I. II.

Clinical Question: What is the Impact of Urinary Schistosomiasis on Nutritional Status of School Children in South-Eastern Nigeria? Citation: C. J. Uneke !. U. Egede " Impact #f Urinary Schistosomiasis #n Nutritional Status #f School Children In South-Eastern Nigeria. $he Internet Journal of %ealth. &''( )olume ( Num*er + Study Characteristics: A. Patients 403 male and female primary school pupil B. Interventions Compared A out !0ml of clean"catch# midstream urine samples $ere collected in %0ml capacity autoclaved $ide mouthed# lea&# proof universal containers y su 'ects themselves# $ho $ere previously carefully instructed $ith illustration aids. Samples $ere o tained et$een (0:00hrs and (4:00hrs !!. Samples $ith visi le haematuria $ere noted. )he specimens $ere appropriately la eled $ith identification num ers and placed in a cold o* $ith ice pac&s# immediately after collection. )hey $ere processed ("!hrs of collection. In situations $here delay in transportation of specimens to la oratory $as inevita le# ordinary household leach $as added to the urine samples +ratio, (ml leach: %0ml urine- to preserve any schistosome ova present !!#!3. Assessment of nutritional status via anthropometric parameters Anthropometric measurements $ere conducted for ody $ei.ht# hei.ht and mid" upper arm circumferences. Body $ei.ht $as measured $ith minimum clothin. to the nearest (00. $ith minimum clothin. +only )"shirts and shorts- and usin. attery" operated di.ital scales +S/CA# manufactured for 01IC/2-. 2or hei.ht# the child stood erect a.ainst a stadiometer affi*ed to a $all for measurement to the nearest 0.( cm. 3id"upper arm circumference +30AC- $as measured $ith a fle*i le tape and recorded to 0.( cm. C. 4utcomes 3onitored )his study evaluated the impact of S. haemato ium infection on the nutritional status of school children y considerin. the anthropometric parameters of the children in relation to the infection usin. standard techni5ues. )he findin.s of this study indicate that the prevalence of S. haemato ium infection is very hi.h +67.48- amon. children in the study locality and this satisfies the 9:4 classification as endemic %. In this study a clear relationship $as esta lished et$een S.

III.

haemato ium infection and the nutritional status of the children as e*pressed y the anthropometric parameters.

;. ;oes the study focus on a si.nificant pro lem in clinical practice <es# the study focuses on the outcomes of poor nutritional status of children and the impact of urinary schistosomiasis endemically affectin. South# 1i.eria associated $ith the ne.ative influence of infection caused y S. :aemato ium. )he lac& of proper &no$led.e of the cause of the disease and insufficient safe $ater supply coupled $ith inade5uate health care facilities had influenced the infection rate +;r 2aru& Sar&infada# ;epartment of 3edical 3icro iolo.y and Parasites# 2aculty of 3edicine# Bayero 0niversity# !007-. Althou.h# as it $as ein. surveyed y the medical team of 0niversity of =ano# Bayero# appropriate intervention and health education $as .iven"such as, re.ular school" ased de$ormin. and readily availa le sustained infrastructure to$ards to the community of South 1i.eria. >ar.e proportions of the populace $ere not a$are of the preventive measures# so they re5uired appropriate health teachin. to the children and the $hole community itself for the control and prevention of urinary schistosomiasis includin. the attendant illnesses. So $e must advocate the importance of health education of de$ormin. in community to o tain a pro.ressive drop in prevalence of certain health pro lems. I?. 3ethodolo.y@;esi.n a. 3ethodolo.y used 3aterials and 3ethods Study Area and population )his study $as conducted from April !006 to 2e ruary !00A in /BBa"1orth local .overnment area +>CA- of / onyi State# south"eastern 1i.eria. )he climate is tropical and the ve.etation characteristic is predominantly the rain forest $ith an avera.e annual rainfall of a out (D00mm and avera.e atmospheric temperature of 30oC. )here are t$o distinct seasons# the $et and the dry season. )he former ta&es place et$een April and 4cto er# $hile the latter occurs from 1ovem er to 3arch. )he study too& place in selected primary schools in the rural communities of the >CA. )he schools $ere Community Primary School CPS 0.ala a# and Community Primary School CPS Achia.u. )he ma'or sources of $ater supply in these communities are rivers# streams and ponds. Systematic schistosomicidal treatment had never een applied in the >CA.Primary school pupil $ere selected for this study ecause: +i- schools are accessi le $ithout much difficulties# +ii- the pea& of prevalence of schistosomiasis is to e found in this .roup (7 and +iii- e*perience sho$s that there is .eneral .ood compliance from children and parents !0. /thical Consideration

)his study protocol $as approved y the ;epartment of 3edical 3icro iolo.y@Parasitolo.y# 2aculty of Clinical 3edicine / onyi State 0niversity. )he study $as also approved y the /BBa"1orth >ocal Covernment Council Authorities# the >ocal Covernment :ealth ;epartments and the Parent")eachers Association +P)A- of each of the schools used for the studied. Informed consent $as o tained from each of the pupils efore inclusion in the study. All $or& $as performed accordin. to the international .uidelines for human e*perimentation in iomedical research !(. Assessment of nutritional status via anthropometric parameters Anthropometric measurements $ere conducted for ody $ei.ht# hei.ht and mid" upper arm circumferences. Body $ei.ht $as measured $ith minimum clothin. to the nearest (00. $ith minimum clothin. +only )"shirts and shorts- and usin. attery" operated di.ital scales +S/CA# manufactured for 01IC/2-. 2or hei.ht# the child stood erect a.ainst a stadiometer affi*ed to a $all for measurement to the nearest 0.( cm. 3id"upper arm circumference +30AC- $as measured $ith a fle*i le tape and recorded to 0.( cm. >a oratory Analysis )he urine sedimentation techni5ue descri ed previously !!#!3 $as used to detect the presence of S. haemato ium ova in the urine samples and to determine the intensity of the infection in each case. Intensity $as reported as the num er of ova@(0ml of urine and $as cate.oriBed as li.ht +E %0 ova@(0ml of urine- and heavy +E%0 ova@(0ml of urine-. A fe$ drops of saponin solution $ere added to samples $ith visi le haematuria to enhance clarity in microscopy !3. Statistical Analysis ;ifferences in proportion $ere evaluated usin. the Chi"s5uare test. Statistical si.nificance $as achieved it P F 0.0%. *. ;esi.n Control .roup ;esi.n c. Settin. Community Primary School CPS 0.ala a# and Community Primary School CPS Achia.u d. ;ata Sources G Community Primary School CPS 0.ala a G Community Primary School CPS Achia.u

