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Schistosomiasis: a child health development challenge
Early childhood development is recognized as a critical period of intense physical and cognitive growth, during which health challenges may have long-lasting consequences.
The well-being of infants and children is a multi-dimensional and dynamic system of closely interrelated factors tightly linked to their environment. Currently, efforts to secure improvements in early childhood development in sub-Saharan Africa may be undermined due to infections such as schistosomiasis not being considered among the factors impacting this crucial life stage.
A review of recent peer-reviewed publications indicates that schistosomiasis infection in preschool-aged children may be a cause for additional anemia and malnutrition and is directly linked to decreased immune responses to certain vaccines and treatments.
Schistosomiasis may also be a cause of accumulated morbidities due to egg trapping and inflammatory local responses, with various degrees of severity depending on the intensity of the infection.
Schistosomiasis poses a major child health development challenge
Key links between schistosomiasis morbidities and child health
The long-term impacts of schistosomiasis in terms of decreased quality of life, cognitive impairment, and educational loss are well-known and we detail them here:
Anemia
Schistosomiasis infection can lead to anemia in children. Severe infection can increase the severity of anemia.4,5
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- Children infected with intestinal schistosomiasis are at risk of anemia. This is most commonly ‘anemia of inflammation’ or anemia of chronic disease – a type of iron deficiency caused by long-term infection 5
- The occurrence of anemia in children infected with schistosomiasis is related to the severity of the infection – i.e., the number of parasites in a child’s body 5
- Treatment of intestinal schistosomiasis in children with praziquantel has been shown to reduce anemia 11-13
- Fecal occult blood (blood found through testing stool samples) may indicate infection with intestinal schistosomiasis in young children 4
Malnutrition & stunted growth
Schistosomiasis is a major cause of severe malnutrition in children14
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- Long-term schistosomiasis infection is associated with decreased fitness, likely due to anemia and impaired growth resulting from the infection 15,16
- There is evidence that treatment of intestinal schistosomiasis with praziquantel has improved the nutritional status of infected children and adolescents 12
- There is evidence linking parasitic infection with low weight relative to height in children and pregnant women, and some evidence showing links between urogenital schistosomiasis and impaired growth6,7
Cognitive impairment
Schistosomiasis infection has significant negative impacts on child development and learning8,10,17
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- Schistosomiasis infection negatively impacts educational learning and memory8,17
- Schistosomiasis infection has been linked with poor early childhood development10
Impaired immune response
Schistosomiasis can negatively impact the body’s immune response and reaction to some vaccines18, 19, 21, 22
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- Schistosomiasis can negatively impact the body’s immune response to pathogens, allergens, and vaccines19,21
- Infection has been linked with a reduced immune response to the Hepatitis B and measles vaccines18,21
- Intestinal schistosomiasis infection has been linked with reduced immune response to the poliovirus vaccine in school-age children22
- Treatment of intestinal schistosomiasis with praziquantel has been shown to partially restore immune response to the poliovirus vaccine22
Association with co-infections
Schistosomiasis infection can increase the severity or negative impacts of other childhood infections22,23
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- Schistosomiasis infection in pre-school age children can increase the severity of infections such as upper respiratory tract infection, dermatophytosis, malaria, and fever of unknown origin22
- Preschool-age children infected with urogenital schistosomiasis have an increased risk of developing pneumonia and severe pneumonia23
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4Betson M, Sous-Figueiredo JC, Rowell C, et al. Intestinal schistosomiasis in mothers and young children in Uganda: investigation of field-applicable markers of bowel morbidity. Am J Trop Med Hyg. 2010; 83(5):1048-55.
5Butler SE, Muok EM, Montgomery P, et al. Mechanism of Anemia in Schistosoma mansoni–Infected School Children in Western Kenya. Am J Trop Med Hyg. 2021; 87(5):862-7.
6Osakunor DNM, Mduluza T, Midzi N, et al. Global Health Dynamics of paediatric urogenital schistosome infection, morbidity and treatment: a longitudinal study among preschool children in Zimbabwe. BMJ Glob Health. 2018; 3:e000661.
