Advances in Infectious Diseases, 2012, 2, 62-66
http://dx.doi.org/10.4236/aid.2012.23009 Published Online September 2012 (http://www.SciRP.org/journal/aid)
The Serological Survey for Human Cysticercosis
Prevalence in Mbulu District, Tanzania
Beda J. Mwang’onde1,2*, Gamb a Nkwengulila1, Mwita Chacha1
1Department of Zoology and Wildlife Conservation, University of Dar es Salaam, Dar es Salaam, Tanzania; 2Division of Livestock
and Human Disease Vector Control, Tropical Pesticides Research Institute, Arusha, Tanzania.
Received July 4th, 2012; revised August 2nd, 2012; accepted September 3rd, 2012
ABSTRACT
Human cysticercosis, a zoonotic disease due to Taeniasolium, is of the highly debilitating and stigmatizing neglected
tropical diseases due to epilepsy, ophthalmia and dermatological disorders in endemic developing countries. Tanzania is
among the sub-Saharan African countries with an average prevalence of porcine cysticercosis 17.2% [1], which in-
creases the risk of human cysticercosis infection. Studies on people with epilepsy in northern zone of Tanzania show a
16.2% [2] to be suffering from neurocysticercosis. While this was the case, there were no single report on the preva-
lence of human cysticercosis neither to regu lar hospital visitors, admissions, and nor general public that result to insuf-
ficient deployment of intervention strategies. Study was performed to assess the prevalence of human cysticercosis in
general public in Mbulu district. The cephalic venous blood was collected from assorted community members. Serum
was extracted and then subj ected to Cysticercus IgG Western Blot Assay for human cysticercosis sero-screening. It was
found that about 16.3% of the community members had antibodies signifying infection by human cysticercosis. This is
the first ever study to assess the prevalence of human cysticercosis in the country and it has revealed the problem to be
very high. This study can be valuable for deployment of appropriate intervention measures on human cysticercosis in
the study area and extend to the entire country.
Keywords: Human Cysticercosis; Taeniasolium; Mbulu-Tanzania; Prevalence
1. Introduction
Human cysticercosis is a zoonotic disease which is ca us ed
by the larval stage of pork tapeworm (Taeniasolium cys-
ticercosis) and poses serious public health co ns e qu e n ce s i n
developing countries [3]. The disease affects no less than
20 million people with an annual fatality rate of ap-
proximately 50,000 people worldwide [4]. Human cysti-
cercosis accounts for about 10% of all acute neurological
admissions and a main cause of late onset epilepsy in
endemic areas [5] with about 20% - 50% of all late-onset
epilepsy cases globally [6]. Human cysticercosis infec-
tion can go unnoticed therefore, its public health conse-
quence may be grave than it is estimated. Recent trends
due to international tourism into remote or rural areas,
expansion of global business and increase of the number
of trans-migrants from rural to urban areas as well as in-
crease of immigrants and refugees, have drastically in-
creased the cases of taeniasis and cysticercosis in devel-
oped countries, Orthodox Jewish [7] and Muslim com-
munities [8,9].
Human cysticercosis is highly reported in Latin Amer-
ica, Asia and Africa. Studies in some regions of Mexico
show a prevalence of 3.6% of the general population [4];
in Asia 3.2% [10]; in Caribbean particularly in Haiti
2.8%, [11] and; in western Africa the prevalence of hu-
man cysticercosis range from 1.3% - 2.4% [12]. On the
other hand, in sub-Saharan Africa about 30% of people
with epilepsy have been diagnosed with neurocysticerco-
sis [13]. Neurocysticercosis due to Taeniasolium cysti-
cercosis is reported to be a disease of poverty and under
development as to why being one of the main causes of
epilepsy in developing countries [14]. Nevertheless, the
importation T. solium by tourism, migration of tapeworm
carriers or indirectly by importations of infected pigs, or
pig meat poses risks of the disease in Europe [15]. Be-
cause of globalization, human cysticercosis begins to
appear in industrialized countries particularly Portugal
and Northern Spain [16] and in North America[17]; and
in Islamic [18] and Orthodox Jewish [17] communities.
That is to say that the epidemiology of human cysticer-
cosis spares no community in the world because of glob-
alization.
The risk of human cysticercosis in Tanzania is very high
because the average prevalence of Taenia cellulosa e was
*Corresponding a uthor.

