Epidemiology of human Schistosoma haematobium infection around Volta Lake, Ghana, 1973-75

Abstract There was a dramatic rise in the prevalence of urinary schistosomiasis around Volta Lake within a year of its full impoundment in 1968. Research was undertaken to investigate the epidemiology of the disease in preparation for a control programme. The interplay of three factors—age, sex, and ethnic affiliation—largely defined the demographic patterns of the prevalence and the intensity of infection. Both of these increased in young children up to a peak at age 10-14 years, and then declined, the intensity of infection more rapidly than the prevalence. The prevalence and intensity of infection were both greater in males than females (above ages 15-24 years and 5-9 years, respectively), and differences between the two main ethnic groups were related to differences in their lake-related activities. Differences between the patterns of prevalence and intensity of infection are attributed to the greater sensitivity of the latter measurement in indicating changes in the level of transmission. Practical difficulties were encountered in obtaining a precise measurement of incidence, the most important being the considerable degree of population movement. A field cohort study showed a seasonality of transmission, greatest between January and April, during the period of high level of the lake and in the early part of the draw-down. Research on the intermediate snail host (Bulinus truncatus rohlfsi) and lakeside ecology established the focality of transmission at human water-contact sites serving the shore-line communities and, in conjunction with parasitological surveys, its seasonality: variations in ecology that accompanied the annual rise and fall of the lake led to high levels of transmission when the water level was high and lower levels during the draw-down. The geographical distribution of the infection was also affected by differences in ecology, specifically by variations in the distribution and abundance of the aquatic weed Ceratophyllum demersum. A non-seasonal decline in transmission observed in one locality during the period from 1973 to 1975 resulted from a local decrease in the amount of Ceratophyllum.