I. INTRODUCTION
Schistosomiasis is a parasitic infection caused by digenetic blood trematode worms of the family Schistosomatidae, is one of the most prevalent neglected tropical diseases (NTDs) and still considered as a major public health ravaging 77 developing countries in the tropics and subtropics [22]. Nigeria has a higher number of cases of schistosomiasis worldwide [9], with about 29 million infected people, among which 16 million are children, and about 101 million people are at risk of schistosomiasis [20, 8, 1, 22]. Water related activities such as harvesting hippo grass, fishing, washing clothes, washing utensils, bathing and fetching water from rivers or streams and open air defecations were observed to be risky behavior practices that enhanced disease transmission [4, 21,15,11,23, 13, 6, 2, 5,14, 16, 10, 12]. Looking a way forward towards justifying the menace of Schistosoma infections among rural endemic communities, traditional method were employed such as the use of herbs in treating Schistomiasis. Ethnobotany and ethno-medical studies are today recognized as the most viable methods of identifying new medicinal plants or refocusing on those earlier reported for bioactive constituents [7]. Plants have been of immense value to human health and roughly eighty percent (80%) of the world's populations rely on them for cure of various ailments [17]. The continual search for natural plant products used as medicines has acted as a catalyst leading to the widespread use of traditional medicinal practices today, are an important part of the primary health care delivery system in most of the developing world [3]. A study on South African medicinal plants revealed the efficiency of 21 plant species against schistosomula worms [18]. Ricinus com-munis leaf in association with Capparistomentosa leaf; Trichiliaemetica root in association with Afromomumlatifolium fruit and Zyziphusmucronata root bark in association with Stylosantheserecta whole plant were also reported to be used against urinary schistosomiasis [24]. This study highlighted on the knowledge and prevalence of Schistosoma infection and traditional approaches on morbidity and case management of urinary schistosoma infection in rural communities of Ogun State, Nigeria.
a) Research Method
i. Description of the study location
This study was carried out at Ibaro Oyan and Apojola community area of Abeokuta, located at the Ogun State, South-Western Nigeria. It is within longitude 7° 7' 34.5" North and 3°8' 99.8" east. Major occupation of people of these communities is fishing and farming, trading activities.
ii. Ethical Approval
Ethical approval was gotten from the Ogun State Ministry of Health, and from College of Biological Sciences, Federal University of Agriculture, Abeokuta.
iii. Informed Consent
Before the study began, the village heads together with the people of the communities were fully briefed on the objectives of the study.
iv. Data Collection
A structured questionnaire was used in collection of data required for the study. This contains questions on knowledge, attitude and practice which includes traditional in treatment of the infection.
v. Urine Collection
Dark (black), sterile, plastic universal containers (labeled) were given to the people both Children and Adult to collect urine samples. This was done between the hours of 10.00 am to 2.00 pm. The urine collected was taken to the laboratory for analysis. Each sample collected was visually examined for the presence of visible blood in urine.
vi. Examination of Urine for Haematuria
A reagent strip Medi-test Combi 9 was carefully dipped into the dark sterile bottle containing the urine for 5 seconds. The strip was drawn across the rim of the container to remove excess urine. After 30 to 60 seconds, the resulting change in color of the strip was compared with the manufacturers colour chart to estimate amount of blood in the urine. Each sample collected was visually examined for the presence of haematuria.
vii. Examination for Schistosoma Haematobium Egg
Ten (10) millitres of the urine sample was centrifuged at 2500 rpm for 10 minutes to separate the Schistosomahaematobium ova from the urine. The supernatant was discarded to leave sediment which was transferred to the centre of a clean grease-free glass slide. This was mounted on a light microscope and examined at x 10 and x 40 objectives to identify a Schistosomahaematobium ovum which is characterized with a terminal spine.
viii. Statistical analysis of data
The data was entered and analysed using SPSS version 20.0 for Windows. The questionnaire was analysed on Microsoft word excel using chi square.