The Serological Survey for Human Cysticercosis Prevalence in Mbulu District, Tanzania 63
reported to be 17.2% [1]. On the other hand, piggery in-
dustry has significantly grown in the country due to rapid
economic turnover and a drastic rise in pork consumption
in many rural and urban areas [19]. In urban communi-
ties, pork is a delicacy that goes together with alcohol
consumption [20]. The free range system of keeping pigs,
lack and or improper use of latrines, clandestine slaugh-
tering and marketing of pork, absence of pork inspection
and barbecuing [21-23], further increase the risk of hu-
man cysticercosis infection in Tanzania populations’. With
the reported high risks of human cysticercosis, studies
mainly have been reporting porcine cysticercosis [1,6,21,
24]. The few studies that report cysticercosis infections
in human are based on neuro cysticercosis particularly to
people with epilepsy [2,25]. Hospital based studies in
people with epilepsy in northern Tanzania report an av-
erage neurocysticercosis prevalence of 16.2% [2,25]. Be-
cause human cysticercosis can go unnoticed for quite long,
these reported studies in human do not adequately pro-
vide with the cysticercosis prevalence picture in the Tan-
zania’s population.
This study reports a serological survey of human cys-
ticercosis based on antibodies determination in the gen-
eral community from Mbulu district, in the northern part
of Tanzania.
2. Materials and Methods
2.1. Study Area and Ethical Clearance
The study was carried out in Mbulu District (3.80˚S -
4.50˚S, 35.00˚E - 36.00˚E). Mbulu district has a popula-
tion of 321,359 (DED, 2011). The area lies at an esti-
mated altitude of 1000 - 2400 m above sea level. Climate
ranges from semi-arid to sub-humid with an annual rain-
fall of <400 and >1200 mm, respectively. There are two
rainy seasons with two peaks of maximum rains. The
long rainy season extends from about March to mid- May
and the short rainy period from November to December.
In between (January through February) is a dry season.
Relative humidity ranges from 55% to 75% and mean
annual temperatures range from 15˚C to 24˚C. The ethi-
cal clearance and approval of the study was sought from
the National Institute for Medical Research (NIMR) (ref.
NIMR/HQ/R.8a/Vol. IX/1297). NIMR is one of the United
Republic of Tanzania research organs responsible for
health research and the key board that oversees all regu-
latory issues of health research in the country.
2.2. Data Collection for Serological Survey of
Human Cysticercosis
The goal of this survey was to assess the proportion of
people in the study area carrying Abs of T. solium cysti-
cercosis as an indication of infection by the cestode.
Blood samples from randomly selected and consented
community members were collected.
About 544 individuals of different age groups and sex
from general community participated in the study. About
3 mls of cephalic venous blood was collected from each
of the consented participants by the use of evacuated
collection tubes. The samples were centrifuged at 3500
rpm at Mbulu District Hospital for serum extraction, ali-
quoted and stored in cryogenic vials in freezers before
they were transported to the University of Dar es Salaam
for further storage at –20˚C. The determination of anti-
bodies for human cysticercosis infection was carried out
by using Cysticercus IgG Western Blot Assay (LDBIO
Diagnostics 69009 Lyon-France) at Biotechnology La-
boratory, Department of Molecular Biology and Bio-
technology, University of Dar es Salaam.
Cysticercus IgG Western Blot Assay detects the pres-
ence of cysticercosis antibodies. However, the test may
be cross-reactive with other parasites. The principle of
the test is based on Cysticercus antigens from a crude
larval extract which have been resolved by electrophore-
sis into bands and transferred by electroblotting onto a
nitrocellulose membrane which is readly cut into testing
str ips. The presence on the strip of a minimum of 2 well-
defined bands among the 6 (i.e. 6 - 8; 12; 23 - 26; 39; 45;
50 - 55 kDa) described bands were considered as an in-
dication of human cysticercosis. However, the presence
of the lower molecular weight band (6 - 8 kDa) was also
described as an indication of active cysticercosis [26].
2.3. Statistical Analysis
Data entry and validation was carried ou t using ms-excel
2010 version (Ms Corp., Redmond, WA, USA). Data on
human cysticercosis seroprevalencewas analyzed using
the Statistical Package for Social Sciences version 19.0
(SPSS Statistic 19, 2010 IBM). Descriptive statistics
were used to obtain the percentage prevalence of both
human cysticercosis and other helminthes infections that
were able to be detected by the kit in differen t age groups
of the sampled population. The unequal variance t-test
(Welch’s t-test) was used to test for the variations of in-
fection between different age groups and gender,

.
