FEMALE GENITAL SCHISTOSOMIASIS (FGS) IN ABEOKUTA, NIGERIA STAC36 - March 2014 FEMALE GENITAL SCHISTOSOMIASIS (FGS) IN ABEOKUTA, NIGERIA 1U F Ekpo, 1O M Odeyemi, 1HO Mogaji, 1A S Oluwole, 2H O Abdussalam 1Federal University of Agriculture, Abeokuta, Nigeria; 2Federal Medical Centre, Abeokuta, Nigeria;   Contact Address: Spatial Parasitology and Health GIS unit, Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria. Email: ufekpo@hotmail.com 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.

SCHISTOSOMIASIS Water borne trematode parasitic disease. Over 200 million people affected worldwide (WHO, 2010). 85% of them are resident in sub- Saharan Africa (WHO, 2010). Nigeria is the leading country in Sub-Saharan Africa for schistosomiasis with over 29 million affected people (Hotez et al., 2012) Water borne trematode parasitic disease. Parasite belongs to the genus Schistosoma. Currently six species have been reported to infect man (WHO, 2014) Figure 1: Life cycle of Schistosoma 54th BSP Spring Meeting 2016, Imperial College London

FEMALE GENITAL SCHISTOSOMIASIS (FGS) FGS is a disease condition where migrating eggs laid by Adult Schistoma haematobium (urogenital schistosomiasis) are trapped in genital organs such as fallopian tube, ureter, cervix, and vagina (Mbabazi, 2011; Hotez, et. al., 2009: Kjetland, et.al., 2012) According to WHO (WHO, 2009 ), over 44 million women living in sub-Saharan Africa (SSA) are currently affected by FGS : areas where eggs are trapped FGS is an emerging public health problem for female living in urogenital schistosomiasis endemic areas. 54th BSP Spring Meeting 2016, Imperial College London

Female Genital Schistosomiasis – Signs & SYMPTOMS FGS Clinical Signs and Symptoms. Chronic female genital-tract inflammation Vaginal itching and discharge (Kjetland, 2008) Post-coital bleeding (Poggensee, 2000) Genito-pelvic discomfort (Leutscher, 2008) Infertility (Kjetland, 2006) Menstrual disorders (Nour, 2010) Anaemia (Nour, 2010) Preterm Labour (Nour, 2010). Female participate mostly in water contact activities where they are exposed to infection

RATIONALE FOR THE STUDY FGS have been studied in South Africa (Hergertun, et. al., 2013), Tanzania (Downs, et.al., 2011), Madagascar and Ghana (Owusu-Bempah, et. al., 2013), and Zimbabwe (Kjetland, 2008). Despite the fact that Nigeria is the most endemic country for schistosomiasis in sub-Saharan Africa, there are no epidemiological and clinical evidences for FGS in Nigeria. This study was conducted in Abeokuta. Abeokuta is located in Ogun State, South Western Nigeria. The area is endemic for urogenital Schistosomiasis (Ofoezie et al, 1991; Ekpo et al, 2008; Ekpo et. al. 2010) 54th BSP Spring Meeting 2016, Imperial College London

Methods Study procedures Interviewing of study participants (n=317) Enrollment of Study Participants (n=317) Interviewing of study participants (n=317) Collection of Urine samples (n=317) Laboratory analysis (Dipstick and Microscopy) Gynecological examination (n=20) Study design – cross sectional Study sites - Four urogenital schistosomiasis endemic communities of Imala Odo, Apojola, Abule titun and Ibaro. Inclusion Criteria Young girls (5-14 years ) Child bearing female (15-49yrs) Exclusion Criteria Girls below 5 years of Age Women above 49 years 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.

