Graduation Date

Spring 5-10-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Epidemiology

First Advisor

Abraham Mengist

Abstract

Urogenital schistosomiasis continues to impact the wellbeing of hundreds of millions of people worldwide and remains a significant public health challenge across Ethiopia. Despite existing knowledge on the disease, there remain significant unanswered questions with regard to its treatment and diagnosis. This dissertation evaluated the efficacy of praziquantel at treating urogenital schistosomiasis, improving nutritional parameters among children and the performance of FlukeCatcher at detecting and determining the intensity of infection. In effecting this, a total of 977 children aged 5 through 15 from the Afar and Gambella regions of Ethiopia were screened for S. haematobium infection using urine filtration microscopy and followed for one month. S. haematobium infection and nutritional status of the children were assessed at baseline and one month after treatment. Nutritional status was determined using height, weight and mid-upper arm circumference measurements. The samples collected from children in the Afar region at baseline were also examined for S. haematobium egg using FlukeCatcher. Children infected with S. haematobiumat baseline were treated with 40 mg/kg of praziquantel. Results indicated a significant reduction in infection rates post-treatment, with an 86% overall cure rate and a 97% overall egg reduction rate. Infection with urogenital schistosomiasis was strongly associated with underweight at baseline (aOR: 1.76, 95% CI: 1.63 – 1.90). Nutritional status did not notably improve within one month of treatment among children who received praziquantel therapy. Using the combined results based on FlukeCather and UFM as a reference, FlukeCatcher demonstrated a sensitivity of 84% whilst standard urine filtration microscopy had a sensitivity of 65%. FlukeCatcher, however, had a very poor ability to properly categorise infection intensity. This study concludes that praziquantel at a dose of 40 mg/kg remains highly effective in treating S. haematobium infection, but does not have a significant short-term effect at reversing disease-related malnutrition. Furthermore, FlukeCatcher is superior at diagnosing the infection compared to standard urine filtration microscopy, but has a poor ability to characterise infection intensity. These findings have significant implications for public health strategies, emphasising the need for deeper research into these topics and the deployment of more holistic approaches to combatting schistosomiasis in Ethiopia.

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2025 Copyright, the authors

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