G /BBa"1orth >ocal Covernment Council Authorities G >ocal Covernment :ealth ;epartments G Parent")eachers Association +P)A- of each of the schools used for the studied G ;epartment of 3edical 3icro iolo.y@Parasitolo.y# 2aculty of Clinical 3edicine / onyi State 0niversity

e. :as the ori.inal study een replicatedH <es. )his study is from Internet Iournal of :ealth is the property of Internet Scientific Pu lications. Its content may not e copied or emailed to multiple sites or posted to a listserv $ithout the copyri.ht holderJs e*press $ritten permission. :o$ever# users may print# do$nload# or email articles for individual use. f. 9hat are the ris& and enefits of the nursin. action or intervention tested in the studyH ;e$ormin. pro.rammes and health education can cost"effectively reverse and prevent much of the mor idity associated $ith urinary schistosomiasis in children. )he importance of information and education for children and the role of school and teachers in disease prevention is easily demonstrated y diverse e*amples of successful strate.ies that reflect the pro.ressive drop in prevalence and incidence of certain health pro lems# verified throu.h lon.itudinal analyses. ?. Kesults of the Study 4f the total of 403 school children $ho participated in the study# 3!0+67.48$ere infected $ith S. haemato ium. )he prevalence of infection $as hi.her amon. the male children +A!.78- compared to the female children +64.(8-. )he prevalence of infection increased $ith decrease in a.e of the children $ith those a.ed si* years old and elo$ havin. the hi.hest prevalence of infection. )he result of the association et$een S. haemato ium infection and the assessment of the nutritional status of the children sho$ that children $ith lo$er ody $ei.ht $ere the most infected cate.ory $ith the hi.hest prevalence recorded amon. those $ho $ei.hed (7.0"!!.0& . +AA.A8- $hile the least prevalence $as recorded amon. those $ho $ei.hed a ove 3(.0&.. )here $as a si.nificant association et$een hei.ht of the children and S. haemato ium infection. Children of lo$er hei.ht +4.0"%.7m- $ere si.nificantly more infected $ith S. haemato ium. Similarly# children $ith lo$er arm circumference +D.0"6.0cm- recorded si.nificantly more prevalence of S. haemato ium infection than those $ith hi.her arm circumference.

?I. Authors conclusion and recommendation (- 9hat contri ution to health status does the nursin. action@intervention ma&eH In this study# it contri utes re.ular school" ased de$ormin. pro.rammes and health education that can cost"effectively reverse and can prevent much of the mor idity associated $ith urinary schistosomiasis in children. 2urthermore# schools offer a readily availa le# e*tensive# and sustained infrastructure $ith a s&illed $or&force that is in close contact $ith the community. 9ith support from the local health system# teachers can deliver the dru.s safely and teachers need only a fe$ hours of trainin. to understand the rationale for de$ormin. and to learn ho$ to .ive out the pills and &eep a record of their distri ution.

!- 9hat overall contri ution to nursin. &no$led.e does the study ma&eH )he overall contri ution to nursin. &no$led.e the study made $as the importance of information and education a out the disease prevention on children.

?II. Applica ility (. ;oes the study provide a direct enou.h ans$er to your clinical 5uestion in terms of type of patients# intervention and outcomeH

,es- the study pro.ides a direct ans/er to our clinical 0uestion in terms of patients /hich they used male and female primary school pupil. $he inter.ention and outcomes as the results of the study sho/s the association *et/een S. haemato*ium infection and the assessment of the nutritional status of the children sho/ that children /ith lo/er *ody /eight /ere the most infected category /ith the highest pre.alence recorded among those /ho /eighed +(.'-&&.'k g 122.234 /hile the least pre.alence /as recorded among those /ho /eighed a*o.e 5+.'kg. $here /as a significant association *et/een height of the children and S. haemato*ium infection.

!. Is it feasi le to carry out the nursin. action in the real $orldH

$he study is practical to carry out the nursing action in the real /ord since proper nursing assessment /as done to get the effect of urinary schistosomiasis on nutritional status of school children in south east Nigeria- it is easy to accomplish the nursing action in the real /orld.

?III. Kevie$erJs Conclusion $he high incidences of infected children /ith S. haemato*ium are those children /ith lo/er *ody /eight- lo/er height and lo/er arm circumference. $his result sho/s that school children /ith lo/ nutritional status are more suscepti*le to ha.e urinary schistosomiasis caused *y S. haemato*ium. !ale children are more infected than female children. $hey are infected due to lack of pu*lic health ser.ices- they are not a/are of the risks and poor sanitary conditions. $hey failed to gi.e patients anti-schistosomal drugs /hich is para6i0uante *ecause of po.erty. No/- they are taking inter.entions through school health /ith the help of teachers. $his is *y de/orming programs- gi.ing medications and information education and the role of school and teacher for the disease pre.ention.