1. TWO PROPOSED MODELS EXPLAINING EXCRETED URINE-ALBUMIN AETIOLOGY School-aged children [top/left]: Pairs of S. haematobium worms migrate to the vesical plexus and veins draining the ureters Egg production commences; eggs pass from the lumen of blood vessels; many penetrate the bladder mucosa being shed in the urine (blue arrows) Tissue damage and subsequent haemorrhage (red arrow) follow, increasing albumin concentration in urine Acknowledgements: Dr Amadou Garba (SCI, Niger); Mr Khamis Adulrahman Simai, Mrs Salma Suleiman Seif, Mr Mahmoud Badru Ali and Mr Masoud Hassan Juma (Unguja ultrasonographers); Health Foundation, UK (DR, JRS); MRC (M-GB); Part of the MSc in Modern Epidemiology, Imperial College – London (JCSF) URINE-ALBUMIN AND ULTRASONOGRAPHY In school-aged children, raised urine-albumin levels were found indicative of positive S. haematobium egg counts (OR=29.5, p<0.001) [not in adults, p=0.58] In school-aged children, prevalence of UTPs was found associated with positive S. haematobium egg counts (OR=5.4, p<0.001) [not in adults, p=0.56] USE OF PORTABLE ULTRASONOGRAPHY AND URINE-ALBUMIN ASSAYS FOR DETECTION OF URINARY TRACT PATHOLOGIES (UTPs) ASSOCIATED WITH URINARY SCHISTOSOMIASIS ON UNGUJA ISLAND, ZANZIBAR J.C. Sousa Figueiredo 1, A.F. Mgeni 2, M.-G. Basáñez 1, D. Rollinson 3, J.R. Stothard 3 1 Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, UK 2 Helminth Control Laboratory Unguja, Helminth Control Programme, Zanzibar 3 Department of Zoology, Natural History Museum, London SW7 5BD, UK Prevalence of urinary schistosomiasis was 36% [CI 95 28-44%] in schools and 47% [CI 95 33-61%] in Chaani Health Centre In the population surveyed at the health centre, UTPs were more common (64%) than in school-aged children (40%) Bladder pathologies accounted for the majority of UTPs identified in the population (90%) Raised urine-albumin concentration (≥40mg/l) was found to be indicative of: Infection (OR=3.7, p=0.11) and microhaematuria (OR=135.3, p<0.000) in school-aged children (n=132)* Bladder pathologies (OR=8.4, p<0.01) in male adults (n=47)* Key Findings Adults [top/right] : Long term pathologies (particularly bladder lesions) are induced by high burdens and exposure to S. haematobium Through these lesions, albumin-rich blood- serum infiltrates the bladder (orange arrows) Infiltration leads to increase in urine- albumin levels without the direct influence of S. haematobium egg excretion and without causing haematuria FIELD WORK Three schools from Unguja Island (Chaani, Kinyasini, and Mwera) were surveyed (n = 140 children aged 9 to15 yr) A cross-sectional study of adult males (n = 47) attending Chaani Health Centre was also conducted URINARY SCHISTOSOMIASIS AND ZANZIBAR Schistosoma haematobium infection, the cause for urinary schistosomiasis, is responsible for a variety of debilitating conditions, including urinary tract pathologies (UTPs). Ultrasonography is commonly used to detect UTPs, however new non-invasive, rapid epidemiological assessment tools need to be investigated. Objective: To identify associations between excreted urine-albumin, a known proxy of S. haematobium infection in children, and UTPs, as detected in ultrasonography Urine samples - haematuria Urine-albumin photometer Ultrasonograph of bladder * Model selected by stepwise (AIC) logistic regression controlling for sex, age, and location URINE-ALBUMIN AS A RAPID EPIDEMIOLOGICAL ASSESSENT TOOL FOR UTPs Despite ongoing efforts to control S. haematobium, UTPs are still common in school-aged children and adults Future work should be directed at monitoring the extent to which UTPs improve during control programmes Future work should be directed at monitoring the extent to which UTPs improve during control programmes Urine-albumin assays can be used as a rapid, field-applicable screening tool for assessing UTP prevalence Urine-albumin assays can be used as a rapid, field-applicable screening tool for assessing UTP prevalence MORBIDITY Infection was found associated with pain on urination in children (OR=3.9, p<0.01) and adult males (OR=9.9, p<0.01) MicrohaematuriaMacrohaematuriaUTPs Raised urine-albumin Schools41%8%40%34% Health Centre60%4%64%28%