Elimination of schistosomiasis haematobia as a public health problem in five governorates in Upper Egypt.
The prevalence and intensity of Schistosoma haematobium infection was determined among schoolchildren living in five governorates in Upper Egypt. Between November 2016 and March 2017, urine samples were collected from 30,083 schoolchildren (6-16 years of age) from the governorates of Assiut (n = 7,496; 6 districts), Bani Sweif (n = 4,493; 7 districts), Fayoum (n = 4,597; 6 districts), Menia (n = 7,500; 9 districts) and Sohag (n = 5,997; 11 districts). All samples were processed using urine filtration to detect and quantify S. haematobium eggs. The overall prevalence was 1.3% (95% Confidence Interval (CI) = 1.1%, 1.4%), but the prevalence varied considerably across districts in the studied governorates (from 0%, Fayoum to 13.4%, Sohag). The prevalence of heavy-intensity infections (≥50 egg/10 ml) varied from 0.05% (95% CI = 0.01-0.1) in Sohag to 0.3% (95% CI = 0.1-0.4) in Menia. No subject with heavy intensity of infection was detected in Fayoum and Bani Sweif governorates. Of the 39 studied districts 97.4% had prevalence of heavy intensity infection of <1%, indicating elimination of schistosomiasis haematobia as a public health problem in these districts. Of those studied 72.0% were male. Males were 2.9 times as likely to be infected (1.5% [95% CI: 1.4-1.7]) as females (0.5% [95% CI: 0.3-0.7]); χ2 = 51.2, p < 0.0001. Heavy intensity of infection was detected only in males. The prevalence of S. haematobium infection increased steadily with age, and the age group >15 years was 7 times as likely to be infected as the younger age group (6-<9; 0.8%); χ2 = 44.9, p < 0.0001. The national schistosomiasis control programme (NSCP) adopted a new elimination strategy by readjusting thresholds for MDA using praziquantel and targeting all transmission areas. The NSCP, after this major achievement of elimination of schistosomiasis haematobia as a public health problem, is now moving to interruption of its transmission.