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FACTORS AFFECTING INFECTION OR REINFECTION WITH SCHISTOSOMA HAEMATOBIUM IN COASTAL KENYA: SURVIVAL ANALYSIS DURING A NINE-YEAR, SCHOOL-BASED TREATMENT PROGRAM

Urinary schistosomiasis remains a significant burden for Africa and the Middle East. Success of regional control strategies will depend, in part, on what influence local environmental and behavioral factors have on individual risk for primary infection and/or reinfection. Based on experience in a multi-year (1984–1992), school-based Schistosoma haematobium control program in Coast Province, Kenya, we examined risk for infection outcomes as a function of age, sex, pretreatment morbidity, treatment regimen, water contact, and residence location, with the use of life tables and Cox proportional-hazards analysis. After adjustment, location of residence, age less than 12 years, pretreatment hematuria, and incomplete treatment were the significant independent predictors of infection, whereas sex and frequency of water contact were not. We conclude that local physical features and age-related factors play a predominant role in S. haematobium transmission in this setting. In large population-based control programs, treatment allocation strategies may need to be tailored to local conditions on a village-by-village basis.

Received November 11, 2005. Accepted for publication February 23, 2006.

Acknowledgments: We thank the people of Mwaembe, Kisimachande, Sawa Sawa, Vingujini, Bomani, Nganja, Milalani, Marigiza, and Vindungeni villages for their ready participation with this project. We also thank Henry Kinyanjui, Peter Mungai, Saidi Tosha, Iddi Masemo, Malick Ndzovu, Wallace Saha Ndune, Fredrick Thiongo, Bob Sturrock, Ralph Klumpp, and the late Peter Dalton for their extensive efforts in the fieldwork that contributed to the success of this project. This work is published with the kind permission of the Director of Medical Services, Ministry of Health, Kenya.

Financial support: This research was supported by grants from the Edna McConnell Clark Foundation, the Rockefeller Foundation/World Health Organization–Tropical Disease Research joint funding venture, and the National Institutes of Health (AI15351, AI45473 [National Institute of Allergy and Infectious Diseases], and TW/(Fogarty International Center).

^* Address correspondence to Charles H. King, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Wolstein 4126, 10900 Euclid Avenue, Cleveland, OH 44106-7286. E-mail: chk{at}cwru.edu

Authors’ addresses: Sudtida Satayathum, Department of Pediatrics, Case Western Reserve University School of Medicine, 11400 Euclid Avenue, Cleveland, OH 44106, Telephone: 216-844-6283, Fax: 216-844-6233, E-mail: ssata{at}hotmail.com. Eric M. Muchiri, Division of Vector Borne Diseases, Ministry of Health, PO 20750, Nairobi, Kenya, Telephone: 254-20-2725833, Fax: 254-20-2720030, E-mail: schisto{at}wananchi.com. John H. Ouma, Biomedical Sciences and Technology Programme, Maseno University, Private Bag, Maseno, Kenya, Telephone: 254-733-725721, Fax: 254-20-2725833, E-mail: ouma{at}wananchi.com. Christopher C. Whalen, Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106, Telephone: 216-368-4192, Fax: 216-368-3970, E-mail: ccw{at}po.cwru.edu. Charles H. King, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Wolstein 4126, 10900 Euclid Avenue, Cleveland, OH 44106-7286, Telephone: 216-368-4818, Fax: 216-368-4825, E-mail: chk{at}cwru.edu.

Reprint requests: Charles H. King, Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Wolstein 4126, 2103 Cornell Road, Cleveland, OH 44106-7286.

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