Results Overview of the study participants Age group (years) Ibaro NE (%) Imala-Odo Abule-titun NE (%) Apojola Total 5-15 36 (56.2) 88 (67.1) 33 (47.8) 30 (56.6) 187 16-25 11 (17.2) 22 (16.7) 17 (24.6) 12 (22.6) 62 26-49 17 (26.6) 21 (16.0) 19 (27.5) 11 (20.8) 68 Total (%) 64 (100) 131 (100) 69 (100) 53 (100) 317 A total of 317 females were examined, with majority of them within the age range 5-15 years 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.

PREVALENCE OF HAEMATURIA AND URINOGENITAL SCHISTOSOMIASIS Ibaro NE(%) Imala-odo NE(%) Abule-titun NE(%) Apojola NE(%) Total Positive (%) 29 (45.3) 78 (59.5) 11 (15.9) 32 (60.4) 150 (47.3) Haematuria Negative (%) 35 (54.7) 53 (40.5) 58 (84.1) 21 (39.6) 167 (52.7) 64 131 69 53 317 77 (58.8) 149 (47.0) S. haematobium infection 54 (41.2) 168 (53.0) A total of 149 (47.0%) of the 317 females examined were infected with S. haematobium 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.

PREVALENCE BY AGE GROUP No. examined Prevalence Intensity P-value 5-15 187 121 (64.7) 0.9446 ±0.5628 ᵇ Age group 16-25 62 18 (29.0) 0.4160 ± 0.8573ᵃ 26-49 68 10 (14.7) 0.1861 ± 0.5883ᵃ Total 317 149 (47.0) 0.6785 ± 0.4329ᵃ 0.000 Prevalence 121 (64.7%) and intensity of infection (0.0446±0.5628) were significantly (p <0.05) higher in young girls (aged 5-15 years) than their older counterparts 54th BSP Spring Meeting 2016, Imperial College London

GYNAECOLOGICAL RESULTS Only 20 female participants consented to this procedure… Age group (years) Positive (%) Negative (%) Total 16-25 5 (71.4) 2 (28.6) 7 (35.0) 26-49 9 (69.2) 4 (30.8) 13 (65.0) 14 (70.0) 6 (30.0) 20 (100) “Of the 20 participants, 14 (70.0%) had FGS” FGS diagnosis: Present of sandy patches which can either be single or clustered grains or appearing as homogenous yellow areas, rubbery papules, nabothian cysts and aceto-negative lesion. 54th BSP Spring Meeting 2016, Imperial College London

GYNEACOLOGICAL RESULT CONT’D Morbidity Number examined Frequency (%) Yellow sandy patches 20 8 (40.0) Grainy sandy patches 14 (70.0) Nabothian cysts and Rubbery papules 1 (5.0) Gynaecological morbidity observed were 70.0% with grainy-sandy patches, 40.0% with yellow sandy patches, 5.0% with nabothian cysts and rubbery papules in their vaginal and cervical wall respectively 54th BSP Spring Meeting 2016, Imperial College London

FGS presentations B C A A: Yellow patches around cervix STAC36 - March 2014 B C A A: Yellow patches around cervix B: Sandy Patches around cervix C: Inflammation of cervix 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.

IMPLICATIONS Implication of our findings This study has confirmed presence of FGS in Ogun State, Nigeria. There is the need to assess its impacts and implications for reproductive health of young girls and women of child bearing age living in urogenital schistosomiasis endemic communities in Nigeria. Measures are needed for early diagnosis and treatment to prevent reproductive health complication of young girls and women of child bearing age. Way forward Creation of awareness about FGS in Nigeria. Assessment of its burden in young girls and women. Advocate for support and funding for studies on FGS in Nigeria. 54th BSP Spring Meeting 2016, Imperial College London

54th BSP Spring Meeting 2016, Imperial College London STAC36 - March 2014 Acknowledgments: Prof Russel Stothard (LSTM) for his support in this investigation Federal Medical Centre, Abeokuta for gynaecological examination support. Contact Address: Spatial Parasitology and Health GIS unit, Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria. Email: ufekpo@hotmail.com 54th BSP Spring Meeting 2016, Imperial College London 54th BSP Spring Meeting 2016, Imperial College London.