Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries

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dc.contributor.authorAlison Craik
dc.contributor.authorMwawi Gondwe
dc.contributor.authorNokthula Mayindi
dc.contributor.authorShingirai Chipungu
dc.contributor.authorBongekile Khoza
dc.contributor.authorXavier Gómez-Olivé
dc.contributor.authorStephen Tollman
dc.contributor.authorJohn Frean
dc.contributor.authorLaurie A. Tomlinson
dc.contributor.authorJune Fabian
dc.date.accessioned2024-02-20T09:56:03Z
dc.date.available2024-02-20T09:56:03Z
dc.date.issued2023-02-10
dc.description.abstractBackground: Urinary schistosomiasis caused by infection with Schistosoma haematobium (S. haematobium) remains endemic in Africa and is associated with haematuria and albuminuria/proteinuria. Kidney Disease Improving Global Outcomes clinical guidelines recommend evaluating proteinuria/albuminuria and glomerular filtration rate for chronic kidney disease (CKD) diagnosis. The guidelines are informed by population data outside of Africa but have been adopted in many African countries with little validation. Our study aimed to characterise the burden of urinary schistosomiasis in rural South Africa (SA) and evaluate its relationship with markers of kidney dysfunction with implications for CKD screening. Methods: In this population-based cohort study, we recruited 2021 adults aged 20 – 79 years in the Mpumalanga Province, SA. Sociodemographic data were recorded, urinalysis performed, and serum creatinine and urine albumin and creatinine measured. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2 and/or urine albumin-creatinine ratio >3.0mg/mmol. S. haematobium infection was determined by urine microscopy. Multivariable analyses were performed to determine relationships between S. haematobium and markers of kidney dysfunction. Results: Data were available for 1226 of 2021 participants. 717 (58.5%) were female and the median age was 35 years (IQR 27 – 47). Prevalence of kidney dysfunction and S. haematobium was 20.2% and 5.1% respectively. S. haematobium was strongly associated with kidney dysfunction (OR 8.66; 95% CI 4.10 – 18.3) and related to albuminuria alone (OR 8.69; 95% CI 4.11 – 18.8), with no evidence of an association with eGFR <90ml/min/1.73m2 (OR 0.43; 95% CI 0.05 – 3.59). Discussion: The strong association between urinary schistosomiasis and albuminuria requires careful consideration when screening for CKD. Screening for, and treatment of, schistosomiasis should be a routine part of initial work-up for CKD in S. haematobium endemic areas. Urinary schistosomiasis, a neglected tropical disease, remains a public health concern in the Mpumulanga province of SA.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/37671
dc.language.isoen
dc.schoolPublic Health
dc.subjectSchistosomiasis, chronic kidney disease, proteinuria, albuminuria, neglected tropical diseases, South Africa, sub-Saharan Africa
dc.titleForgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries
dc.typeArticle
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