7Raj E, Calvo-Urbano B, Heffernan, et al. Systematic review to evaluate a potential association between helminth infection and physical stunting in children. Parasites & Vetors. 2022; 15:135.
8Ezemama AE, Bustinduy AL, Nkwata AK, et al. Cognitive deficits and educational loss in children with schistosome infection - A systematic review and meta-analysis. PLoS Negl Trop Dis. 2018; 12(1): e0005524.
9Jukes M. Heavy schistosomiasis associated with poor short-term memory and slower reaction times in Tanzanian schoolchildren. Trop Med Int Health. 2002; 7(2):104-17.
10Mutapi F, Pfavayi L, Oskaunor D, et al. Assessing early child development and its association with stunting and schistosome infections in rural Zimbabwean children using Griffith Scales of Childe Development. PLoS Negl Trop Dis. 2021; 15(8):e0009660.
11Bhargava A, Jukes M, Lambo J, et al. Anthelmintic treatment improves the hemoglobin and serum ferritin concentrations of Tanzanian schoolchildren. Food Nutr Bull. 2003; 24(4): 332-42.
12Coutinho HM, Acosta LP, McGarvey ST, et al. Nutritional status improves after treatment of schistosoma japonicum-infected children and adolescents. J Nutr. 2006; 136:183-8.
13Nalugwa A, Tukahebwa EM, Olsen A, and Nuwaha F. Regression of Schistosoma mansoni associated morbidity among Ugandan preschool children following praziquantel treatment: A randomised trial. PLoS ONE. 2021; 16(11):e0259338.
14Mohammed M, Vantsawa PA, Abdullah UY, and Muktar MD. Nutritional Status and Prevalence of Intestinal Schistosomiasis among Al-majiri Population in Kawo District of Kaduna Metropolis, Kaduna State-Nigeria. J Bacteriol Parasitol. 2015; 6(4):5 pages.
15Bullington BW, Klemperer K, Mages K, et al. Effects of schistosomes on host anti-viral immune response and the acquisition, virulence, and prevention of viral infections: A systematic review. PLoS Patho. 2021; 17(5): e1009555. https://doi.org/10.1371/journal.ppat.1009555
16Bustinduy AL, Thomas CL, Fiutem JJ, et al. Measuring Fitness of Kenyan Children with Polyparasitic Infections Using the 20-Meter Shuttle Run Test as a Morbidity Metric. PLoS Negl Trop Dis. 2011; 5(7): e1213.
17Bustinduy AL, Parraga IM, Thomas CL, et al. Impact of Polyparasitic Infections on Anemia and Undernutrition among Kenyan Children Living in a Schistosoma haematobium-Endemic Area. Am J Trop Med Hyg. 2013; 88(3):433-40.
18King CH, Binder S, Shen Y, et al. SCORE Studies on the Impact of Drug Treatment on Morbidity due to Schistosoma mansoni and Schistosoma haematobium Infection. Am J Trop Med Hyg. 2020;103(suppl1):30-5.
19Colley DG, Bustinduy AL, Secor WE, and King CH. Human schistosomiasis. Lancet. 2014; 383:2253-64.
20Riner DK, Kavere E, Ndombi EM, et al. Impact of schistosomiasis and soil transmitted helminths on vaccine-induced immune responses. Am J Trop Med Hyg. 2014; Abstract 57.
21Riner DK, Ndombi EM, Carter JM, et al. Schistosoma mansoni Infection Can Jeopardize the Duration of Protective Levels of Antibody Responses to Immunizations against Hepatitis B and Tetanus Toxoid. PLoS Negl Trop Dis. 2016; 10: e0005180.
22Mduluza-Jokonya TL, Naicker T, Jokonya L, et al. Association of Schistosoma haematobium infection morbidity and severity on coinfections in pre-school age children living in a rural endemic area in Zimbabwe. BMC Publ Health. 2020; 20:1570 (9 pages).
23Mduluza-Jokonya TL, Vengesai A, Jokonya L, et al. Impact of Indolent Schistosomiasis on Morbidity and Mortality from Respiratory Tract Infections in Preschool Age Children from a Schistosomiasis Endemic Area. MedRvix. 2020 PREPRINT (26 pages) https://doi.org/10.1101/2020.11.06.20227173.