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  • Title: Urban schistosomiasis: morbidity, sociodemographic characteristics and water contact patterns predictive of infection.
    Author: Firmo JO, Lima Costa MF, Guerra HL, Rocha RS.
    Journal: Int J Epidemiol; 1996 Dec; 25(6):1292-300. PubMed ID: 9027538.
    Abstract:
    BACKGROUND: Schistosomiasis (Schistosoma mansoni) is classically described as a rural disease that occurs in areas with poor sanitary conditions. This cross-sectional study was undertaken in a suburban area of a large industrialized city in Brazil (Belo Horizonte), aiming at examining epidemiological characteristics of schistosomiasis in an urban setting. METHODS: A simple random sample of 658/1896 dwellings was selected and 3049/3290 (92.7%) residents were submitted to stool examination. Of 518 eligible infected cases and 518 uninfected controls, 87.1% and 89.9% participated in the study, respectively. RESULTS: The prevalence of S. mansoni infection was 20%, predominantly low egg counts in stools; no cases of splenomegaly were found. Signs and symptoms associated with infection were bloody stools (odds ratio [OR] = 8.0) and hardened palpable liver at the middle clavicular and at the middle sternal life (OR = 5.5 and 8.0 respectively). Sociodemographic variables and water contacts predictive of infection were age (10-19 and > or = 20 yrs; OR = 7.1 and 3.3, respectively), gender (male; OR = 3.1), contacts for swimming and/or playing (twice a month or less and more than twice a month; OR = 2.2 and 3.0, respectively) and residence in Belo Horizonte (born in the City; OR = 2.5). Ninety per cent of dwellings had a piped water supply; no association between water supply and infection was found. CONCLUSION: Our results emphasize the need for schistosomiasis control measures focusing on water contacts for leisure purposes in this industrialized urban area. During 1991-1992 in the Gorduras district of Belo Horizonte, the capital of Minas Gerais State in Brazil, data on 451 persons over 2 years old who carried Schistosoma mansoni eggs, as detected on at least 1 of 4 slides, were compared with data on 465 same-age persons who were free of such eggs to describe the epidemiology of schistosomiasis in this urban area. The schistosome host, Biomphalaria glabrata, was present at all 11 monitored points along streams. Snails infected with S. mansoni were found at 6 points. Sewerage was entering the streams at 2 points. 92.7% of households had a piped water supply. 89.4% had a sewerage system. 20% of the 3049 sampled peoples had schistosomiasis. The geometric mean of S. mansoni eggs stood at 70.8 eggs/gram. Only 4.7% of persons infected with S. mansoni eggs had bloody stools. Less than 3% had a hardened enlarged liver. No one had splenomegaly or splenectomy. Signs and symptoms independently associated with S. mansoni infection included bloody stools (odds ratio [OR] = 8), palpable hardened liver at the middle clavicular line (OR = 5.5), and palpable hardened liver at the middle sternal line (OR = 8). Sociodemographic variables and reasons for water contact independently associated with S. mansoni infection were age (OR = 7.1 for 10-19 years; OR = 3.3 for =or + 20 years), being male (OR = 3.1), swimming and/or playing in water (OR = 2.2 for =or- 2 times/month; OR = 3 for 2 times/month), and living in Belo Horizonte (OR = 2.5). There was no association between infection and water supply. These findings suggest a need for schistosomiasis control measures centering on water contacts for leisure in this area.
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