Abstract
Background
Previous research has documented an increased risk of subfertility in areas of sub-Saharan Africa, as well as an ecological association between urogenital schistosomiasis prevalence and decreased fertility. This pilot project examined reproductive patterns and the potential effects of childhood urogenital Schistosoma haematobium infection and individual treatment experience on adult subfertility among women who were long-term residents in an S. haematobium-endemic region of coastal Kenya.
Methodology/Principal findings
We analyzed findings from 162 in-depth interviews with women of childbearing age in a rural, coastal community, linking them, if possible, to their individual treatment records from previous multi-year longitudinal studies of parasitic infections. Reproductive histories indicated a much local higher local rate of subfertility (44%) than worldwide averages (8–12%). Although, due to the very high regional prevalence of schistosomiasis, a clear relationship could not be demonstrated between a history of S. haematobium infection and adult subfertility, among a convenience sub-sample of 61 women who had received documented treatment during previous interventional trials, a significant association was found between age at first anti-schistosomal treatment and later fertility in adulthood, with those women treated before age 21 significantly less likely to have subfertility (P = 0.001).
Conclusions/Significance
The high subfertility rate documented in this pilot study suggests the importance of programs to prevent and treat pelvic infections in their early stages to preclude reproductive tract damage. The available documented treatment data also suggest that early anti-schistosomal treatment may prevent the fertility-damaging effects of urogenital schistosomiasis, and lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.
Author summary
Infertility is an unwelcome complication of many infectious diseases. In sub-Saharan Africa, where women experience the highest rates of subfertility in the world, the helminthic parasite Schistosoma haematobium, is also highly prevalent. Chronic and repeated infections with S. haematobium cause inflammation of the pelvic organs and kidneys, a condition known as urogenital schistosomiasis. Past studies have statistically linked past and present S. haematobium infection to the risk of infection-associated female genital lesions and with risk for subfertility in adulthood. The present study used in-depth interviews to document reproductive health histories of 162 women, aged 15 to 62, residing in an S. haematobium-endemic area of coastal Kenya, in order to examine the association of their earlier anti-schistosomal treatment with their fertility patterns. A self-reported history of past treatment was not associated with lower odds of infertility. However, among 61 with verified treatments given during previous local campaigns, it was found that women who were treated before age 21 experienced significantly fewer period of subfertility during their adult life. The findings suggest that anti-schistosomal treatment during childhood may prevent the fertility-damaging effects of urogenital schistosomiasis. They also lend support for programs that provide universal treatment of children in S. haematobium-endemic regions.