Schistosomiasis in Egypt PDF

Schistosomiasis Endemic disease in Egypt since pharonic time Discovered by Theodor Bilharz German scientist who discovered the parasite of bilharziasis in Egypt in 1851 Head of tropical medicine...

Schistosomiasis Endemic disease in Egypt since pharonic time Discovered by Theodor Bilharz German scientist who discovered the parasite of bilharziasis in Egypt in 1851 Head of tropical medicine dept. in Kasr Eleini Died of Typhoid fever Famous victims Died of treatment of liver cirrhosis in LONDON Famous victim Some also mentioned that Napoleon Bonaparte was infected with this parasite after swimming in Egypt.  Person distribution Age: Any age can be affected but children are more affected than adults, as they swim more in canals. The peak of the incidence is in the age group from 5 to15 years. Sex: Up to 15 years old, females have a lower incidence than males. After 15 years age, the prevalence of the disease among females drop rapidly more than among males; in general boys are more affected than girls.  Time distribution a. Swimming and contamination of canal water by urine or faeces is more common in summer. b. The out-put of cercariae from infected snails is more in summer, as the light is strong and heat is maximal, since the cercariae are thermo- tropic and photo-tropic. c. Minimal infection occur in winter as the out- put of cercariae from infected snails are sluggish, as well as the cycle inside the snails is reduced during winter.  Place distribution Sch. Haemotobium is present allover Egypt as the snail bolinus trancaus is present. Sch. Mansoni is present more in Delta, in Northern eastern and western part of Delta than in the central and southern part as the water current is sluggish and suitable for survival of snail. Also there are some foci of infection in Upper Egypt. Who Any age but children most affected 5-15 years (peak incidence) More common in summer: When Passing of cercaria from snail , Swimming S. Haematobium all over Egypt Where while Mansoni more in delta  Susceptible HOW Swimming or Washing clothes- Irrigation and bathing in dishes.. in canals farming canals (inevitable) (occupational disease)  Prevention & Control program Schistosomiasis control program: The program is composed of four approaches that must run together 1-Chemotherapy 2-Snail control 3-Health education 4-Environmental sanitation  Chemotherapy Praziquental Orally, minimal side effects, 40mg/kg, maximum dose 2.4 gms (Single dose) -oxaminquine--- sch. Mansoni 1-Mass comprehensive treatment--- It is mass treatment to all the entire population without prior investigation. It is indicated when the disease is highly endemic, the drug given must be cheap, effective, with minimal side effects. 2-selective population treatment: urine and stool examination for positive cases only 3-selected group treatment: school  Snail control Mechanical methods Clearing of vegegtation, proper banking, straight canals, double canal system, application of nets to prevent passage of snails 2-Chemical methods (moullscicides) copper sulphate, bayluscide  Health education Aim: change habits of individuals to acquire healthy habits, to give new information required for control program Components Educator -------message------ recipient Educator: doctor, nurse, teacher, home visitor. Good personality, popular, efficient with ideal behaviors. Schools are suitable for health education, chance for training and supervision.  Health education Recipients: study their traditions, characters and living conditions. Methods of approach: Mass media, TV radio newspapers Face to face, lectures Training To do proper health education, use all approaches at same time (health education campaigns)  Prevention Health education Directed at : not to swim or bath in canals Not to wash clothes-dishes in canals Treatment of diseased Continuous check up for farmers and treatment  Prevention Environmental sanitation Recreational Mechanical Pure water Sanitary methods for places for supply WC irrigation children  Situation in Egypt 70 60 48 50 50 % 40 32 Sch.hb 30 Sch.man 20 10 11 10 5 3.5 3 0 1937 1979 1996 2002  Situation in Egypt In 1997, the National Schistosomiasis Control Program (NSCP) was launched in the Nile Delta. It adopted morbidity control strategy with Praziquantel mass treatment as the main component. In villages where schistosomiasis prevalence is 3%, mass treatment, snail control and clean water and sanitation are stressed