Clinical usefulness of urinary symptoms and urinalysis in diagnosis of Schistosoma haematobium infection in an endemic area in Southern Nigeria: descriptive study


  • Chinyere A. Nwaoha Department of Paediatrics, Federal University Teaching Hostipal Owerri, Imo State, Nigeria
  • Emeka C. Nwolisa Department of Paediatrics, Federal University Teaching Hostipal Owerri, Imo State, Nigeria
  • Udochikwuka P. Ikejiaku Department of Paediatrics, Federal University Teaching Hostipal Owerri, Imo State, Nigeria
  • Ifeyinwa B. Amamilo Department of Paediatrics, Federal University Teaching Hostipal Owerri, Imo State, Nigeria
  • Emmanuel E. Ekanem Department of Paediatrics, University of Calabar and University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria



Urinary, Schistosomiasis, Symptoms, Signs, Diagnosis


Background: Schistosoma haematobium infection occurs worldwide with the largest number of cases seen in sub-Saharan Africa. Most of the infections are acquired during childhood and are linked to urogenital diseases which contributes significantly to morbidity and mortality. A study on the use of urinary symptoms, signs and urinalysis in the diagnosis of S. haematobium infection might aid in providing early, prompt and rapid intervention that will limit associated complications.

Methods: The study was a descriptive cross-sectional of 421 children aged 6-12 years in Ohaukwu LGA, Ebonyi State, recruited from four public primary schools using multistage sampling method. Urinary symptoms and signs were obtained using a questionnaire; urine samples were collected for urinalysis and urine microscopy. Simple proportions and odds ratio (CI) were used to analyze the data. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for various symptoms and signs. The data was analyzed with IBM-SPSS 20. Significance was set at p<0.05.

Results: The prevalence of S. haematobium infection among school children in Ohaukwu LGA was 30.17%. Visible blood in urine 71.77% and dysuria 70.16% were the predominant symptoms while liver tenderness 8.87% was the most common sign. The sensitivity vs specificity of visible blood in urine and microscopic haematuria were 71.77% vs 94.43% and 100.00% vs 97.21% respectively.

Conclusions: Microscopic haematuria alone was highly sensitive and specific and can be a reliable alternative to the gold standard in making diagnosis of S. haematobium infection in children living in this endemic region.


Ross AGP, Bartley PB, Sleigh AC, Olds GR, Williams GM, McManus DP, et al. Schistosomiasis. N Eng J Med. 2002;346(16):1212-9.

Fenwick A. The global burden of neglected tropical diseases. Public Health. 2012;126(3):233-6.

World Health Organization. Schistosomiasis: progress report 2001-2011 and strategic plan 2012-2020. Geneva: WHO. 2013. Available at: Accessed on 17th January 2024.

World Health Organization. Weekly epidemiological record. 2015;90:5. Available at: Accessed on 17th January 2024.

Hotez PJ, Asojo OA, Adesina AM. Nigeria ''Ground Zero'' for the high prevalence neglected tropical diseases. PLoS Negl Trop Dis. 2012;6(7):54.

Gray DJ, McManus DP, Yuesheng Li, Willams GM, Bergquist R, Ross AG. Schistosomiasis elimination: Lessons from the past guide, the future. Lancet Infect Dis. 2010;10(10):733-6.

Hotez PJ, Kamath A. Neglected tropical diseases in sub-Saharan Africa: Review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis. 2009;3(8):e412.

Ekpo UF, Mafiana CF. Epidemiological Studies of Urinary Schistosomiasis in Ogun State, Nigeria. Identification of high-risk Communities. Nig J Parasitol. 2004;25(1):111-9.

Schneider J, Fripp PJ. The diagnosis of Bilharzia. S Afr Med J. 1977;51(16):536-40.

Ohaukwu Local Government Area-The Background Information Accessed on 20 January, 2024.

Ozowara NL, Njoku OO, Odikamnoro OO, Uhuo C. Study of the prevalence of Schistosoma haematobium infection and the treatment using praziquantel among school children in Ezza north local government area of Ebonyi state, Southeast Nigeria. Euro J Exp Bio. 2011;1(2):103-8.

Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res. 2010;1(1):55-7.

Mbabazi PS, Andan O, Fitzgerald DW, Chitsulo L, Engels D, Downs JA. Examining the Relationship between Urogenital Schistosomiasis and HIV Infection. PLoSNegl Trop Dis. 2011;5:e1396.

Ochodo EA, Gopalakrishna G, Spek B, ReitsmaJB, VanLieshout L, Polman K, et al. Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas. Cochrane Database Syst Rev. 2015;11(3):1-292.

Cheesbrough M. District Laboratory Practice in Tropical Countries, part 1 Cambridge Press, London, 1998;454:236-9.

Mott KE. A reusable polyfilter for diagnosis of Schistosoma haematobium infection by urine filtration. Bull Societe Pathologieexot. 1983;76(1):101-4.

Abdallah A, Mousa AH. Schisotosomiais and other Trematode Infection. In Woodruff AW ed. Medicine in the Tropics. Edinburgh; Churchill Livingstone. 1979;173-82.

Okoli CG, Anosike JC, Iwuala MOE. Prevalence and Distribution of Urinary Schistosomiasis in Ohaji/Egbema Local Government Area of Imo State. Nigeria J Am Sci. 2006;2(4):45-8.

Ekanem EE, Asindi AA, Ejezie GC, Antia-Obong OE. Effect of Schistosoma haematobium infection on the physical growth and school performance of Nigerian children. Cent Afr J Med. 1994;40(2):38-44.

Lengeler C, Mshinda H, Morona D, De Savigny D. Urinary Schistosomiasis: testing with urine filtration and reagent sticks for haematuria provides a comparable prevalence estimate. Acta Trop. 1993;53(1):39-50.

Red Urine Study Group Identification of High Risk Communities for Schistosomiasis in Africa: a Multi-Country Study. Social and Economic Research Project Reports No. 15. Geneva. 1995.

Ezeadila JO, Okoli I, Agomuo M, Aneke FC, and Egbuche CM. Prevalence of urinary schistosomiasis among community primary school pupils in Amagunze, Enugu State, Nigeria. World Rural Observ. 2015;7(1):46-51.

Morenikeji O, Quazim J, Omoregie C, Hassan A, Nwuba R, Anumudu CAA. Cross-sectional study on urogenital schistosomiasis in children; haematuria and proteinuria as diagnostic indicators in an endemic rural area of Nigeria Afr Hlth Sci. 2014;14(2):390-6.

Barsoum RS, Bassily S, Soliman MM, Ramzy MF, Milad AM, Hassaballa A. Renal amyloidosis and Schistosomiasis Trans R Soc Trop Med Hyg. 1979;73(4):367-74.

Okeke OC, Ogochukwu PO. Urinary schistosomiasis in urban and semi-urban community in South-Eastern Nigeria. Iranian J Parasitol. 2013;8(3):467-73.

Ogbonna CC, Dori GU, Nweze EI, Muoneke G, Nwankwo IE, Akputa N. Comparative analysis of urinary schistosomiasis among primary school children and rural farmers in Obollo-Eke, Enugu State, Nigeria: implications for control. Asian Pac J Trop Med. 2012;5(10):796-802.

Salawu OT, Odaibo AB.Urogenital schistosomiasis and urological assessment of hematuria in preschool-aged children in rural communities of Nigeria. J Pediatr Urol. 2014;10(1):88-93.






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