3. Results
3.1. Prevalence Rate of Human Cysticercosis and
other Helminthes
The mean age of respondents was 34.49 ± 18.44 with a
range of 92. The female to male ratio was 0.64. The
prevalence of human cysticercosis for circulating cysti-
cercal antibodies in Mbulu general community was
16.3% (n = 544). The infection rate was found to in-
crease with age and the male participants were more

The Serological Survey for Human Cysticercosis Prevalence in Mbulu District, Tanzania 64
positive to human cysticercosis than female participants.
Based on age cohorts, the prevalence rates were 2% (0 -
10 years); 8% (11 - 15 years); and 52% (16 - 45 years).
Then the prevalence rate decreased to 19% (45 - 60
years); 5% (61 - 75 years); and 1% in above 76 years of
age. About 75% of the positive cases were males with
56.3% of all positive cases in both female and males
suggesting neurocysticercosis infection. The frequencies
of other parasitic infections were echinococcosis 12.1%,
schistosomiasis 6.8%, toxocariasis 14.1%, and toxoplas-
mosis 1.7%. The age cohort between 16 - 45 years was
significantly more infected with human cysticercosis than
cohorts between 0 - 10 years (p < 0.00015, df = 46); 11 -
15 years (p < 0.0065 , df = 51); 46 - 60 year s (p < 0.0062,
df = 61); 61 - 75 years (p < 0.0004, df = 48) ; and 76 and
above (p < 0.0001, df = 45).
4. Discussions
Human cysticercosis infections are one of the major
causes of epilepsy and other neurological syndromes
which are highly debilitating and thus resulting into so-
cial stigmatization in developing endemic countries. Based
on the findings from this study, the disease is highly
prevalent in Mbulu. Because Mbulu district is one of the
main sources of pork in urban, the risk of human infec-
tion in Tanzania mighty be very high as under cooked
pork consumption increase chances of pork tapeworm
infestation. The fact that the epidemiology of human cys-
ticercosis is favoured by food, water or environmental
contamination by pork tapeworm eggs from tapeworm
carriers, the threat of the disease in the country might be
holistic.
The study found anticysticercal antibodies for human
cysticercosis in eighty eigh t participan ts correspond ing to
16.3% of all tested community members from the general
public in Mbulu, a district in the northern zone of Tanza-
nia. These findings correspond to the 16.7% (by Ag-
ELISA) of active human cysticercosis which was re-
ported from Mbozidistrict [27], a district in a southern
zone of Tanzania, again one of the main sources of pork
in both rural and urban areas. Elsewhere, in Rwanda and
Mozambique, the seroprevalence of human cysticercosis
was found to be 2.8% and 12.1% [28,29], respectively.
While all human cysticercosis results contrasted in here
are from Africa south of Sahara, the observed differences
might have been contributed by target groups for study,
method of testing and risk factors for the disease. The
risk of human cysticercosis in Mbulu is very high be-
cause of traditional behaviour of keeping pigs under free
range system.
On the other hand, the observed prevalence is signifi-
cantly less to that reported byNsengunya et al. [30]
which was 31.5% (n = 648) of the health individuals
positive to an ticysticercal antibodies in Burundi. The hu-
man cysticercosis prevalence reported by this study had
the highest frequency in ages between 16 - 45 years. This
is in complement with that reported by Samir et al. [31],
however, under the reported study the higher frequency
is attributed by high return of the participants for the re-
ported age range than other cohorts. Males were detected
more positive (75%) to human cysticercosis than females
(p = 0.0099, df = 86). The differences in human cysti-
cercosis seropositivity rates between sexes and age groups
possibly reflect levels of exposure by gender to risk fac-
tors. Males and the reported productive age group (16 -
45) might be spending more time in local brews clubs
where they are subjected to eating undercooked pork and
or contaminated food or drinks by tapeworm eggs. How-
ever, further studies need to be done to find out whether
there is any genetic, sexual or senility relations hip for hu-
man cysticercosis infections. The prevalence rate of hu-
man cysticercosis was also found to decrease with the
increasing age particularly at ages above 50 years old.
This may have been also contributed by the low return
rate to participating to the study because of decreased
chances of being picked for sampling as the life expec-
tancy in Tanzania is 48 years due to HIV/AIDS pan-
demic and the leading cause of death, and malaria, the
number one killer of children under five [32]. High pre-
valence of human cysticercosis in the study region is
contributed by the free range system of keeping pigs and
the indiscriminate disposal of human faeces that are later
easily picked by pigs and thus enhance the parasite life-
cycle. The best intervention measure for this highly de-
bilitating and stigmatizing disease is education to deny
human faeces-pig contact followed by mass che mot herapy
by physician prescribed anthelmintic drug of choice to
humans.
