The epidemiology of schistosomiasis in Egypt: Fayoum Governorate

Health questionnaires and parasitologic examinations of urine and stool wer e performed upon a stratified random sample of 7,710 individuals from 1,109 households in 21 rural communities in Fayoum Governorate, Egypt in 1992 to investigate the prevalence of risk factors for, and changing pattern of, i nfection with Schistosoma sp. in the governorate. A subset, every fifth hou sehold, or 1,038 subjects, had physical and ultrasound examinations to inve stigate prevalence of, and risk factors for, morbidity. The prevalence of S . haematobium ranged from 0% to 27.1% and averaged 13.7%. The geometric mea n egg count (GMEC) was 10.0 eggs/10 ml of urine. Age-stratified prevalence and intensity of infection were 18-25% and 10-15 eggs/10 ml of urine in tho se 5-25 years of age. Schistosoma mansoni were detected in inhabitants of 1 3 communities, but 78.5% of the infections were focally present in a group of 4 satellite hamlets around a single village. The overall prevalence of S . mansoni in the governorate was 4.3% and the GMEC was 44.0 ova/g of stool. Risk factors for infection with either species were male sender, an age <2 0 years, living in smaller communities, and exposures to canal water by mal es. Histories of burning micturation, blood in the urine, or prior schistos omiasis and reagent strip-detected hematuria and proteinuria were risks for S. haematobium, but not for S. mansoni. Both urinary tract and higher grad es of hepatic morbidity were rare. Obstructive uropathy was present in 6.3% of the subjects and was more common in males and older people. Ultrasonogr aphy-detected bladder lesions were present in 5.2% and correlated with S. h aematobium only in younger subjects and in those with hematuria and protein uria. The prevalences of hepatomegaly, splenomegaly, and periportal fibrosi s (PPF) were associated with each other and increased with age and in males . Ultrasonography-detected hepatomegaly and splenomegaly were weakly associ ated with S. mansoni infections only in children. The prevalence of PPF was greater in the 4 communities with >25% S. mansoni infection rates in compa rison with the 17 other villages and ezbas. Transmission of S. mansoni is f ocally well established in Fayoum, which also has the highest prevalence of S. haematobium in the governorates surveyed by the Epidemiology 1, 2, 3 Pr oject. However, both urinary tract and hepatic morbidity are relatively rar e in the governorate. This probably results from the long-standing schistos omiasis control program in Fayoum, which suppressed intensity more than pre valence of infection, leading to less community morbidity.