Evaluation of Urine CCA Strips for (Field) Diagnosis of Active Schistosoma mansoni Infection in a Low Endemic Kenyan Community

Main Article Content

Ephraim Odek Adel
George O. Orinda
Mariam T. Mwanje


Schistosomiasis is a chronic parasitic disease caused by a digenetic trematode blood fluke of the genus Schistosoma. The disease remains a serious public health problem in endemic countries and affects at least 207 million people worldwide, with 85% in Africa. In Kenya, more than 3.5 million are infected. A definite diagnosis of the disease plays a key role in the control of schistosomiasis. The detection of Schistosome Circulating antigens is an effective approach to discriminate previous exposure and current infection. Simple, non-invasive tools for detection of S. mansoni would be highly valuable with the view of post-intervention assessment in programmes but also for treatment/re-treatment of the individual patient. The study was conducted in Makueni, a low infection area (6 to 90 years old). The prevalence was 56.4% after three consecutive Kato-Katz stools. A population sample of n= 521 individuals was selected from an initial study cohort in an epidemiological follow-up of Schistosome infections in this foci. All the subjects in the sub-sample had been treated with praziquantel 40 mg/kg. The study was to determine the prevalence of S. mansoni using Kato technique and CCA (Circulating Cathodic Antigen) urine Elisa strips at baseline and 24 hours then also at 2 years later. The cohort study population at baseline had a prevalence of 62% of the schistosomiasis infection. The detection of schistosomiasis CCA at baseline using the CCA Elisa strip on urine samples gave a prevalence of 71.9%. The CCA was determined 24 hours after treatment with PZQ and the prevalence was 44.1%. In conclusion, Kitengei village is low endemic for schistosomiasis. Finally, circulating cathodic antigen can be used as a diagnostic tool, for the follow-up of chemotherapy and re-infection and as a field test and/or screening tool in control programmes.

Circulating Cathodic Antigen (CCA), Schistosoma mansoni, diagnosis, prevalence.

Article Details

How to Cite
Adel, E. O., O. Orinda, G., & T. Mwanje, M. (2019). Evaluation of Urine CCA Strips for (Field) Diagnosis of Active Schistosoma mansoni Infection in a Low Endemic Kenyan Community. Journal of Advances in Medicine and Medical Research, 31(6), 1-11. https://doi.org/10.9734/jammr/2019/v31i630301
Original Research Article


Akogun OB, Akogun MK. Human behaviour, water usage and Schistosomiasis transmission in a small settlement near Yola, Nigeria. Annals of Tropical Medicine and Parasitology. 1996;90:303–311.

Akinwale OP, Akpunonu VN, Ajayi MB, Akande DO, Adeleke MA, Gyang PV, Adebayo MO, Dike A. Urinary Schistosomiasis transmission in Epe, an urban community of Southwest Nigeria. Tropical Parasitology. 2011;1(2):99–103.

Fenwick A, Webster JP, Bosque – Oliva E, Blair L, Fleming F. The schistosomiasis control initiative (SCI) rationale, development and implementation from 2002 – 2008. Parasitology. 2009;136(13): 1719–1730.

World Health Organization. The Control of Schistosomiasis. Report of a WHO Expert Committee. World Health Organization Technical Report series. 1993;830.

Chitsulo LD, Engels D, Montresor A, Lorenzo Savioli. The global status of schistosomiasis and its control. Acta Tropica. 2000;77(1):41–51.

WHO. Prevention and control of schistosomiasis and soil-transmitted helmithiasis- report of a wHO expert committee, In: Report W,T,S (Ed) WHO Technical report series, WHO, Geneva; 2002.

Kinoti GK. The Epidemiology of Schistosoma haematobium infection in Kano plains. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1971;65:637-645.

Sturrock RF, Kinyanjui H, Thiong’o FW, Tosha S, Ouma JH, King CH, Koech D, Siongok TK, Mahmoud AAF. Chemotherapy-based control of Schistosomiasis haematobium. Snail studies monitoring the effect of chemotherapy on transmission in the Msambweni area, Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1990;84:257-261.

Brown DS. Freshwater snails of Africa and their medical importance. Second Edition. Taylor and Francis Ltd., London; 1994.

Kahama AI, Nibbeling HAM, van Zeyl RJM, Vennervald BJ, Ouma JH, Deelder AM. Detection and quantification of soluble egg antigen in urine of schistosoma haematobium infected children from Kenya. American Journal of Tropical Medicine and Hygiene. 1998;59(5):769-774.

Mutinga MJ, Ngoka JM. Prevalence of intestinal schistosomiasis in Machakos District, Kenya. East African Medical Journal. 1971;48:559–564.

Arap Siongok TK, Mahmoud AAF, Ouma JH, Warren KS, Muller AS, Handa AK, Houser HB. Morbidity in Schistosoma mansoni in relation to intensity of infection: Study of a community in Machakos, Kenya. American Journal of Tropical Medicine and Hygiene. 1976;25: 273– 284.