Based on these findings, human cysticercosis is a big
problem in the country that requires an in-depth review
and serological survey all over the country, mapping and
then development of a logical framework for interv entio n
strategies of the disease.
5. Acknowledgements
The research for this paper was carried out within the
framework of the consortium Afrique One “Ecosystem
and Population Health: Expanding Frontiers in Health”.
Afrique One is funded by the Wellcome Trust (WT-
087535MA) and the University of Dar es Salaam for
hosting and experimental facilitation of the project.
REFERENCES
[1] I. K. Phiri, H. Ngowi, S. Afonso, E. Matenga, M. Boa, S.
Mukaratirwa, S. Githigia, M. Saimo, C. Sikasunge, N.
Maingi, et al., “The Emergence of Taenia Solium Cysti-
cercosis in Eastern and Southern Africa as a Serious Ag-

The Serological Survey for Human Cysticercosis Prevalence in Mbulu District, Tanzania 65
ricultural Problem and Public Health Risk,” Acta Tropica,
Vol. 87, No. 1, 2003, pp. 13-23.
[2] A. S. Winkler, J. Blocher, H. Auerd, T. Gotwalde, W.
Matuja and E. Schmutzhard, “Anticysticercal and Anti-
toxocaral Antibodies in People with Epilepsy in Rural
Tanzania,” Transactions of the Royal Society of Tropical
Medicine and Hygiene, Vol. 102, No. 10, 2008, pp. 1032-
1038.
[3] N. Praet, K. Kanobana, C. Kabwe, V. Maketa, P. Lukanu,
P. Lutumba, K. Polman, P. Matondo, N. Speybroeck et al,
“Taenia Solium Cysticercosis in the Democratic Republic
of Congo: How Does Pork Trade Affect the Transmission
of the Parasite?” PLOS Neglected Tropical Diseases, Vol.
4, No. 9, 2010, p. e817.
doi:10.1371/journal.pntd.0000817
[4] R. W. Tolan, “Taenia Infection,” 2011.
http://wwwtheinfectiousdiseasesdailyom/
[5] F. Fregni, “Taenia Solium (Taeniasis/Cysticercosis),” Col-
laborative Course on Infectious Diseases, 2008.
[6] H. A. Ngowi, I. K . Phir i, S. A fonso, E. Matenga, M. E. Boa,
S. Mukaratirwa, S. Githigia, M. Saimo, C. Sikasunge, N.
Maingi, et al., “Taenia Solium Cysticercosis in Eastern
and Southern Africa: An Emerging Problem in Agricul-
ture and Public Health,” Southeast Asian Journal of Tro-
pical Medicine and Public Health, Vol. 35, No. 1, 2004,
pp. 266-270.
[7] F. Sorvillo, P. Wilkins, S. Shafir and M. Eberhard, “Pub-
lic Health Implications of Cysticercosis Acquired in the
United States,” Emerging Infectious Diseases, Vol. 17,
No. 1, 2011, pp. 1-6.
[8] K. Swastika, C. I. Dewiyani, T. Yanagida, Y. Sako, M.
Sudarmaja, P. Sutisna, T. Wandra, N. S. Dharmawan, K.
Nakaya, M. Okamoto, et al ., “An Ocular Cysticercosis in
Bali, Indonesia Caused by Taenia Solium Asian Geno-
type,” Parasitology International, Vol. 61, No. 2, 2012,
pp. 378-380. doi:10.1016/j.parint.2011.11.004
[9] I. Francis, P. R. Hira, N. A. Abdella, R. Gupta, F. M. Al-
Ali, S. Grover, N. Khalid, S. Abdeen, J. Iqbal, M. Wilson
and V. C. Tsang, “Cysticercosis: Imported and Autoch-
thonous Infections in Kuwait,” Transactions of the Royal
Society of Tropical Medicine and Hygiene, Vol. 98, No. 4,
2004, pp. 233-239. doi:10.1016/S0035-9203(03)00061-0
[10] W. C. Cao, P. C. Van Der, C. L. Gao, J. F. Xu, X. C. Cao,
Z. H. Cui, Z. X. Ren and J. D. F. Habbema, “Seropreva-
lence and Risk Factors of Human Cysticercosis in a Com-
munity of Shandong, China,” Southeast Asian Journal of
Tropical Medicine and Public Health, Vol. 27, No. 2,
1996, pp. 279-285.