II. RESULT
A total of 152 people from the two communities were enrolled for the study (69 people from Ibaro and 83 people from Apojola) submitted their urine samples for analysis. The age range of the participants was from 1-22 years above from both communities (Table 1). The prevalence in demographic information in respondents showing more female participated in the study than male in both communities with female 13(41.9%) and 31(63.3%) and male 18(58.1%) and 18(36.7%) were tested positive at Ibaro and Apojula communities respectively. The school aged children of 5-13 years had high number of population that participated in the study with 22(71.0%) and 20(40.8%) were tested positive. The major occupation of both communities are into fishing and farming, in the study high number of people are into fishing and 23(74.2%) and 39(79.6%) were tested positive in Ibaro and Apojula communities with no significant difference (p>0.05).
| Location | Ibaro | Apojula | |||||
| Positive | Negative | Total | Positive | Negative | Total | ||
| Sex | |||||||
| M | 18(58.1) | 15(39.5) | 33(47.8) | 18(36.7) | 23(67.6) | 41(49.4) | |
| F | 13(41.9) | 23(60.5) | 36(52.2) | 31(63.3) | 11(32.4) | 42(50.6) | |
| P-value 0.151 | P-value 0.007 | ||||||
| Age | |||||||
| 1-4 | 3(9.7) | 8(21.1) | 11(15.9) | 10(20.4) | 10(29.4) | 20(24.1) | |
| 5-13 | 22(71.0) | 22(57.9) | 44(63.8) | 20(40.8) | 10(29.4) | 30(36.1) | |
| 14-22 | 1(3.2) | 4(10.5) | 5(7.2) | 8(16.3) | 6(17.6) | 14(16.9) | |
| <22 | 5(16.1) | 4(10.5) | 9(13.0) | 11(22.4) | 8(23.5) | 19(22.9) | |
| P-value 0.319 | P-value 0.699 | ||||||
| Occupation | |||||||
| Fishing | 23(74.2) | 26(68.4) | 49(71.0) | 39(79.6) | 27(79.4) | 66(79.5) | |
| Farming | 2(6.5) | 1(2.6) | 3(4.3) | 8(16.3) | 5(14.7) | 13(15.7) | |
| Others | 6(19.4) | 11(28.9) | 17(24.6) | 2(4.1) | 2(5.9) | 4(4.8) | |
| P-value 0.524 | P-value 0.621 | ||||||
a) Knowledge and Prevalence of Schistosomiasis and the Exposure to Source of Infection
Table 2: Shows the knowledge and prevalence of schistosomiasis and the exposure to source of infection. At Ibaro and Apojula 51(73.9%) and 80(96.4%) visit the stream, 18(26.1%) and 3(3.6%) do not visit the stream, 20(64.5%) and 48(98.0) were tested positive in both communities. This table shows that some visit the stream daily, weekly and occasionally. At Ibaro high percentage visit rivers daily with 54(78.3%) and
26(83.9%) were tested positive while at Apojula high percentage visit rivers weekly of which 26(53.1%) tested positive with no significant difference (p>0.05). At Ibaro and Apojula community 60(87.0%) and 65(78.3%) have seen blood in their urine, 7(10.1%) and 32(38.6%) experience painful urination, 2(2.9%) and 18(21.7%) have not experience blood in their urine. Information on schistosoma infection in the communities shows that Ibaro and Apojula83(100%), 68(81.9) heard about the disease and 15(18.1%) have no idea of the infection.
