO

2.0 Literature Review 6

2.1 Pathology and Morbidity due to Schistosomiasis 6

2.1.1 Invasion stage

6

2.1.2 Acute Schistomiasis 6

2.1.3 Early manifestation of S.haematobium 7

2.1.4 Late manifestation of S.haematobium 7

2.3 Female Urogenital in Woman of reproductive Age and Pregnant Women 8

2.3.1 Schistosomiasis Morbidity and Mortality in sub-saharan Africa 9

2.3.2 Factors determining the continuous transmission of Schistosomiasis

in sub-saharan of Africa 10

57
2.3.3 Praziquantel treatment and pregnancy 11

CHAPTER THREE

3.0 Materials and Methods 13

3.1 Study Area 13

3.1.2 Study design and Population 13

3.2 Materials 13

3.3 Methods 13

3.4 Anthropometric evaluation 13

3.4.1 Administration of questionnaires 14

3.4.2 Urine collection 14

3.5 Examination of urine for microheamaturia 14

3.5.1 Microscopic examination for Schistosoma haematobium 14

3.5.2 Treatment 15

3.5.3 Ethical Approval 15

CHAPTER FOUR

4.0 Result and Discussion 16

4.1 Results 16

58
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