Researchers of the International Health Program of the Catalan Institute of Health (PROSICS, in Catalan) and the Infectious Diseases group at Vall d'Hebron Institute of Research (VHIR) conducted an epidemiologic study on schistosomiasis in Cubal, main town of a rural area in eastern-central Angola. The research revealed that 61% of children of the region suffer this poverty-related disease. The study was published in Plos Neglected Tropical Diseases.

Cubal has an estimated population of 322,000 inhabitants, and half of them are children under 15. The most important hospital of the region is the Nossa Senhora da Paz Hospital, a religious centre within the Angola public health care network, that every year attends over 20,000 people of the region. Since 2008, the hospital receives support from the infectious diseases specialists of the Vall d'Hebron University Hospital, but also from specialists in microbiology, pediatrics, dermatology, radiology, among other disciplines. All of them participate in regular sessions of telemedicine with two clinicians of the Angolan hospital. This collaboration has improved the quality of the attention of the Nossa Senhora da Paz hospital, despite the extreme poverty of the infrastructures of the country.

In this context, Cristina Bocanegra, researcher and clinician of the PROSICS and VHIR, carried out the epidemiologic study in the field, between children of 9 and 10 years who went to school. "We collected urine and fecal samples from 1,400 children in order to analyze them with indirect diagnostic tests, which have resulted more effective and easier to use for the staff without medical education", says the researcher. These techniques, that were compared with the conventional ones and produced good results, were a urine dipstick and a colorimetric test.Previous studies on the epidemiology of schistosomiasis in Angola detected the disease, in the urine modality, in just the 28% of school-age children. This percentage is clearly under the 61% of prevalence in Cubal. According to VHIR's researcher, this is because the national analysis used imprecise data of this region took from the 1970s.

Cristina Bocanegra says that "we detected that children living closer to the river had higher odds for infection: around the 65% of them showed Schistoma haematobium eggs in urine". This fact demonstrates that "the river is the main source of infection of the disease, because the farther zones to the river have less prevalence". The Cubal River cross the town and the inhabitants of the region use it for bathing and washing their clothes, despite there is no water sanitation. Schistosomiasis is caused by parasitic worms that live in infested waters. The worm penetrates the human skin and reaches the adulthood inside the body. Apart from the damage that causes to the carrier's health, the main author of the study alerts that "the infection continues because some of the eggs are expelled though the urine or the stool that in the case of Cubal go to the river".

The disease causes long term complications such as bladder cancer and renal injuries, and in children can cause stunted growth, anemia and learning problems if it is not treated soon. The most visible symptom is hematuria. Due to its high prevalence in Cubal, Cristina Bocanegra comments that people from this region think that is normal to find blood in urine.

Petition to the WHO

The World Health Organization (OMS) has a strategy to combat schistosomiasis, that it is applied in high-risk communities every year. This plan consists in the administration in all the schools of a drug that kills the worm.

The research conducted at Vall d'Hebron gives an opportunity to Cubal authorities to participate in this WHO strategy. However, for the schistosomiasis control further measures will be also needed, such as clean water supply facilities, sanitation, ecological intervention and heath education.