Doumenge JP, Mott KE, Cheung C, Villenave D, Chapuis O, Perrin MF, Reaud-Thomas G. Atlas of the global distribution of Schistosomiasis. Centre d’Etudes de Geographic Tropicale /WHO. Presses universitet Bordeaux; 1987.

Ouma JH, Waithaka F. Prevalence of Schistosoma mansoni and Schistosoma haematobium in Kitui District, Kenya East African Medical Journal. 1978;55:54–60.

Muchiri E, Ouma JH, King C. Dynamics and control of Schistosoma haematobium transmission in Kenya: an overview of the Msambweni project. American Journal of Tropical Medicine and Hygiene. 1996;81: 426–430.

King CH, Dickman K, Tisch DJ. Reassessment of the cost of chronic helminthic infection: a Meta–analysis of disability – related outcomes in endemic schistosomiasis. Lancet. 2005;365: 1561–1569.

Cheever AW, Hoffmann KF, Wynn TA. Immunopathology of Schistosoma mansoni in mice and men. Immunology Today. 2000;21:465–466.

World Health Organization. Report of the World Health Organization Informal Consultation on Schistosomiasis Control. Geneva; 1999.

King CH. Toward the elimination of schistosomiasis. New England Journal of Medicine. 2009; 360:2.

Van Lieshout L, Polderman AM, Deelder AM. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Tropica. 2000;77:69–80.

Jaetzold R, Schmidt H. Farm Management Handbook of Kenya. East Kenya. Kenya: Ministry of Agriculture. 1983;2:245-285.

Musimba NKR. Knowledge, attitudes and practices study on food production systems in Kikumbulyu and Ngwata locations of Kibwezi Division. A report prepared for Action-Aid (K), Kibwezi; 1994.

Gichuki FN, Mungai DN, Gachene CKK, Thomas DB. Land and water management: Towards sustainable land use in Kenya. Proceedings of the fourth national land and water management workshop: Toward sustainable land use, Nairobi, Kenya. Journal of Environmental Sciences. 2000;13(3).

Doehring E, Vester U, Ehrich JJH, Feldmeier H. Circadian variation of ova excretion, proteinuria, haematuria and leucocyturia in urinary schistosomiasis. Kidney International. 1985;27:667–671.

Van Dam GJ, Wichers JH, Ferreria TM, Chati D, Van Amerongen A, Deelder A. Diagnosis of schistosomiasis by reagent strip test for detection of circulating antigen. Journal of Clinical Microbiology. 2004;42:5458–5461.

Katz N, Chaves A, Pellegrino J. A simple device for quantitative stool thick-smear technique in Schistosoma mansoni. Revisto do instituto de medicina Tropical de Sao Paolo. 1972;14: 397-400.

Peters PA, El Alamy M, Warren KS, Mahmoud AAF. Quick Kato smear for field quantifications of Schistosoma mansoni eggs. American Journal of Tropical Medicine and Hygiene. 1980;29: 217-219.

Gryseels B. The epidemiology of Schistosomiasis in Burundi and its consequences for control. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1991;85:626–633.

Hall JE, Stek MF, Minard P, Dean DA. Immunization of Baboons with schistosoma mansoni cercariae attenuated by gamma irradiation. Science. 1981;26:212(4502):1518 – 20.

De Vlas SJ, Gryseels B. Underestimation of Schistosoma mansoni prevalences. Parasitology Today. 1992;8:274–27.

Engels D, Sinzinkayo E, De Vlas SJ, Gryseels B. Intra - specimen egg count variation in Schistosoma mansoni infection. American Journal of Tropical Medicine and Hygiene. 1997;57: 571–577.

Utzinger J, Booth M, N’Goran EK, Muller I, Tanner M, Lengeler C. Relative contribution of day – to–day and intra – specimen variation in faecal egg counts of Schistosoma mansoni of before and after treatment with praziquantel. Parasitology. 2001;122:537–544.

Zhou YB, Yang MX, Tao P. A longitudinal study of comparison of the Kato – Katz technique and indirect haemagglutination assay (IHA) for the detection of Schistosomiasis japonicum in China, 2001 – 2006. Acta Tropica. 2008;107:251–254.

Booth M, Vounatsou P, E.K.N’goran M. Tanner, Utzinger J. The influence of sampling effort and the performance of the Kato-Katz technique in diagnosing Schistosoma mansoni and hookworm co-infections in rural Coˆ te d’Ivoire. Parasitology. 2003;127:525–531.

Kongs A, Marks G, P. VerleÂ, Van der Stuyft P. The unreliability of the Kato-Katz technique limits its usefulness for evaluating S. mansoni infections. Tropical Medicine and International Health. 2001;6(3):163±169.