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The menace of schistosomiasis on a Nigerian community (Part I)

It is brown with cow dung strewn all over and coming closer, a repulsive odour from decomposing matter that make it shades unattractively darker than algae assaults your nose.  

That is River Eku, the most reliable water source for the over 10, 000 inhabitants of Paikon Kore and other neighbouring communities in Gwagwalada Area Council of the Federal Capital Territory, Nigeria.

The river connects no less than four communities giving them water for domestic use – including drinking, laundry and scrubbing of utensils to watering their animals. It is also a play arena for children and motorcycles wash spot, among others.

But it is also a source of a growing health burden as it distributes schistosomiasis among the women and children who are its most frequent visitors. Sadiya Mali, Binta Musa and Mariam Etu are some of its victims.

A typical day of activities at River Eku

An acute and chronic disease

Schistosomiasis, according to the World Health Organisation (WHO),  is an acute and chronic disease caused by parasitic worms. People get infected during routine agricultural, domestic, occupational and recreational activities that expose them to infested water.

The WHO says that it is prevalent in tropical and subtropical areas, especially in poor communities that do not have access to safe drinking water and adequate sanitation. Although its geographical distribution is mostly Asia, South America, the Middle East and the Caribbean, estimates has it that at least 92% of those requiring treatment for schistosomiasis live in Africa.

The infection initially causes an itchy rash on the skin, additional symptoms such as fever, body aches and abdominal pain may develop after a few weeks. Some people develop a chronic infection, with the worms living in their bodies for months to years. The diagnosis is made based on a history of travel to high-risk areas of the world combined with tests of urine, faeces or blood.

WHO describes it as the second most socioeconomically devastating parasitic disease after malaria.

Mali, 20, was 14 when she suddenly began having abdominal pains similar to menstrual cramps. She felt the discomfort most, whenever she went to urinate.

 “Anytime I go to urinate, I would be in so much pain and would have to sit or bend a while before later standing up. At such times, when I flush the toilet, I notice blood mixed with my urine. I was frightened because I was not having my menstrual cycle. When the blood didn’t stop I went to a chemist (patent medicine store) and bought some medicines,” Mali said during the interview.

For three years, Mali self-medicated without seeing any improvements. The increasing severity of the pain, forced her to go hospital.

The now expectant mother said, “After some queries and tests, the doctor, after I told him [of] our water source in the community concluded that it was the source of my illness. He advised me to stop going to the river, but I can’t stop. We don’t have water in our community. That’s where we all go.

“I take the medicines he prescribed. The bleeding has stopped but I’m still afraid because he warned me that if I continued going to the river, it would return.”

Another case is that of Musa, 22, from Sukuku who is married to a man from Paikon. Sukuku is a community also dependent on the River Eku.

The nursing mother narrated her ordeal saying, “It seemed to have happened suddenly. At first, I thought it was my monthly period. But then it didn’t stop. It is about one year now; I have treated it with medicines my husband bought from a chemist. I missed the intervention when some doctors came to treat us last year.”

For Mariam Etu who is 21-years-old, she noticed it one morning with blood followed by biting pain. It was not until about three months later that she sought help when doctors visited the community to carry out free medical intervention. Although she is better now, Etu worries it may return because of fetching water from the river for her family’s use.

Ten-year old Mariam Musa said as far as she recalls, she has always urinated with blood. “My parents have given me medicines, which I took twice daily.”

“We all play in the river and some of us see blood in our urine,” she and her brothers chorused, big smiles on their faces displaying their ignorance of the inherent dangers they are exposed to.

 

Women and children most affected

Dr. Henrietta Okereke, an epidemiologist at the University of Abuja who first encountered Paikon Kore, as part of her community development intervention programme during her national youth service year in 2011, said, she ascertained that women and children contracted the disease from the river after detailed interactions and research with them.

She said, “Schistosomiasis can only be gotten from wading in water-bodies infested with these schistosomes and invariably the intermediate host, a specie of snail.

“As a matter of fact, while swimming or wading in infected streams, rivers and such bodies, the individual experiences a biting skin sensation which is caused by the penetration of the schistosomecercaria into the skin. Many of the children and villagers attested to with a total of 71 percent of the entire village being infected.”

The infected persons, Okereke said, can benefit from certain specific anti-helminthes, iron and other micronutrients replacement. But of great importance is the prevention of re-infection. As instant succour, Okereke carried out an intervention where she treated the women and children present.

For the people here, the situation is grim as their only community primary health care centre run by extension health workers is in a sorry state of disrepair and ill-equipped to offer services needed. The facility has no running water or toilet.

Head of the community, Dagaci Paikon Kore, Alhaji Yusuf Barawa said, the health centre isn’t functioning optimally. He said, “Although the staff at the centre try their best, there are no medicines. We usually have to go out to buy. Our saving grace is that they live in the community, so they attend to us in emergency cases.”

Whereas Saidu Nda who manages the community health center insisted that the community didn’t have any water problem with enough boreholes catering to its needs, the situation a stark contradiction to that claim.  

The only functional overhead tank pumped once a day

There are four overhead water tanks and no less than 11 taps but there is hardly any water running out of them with weary villagers queueing with buckets and containers hoping they will get flowing.  

Only one tap was working and Mr. Abu Shanabo a member of the community who conducted our reporter around said, it was one of the least used taps because it was close to road and far away from the heart of the community. He said, most women found it easier to go down to the river to get their water and do their chores, rather than travel all the way here.

The most centrally located overhead tank is powered by solar energy and is regulated. It is the only one constructed by the area council that works.

Shanabo explained that, “Water is pumped once a day at sunset. The schedule is not the most convenient because by the time we all converge on the place, the chaos is best imagined and then you have people queuing until late to get water.”

One of most prevalent NTDs in Nigeria

According to a 2016 research led by Salwa Dawaki of Bayero University Kano, “Schistosomiasis remains one of the most prevalent neglected tropical diseases in Nigeria which has the greatest number of infected people worldwide.”

A cross-sectional study conducted by the research team in Kano of Nigeria’s north central where the FCT is also located showed that, “The overall prevalence of schistosomiasis was 17.8%, with 8.9% and 8.3% infected with S. mansoni and S. haematobium, respectively and 0.5% presenting co-infection with both species.”

The disease is treatable

While there is no vaccine to protect against schistosomiasis, the disease can be safely and effectively treated with medication and minimizing exposure to potentially contaminated water in high-risk areas.

Although waterways maybe cleared to allow for free, fast flow of the water and proper hygiene measures observed, as long as those infected urinate in the river the disease will continue to spread.

Dawaki’s research proposes that mass drug administration, health education and community mobilization are imperative strategies to significantly reduce the prevalence and morbidity of schistosomiasis in these communities.

Until deliberate and prompt steps are taken to change the narratives, women and children like Sadiya, Binta and both Mariams will continue to be a part of this statistics.

PHOTOS: Adie Vanessa Offiong

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