| Location | Ibaro | Apojula | ||||
| Positive | Negative | Total | Positive | Negative | Total | |
| Do you visit stream? | ||||||
| Yes | 20(64.5) | 31(81.6) | 51(73.9) | 48(98.0) | 32(94.1) | 80(96.4) |
| No | 11(35.5) | 7(18.4) | 18(26.1) | 1(2.0) | 2(5.9) | 3(3.6) |
| P-value | 0.048 | P-value | 0.631 | |||
| How often do you visit river? | ||||||
| Daily | 26(83.9) | 28(73.7) | 54(78.3) | 22(44.9) | 11(32.4) | 33(39.8) |
| Weekly | 0(0.0) | 3(7.9) | 3(4.3) | 26(53.1) | 23(67.6) | 49(59.0) |
| Occasionally | 5(16.1) | 7(18.4) | 12(17.4) | 1(2.0) | 0(0.0) | 1(1.2) |
| P-value | 0.331 | P-value | 0.563 | |||
| Do you heard of Scistosomiasis? | ||||||
| Yes | 30(96.8) | 37(97.4) | 67(97.1) | 26(76.5) | 42(85.7) | 68(81.9) |
| No | 1(3.2) | 1(2.6) | 2(2.9) | 8(23.5) | 7(14.5) | 15(18.1) |
| P-value | 0.707 | P-value | 0.542 | |||
| Have you seen blood in your urine? | ||||||
| Yes | 31(100.0) | 38(100.0) | 69(100.0) | 38(77.6) | 27(79.4) | 65(78.3) |
| No | 0(0.0) | 0(0.0) | 0(0.0) | 11(22.4) | 7(20.6) | 18(21.7) |
| P-value | 0.707 | P-value | 0.542 | |||
Table 3 Showing intensity rates of the infections among population in both communities which seen in both male and female which is more in the age group of
5-13 years which are the school aged children. The female has more light infection than male 35(52.2%) and 32(46.4%) and 1(50.0%) and 10(71.4%) with heavy infection from Ibaro and Apojula with no significant difference (p>0.05).
| Location | Ibaro | Apojula | |||||
| Light | Heavy | Total | Light | Heavy | Total | ||
| Sex | Male | 32 (47.8) | 1 (50.0) | 33 (47.8) | 37 (53.6) | 4 (28.6) | 41 (49.4) |
| Female | 35 (52.2) | 1 (50.0) | 36 (52.2) | 32 (46.4) | 10 (71.4) | 42 (50.6) | |
| P-value | 1.000 | P-value | 0.141 | ||||
| Age | 1-4 | 11 (16.4) | 0 (0.0) | 11 (15.9) | 18 (26.1) | 2 (14.3) | 20 (24.1) |
| 5-13 | 42 (62.7) | 2 (100.0) | 44 (63.8) | 25 (36.2) | 5 (35.7) | 30 (36.1) | |
| 14-22 | 5 (7.5) | 0 (0.0) | 5 (7.2) | 11 (15.9) | 3 (21.4) | 14 (16.9) | |
| <22 | 9 (13.4) | 0 (0.0) | 9 (13.0) | 15 (21.7) | 4 (28.6) | 19 (22.9) | |
| P-value | 0.760 | P-value | 0.773 | ||||
c) Knowledge of Respondents on Treatment Methods
Table 4 below shows the knowledge of respondents from both communities which indicates that 123(80.9%) people is not totally ignorance of schistosomiasis as a serious disease and 26(17.1%) agreed that it is not a serious disease of which 148(97.4%) has been treated using drugs, herbs and other methods. In the two study communities, the studies show that people where using Trichilia emeticand Stylosantheserectain Ibaro and Apojula for treatment of the schistosomiasis. The result also shows that roots of Trichilia emeticis the most used in the community with 32(46.4%) and stems 27(39.1%), Whiles Stylosantheserecta and Hospital/MDAs are the most promised with 12 (14.5%) and 57 (68.7%) in Apojula. Effective medication period is 15 days by sucking in water as majorly practice traditionally in Apojula with 27 (32.5%) and raw consumption of with 26 (31.3%).
