The population biology and epidemiology of schistosome and geohelminth infections among schoolchildren in Tanzania

A study of helminth infections was undertaken among 3244 schoolchildren from 28 schools in Morogoro Rural District, Tanzania. Schistosoma haematobium was the most common infection, followed by hookworms, Ascaris lumbricoides, S. mansoni, and Trichuris trichiura. Infection prevalence of each species varied among schools and age groups, but not between sexes. There was no relationship between the prevalences of different infections among schools, except for a strong negative correlation between the prevalence of hookworm and S. mansoni infections. Within each age group, there was little excess overlap in the distribution of each infection; thus the number of multiple infections was low whereas the number of individuals harbouring at least one infection was relatively high. More children than expected carried infections of A. lumbricoides and S. mansoni, and the clustering effect increased with age. Only 2 schools had high overall infection prevalences of both geohelminths and schistosomes. Logistic regression analysis of morbidity and parasitological data indicated that individuals with multiple species infections were not at increased risk of morbidity (on a multiplicative scale) compared to individuals with single species infections. This was attributed in part to the low egg counts observed for each parasite species. The results implied little interaction between schistosome and geohelminth infections in the region, both in parasitological terms and in the context of their combined effects on health. Implications for the feasibility and benefits of combined control of geohelminths and schistosomes are discussed.