The epidemiology of schistosomiasis in Egypt: Patterns of Schistosoma mansoni infection and morbidity in Kafr El-Sheikh

This is a descriptive report of the Epidemiology 1, 2, 3 project in Egypt that made use of large probability sampling methods. These results focus on Schistosoma mansoni infection in the northern Nile Delta governorate of Kafr El Sheikh. A probability sample of 18,777 persons, representing the rural population of the entire governorate, was drawn. The sample was designed not to exclude villages based on location or presence of health care facilities and to include representation of the smaller ezbas or hamlets. The objective was to obtain detailed estimates on age- and sex-specific patterns of S. mansoni infection, and to provide a baseline for prospective studies. Stool specimens were examined by the Kato method. The estimated mean ± SE prevalence of S. mansoni infection in the rural population was 39.3 ± 3.3% in 44 villages and ezbas after weighing for the effects of the sample design. The estimated mean ± SE geometric mean egg count per gram of stool (GMEC) was 72.9 ± 7.3. Prevalence and GMEC varied considerably by village and ezba, with ezbas having a significantly higher prevalence. Villages and ezba- specific prevalence was strongly associated with GMEC (r2 = 0.61, P < 0.001). The prevalence of S. mansoni infection increased by age to 55.4 ± 3.2% at age 16 without a significant change in the adult ages. There were no gender differences until age 6, after which males were consistently higher until middle age, when the differences converged. The age- and sex-specific pattern of GMEC varied widely; however, when the GMEC data were collapsed into 5-year age groups, the GMEC peaked at 81.5 ± 12.1 eggs/g in the 10-14- year-old age group. These estimates provide the basis for evaluating control measures for reducing prevalence, intensity of infection, and transmission.