| Location | Ibaro | Apojula | Total | |
| Schistosomiasis is a serious disease | Yes | 61 (88.4) | 62 (74.7) | 123 (80.9) |
| No | 8 (11.6) | 18 (21.7) | 26 (17.1) | |
| I don't know | 0 (0.0) | 3 (3.6) | 3 (2.0) | |
| What herbs do you use for treatment? | (Herbs) | Trichiliaemetic | Stylosantheserecta | |
| (L) | 0(0.0) | 6 (7.2) | 6(3.9) | |
| (R) | 32 (46.4) | 12 (14.5) | 44 (28.9) | |
| (S) | 27 (39.1) | 3 (3.6) | 30 (19.7) | |
| (Se) | 0(0.0) | 5(6.0) | 5(3.3) | |
| Hospital/MDAs | 10 (14.75) | 57 (68.7) | 67 (44.1) | |
| Effective medication period | (T) | (1/4L, 15 days) | (1/4L, 15 days) | |
| Leaves | 0 (0.0) | 5 (6.0) | 5 (3.3) | |
| Dry root/suck in water | 15 (21.7) | 27 (32.5) | 42 (27.6) | |
| Raw consumption | 1 (1.4) | 26 (31.3) | 27 (17.8) | |
| Others | 0 (0.0) | 10 (12.0) | 10 (6.6) | |
| Experience infection after use of herbs | Yes | 67 (97.1) | 67 (80.7) | 134 (88.2) |
| No | 2 (2.9) | 16 (19.3) | 18 (11.8) | |
| Total | 69 (100.0) | 83 (100.0) | 152 (100.0) |
III. Discussion
The result shows that the highest prevalence rate was found among the female of both communities. There was no significant difference in the sex in both communities to the infection (p>0.05). However, this study agrees with some findings carry out in the southern parts of Nigeria which showed that females have a higher prevalence of urinary schistosomiasis than males [25] and [26]. The reason for this is that women are mostly involved in activities known to favour infection due to their gender-assigned responsibilities which include fetching, bathing, religious act, washing these activities are done majorly by the females which probably makes the female has higher chance of infection.
The prevalence of the disease did not increase significantly with the age (p>0.05). This implies that the infection among population in both communities is not age specific. It confirms that the infection could be acquired through water contact activities. The knowledge, attitude and practices are high in both communities in which high population.
The result of this study show that population of both communities has the knowledge of traditional approaches in managing the disease due to no constant of mass administration of medicines (MAMs) in the communities. Findings shows that population in Ibaro communities uses Trichiliaemetic and Stylosantheserecta as a traditional approach in treatment of the infection and Arshe, a local name called by the Udoma people of Benue state. These traditional methods can be done using different methods in preparation of the herbs examples, boiling, drying, raw consumption etc. The result of the study on plant herbs shows that the root and stem of Trichilia emetic has great effect on the treatment of urinary schistosomiasis and whole plant of Stylosantheserecta this research work agreed with where he confirms that extracts of Trichiliaemetica root in association with Stylosantheserecta whole plant has great effects against urinary schistosomiasis.
After treatment using herbs high number of population experience the infection again due to probably re-infection or constant exposure to source of infection. Since both communities are aware of the infection, there is need for the communities to be enlightened more on the dangers of re-infection. Lack of proper water supply was observed in both communities and lack of understanding of mode of transmission of the disease.
IV. CONCLUSION
This study concluded that traditional methods as case management play a vital role in the treatment of infection in the study area. Looking a way forward towards extenuating the menace of Schistosoma infections, traditional method and Ethnobotany and ethno-medical studies should be acknowledged as the most viable methods of identifying new medicinal plants or refocusing on those earlier reported for bioactive constituents. Plants have been of immense value to human health and roughly eighty percent (80%) of the world's populations rely on them for cure of various ailments. The continual search for natural plant products used as medicines, has acted as a catalyst leading to the widespread use of traditional medicinal practices today in most of the developing world.
RECOMMENDATIONS
Collaborative effort between the government and the community are required to reduce water contact behaviors that results in the transmission of urinary schistosomiasis. To make this feasible, health education should repairs all damages boreholes and provides availability of alternative sources of clean and safe water are recommended to complement ongoing efforts to control schistosomiasis and traditional method should be acknowledged as the most viable methods of identifying new medicinal plants in the study communities and other endemic communities of Sub-Saharan Africa.