[11] C. P. Raccurt, P. Agnamey, J. Boncy, J.-H. Henrys and A.
Totet, “Seroprevalence of Human Taenia Solium Cysti-
cercosis in Haiti,” Journal of Helminthology, Vol. 83, No.
2, 2009, pp. 113-116.
[12] N. A. Mafojanea, C. C. Appletonb, R. C. Krecekc, L. M.
Michaeld and A. L. Willingham III, “The Current Status
of Neurocysticercosis in Eastern and Southern Africa,”
Acta Tropica, Vol. 87, No. 1, 2003, pp. 25-33.
[13] A. L. Willingham III and A. Mugarura, “Taenia Solium
Tapeworms and Epilepsy in Uganda,” International Epi-
lepsy News, Vol. 1, 2008, pp. 10-12.
[14] D. K. Pal, A. Carpio and J. W. A. S. Sander, “Neurocys-
ticercosis and Epilepsy in Developing Countries,” Jour-
nal of Neurology, Neurosurgery and Psychiatry, Vol. 68,
No. 2, 2000, pp. 137-143.
[15] European Commission, “Opinion of the Scientific Com-
mittee on Veterinary Measures Relating to Public Health
on the Control of Taeniosis/Cysticercosis in Man and
Animals,” Health & Consumer Protection Directorate Gen-
eral, Brussels, 2000.
[16] N. M. Canas, S. L. Calado and J. Vale, “Treatment of
Racemose Neurocysticercosis of the Spine,” Revista de
Neurologia, Vol. 40, No. 9, 2005, pp. 544-547.
[17] P. M. Schantz, P. P. Wilkins and V. C. W. Tsang, “Immi-
grants, Imaging, and Immunobl ots: The Emerge nce of Neu -
rocysticercosis as a Significant Public Health Problem,”
In: W. M. Scheld, W. A. Craig and J. M. Hughes, Eds.,
Emerging Infections 2, ASM Press, Washingto n DC, 1998,
pp. 213-242.
[18] W. X. Shandera and J. S. Kass, “Neurocy sticercosis: Cur-
rent Knowledge and Advances,” Current Neurology and
Neuroscience Repo r t s, Vol. 6, No. 6, 2006, pp. 453-459.
doi:10.1007/s11910-006-0046-3
[19] M. V. Johansen, “Draft Action Plan for Prevention and
Control of Taenia Solium Cysticercosis/Taeniosis in East-
ern and Southern African Region,” Cysticercosis Working
Group in Eastern and Southern Africa, Morogoro, 2008.
[20] A. Secka, T. Marcotty, R. De Deken, E. V. Marck and S.
Geerts, “Porcine: Cysticercosis and Risk Factors in the
Gambia and Senegal,” Journal of Parasitology Research,
Vol. 2010, 2010, Article ID: 823892.
[21] M. E. Boa, E. A. Mahundi, A. A. Kassuku, A. L. Willing-
ham III and N. C. Kyvsgaard, “Epidemiological Survey
of Swine Cysticercosis Using Ante-Mortem and Post-
Mortem Examination Tests in the Southern Highlands of
Tanzani a,” Veterinary Parasitology, Vol. 139, No. 1-3, 2006,
pp. 249-255. doi:10.1016/j.vetpar.2006.02.012
[22] H. A. Ngowi, A. A. Kassuku, G. E. Maeda, M. E. Boa, H.
Carabin and A. L. Willingham, “Risk Factors for the Pre-
valence of Porcine Cysticercosis in Mbulu District, Tan-
zania,” Veterinary Parasit ology, V ol . 1 2 0 , N o . 4 , 2004,
pp. 275-283.
[23] F. P. Lekule and N. C. Kyvsgaard, “Improving Pig Hus-
bandry in Tropical Resource-Poor Communities and Its
Potential to Reduce Risk of Porcine Cysticercosis,” Acta
Tropica, Vol. 87, No. 1, 2003, pp. 111-117.
doi:10.1016/S0001-706X(03)00026-3
[24] E. M. Mkupasi, H. A. Ngowi and H. E. Nonga, “Preva-
lence of Extra-Intestinal Porcine Helminth Infections and
Assessment of Sanitary Conditions of Pig Slaughter Slabs
in Dares Salaam City, Tanzania,” Tropical Animal Health
and Production, Vol. 43, No. 2, 2010, pp. 417-423.
doi:10.1007/s11250-010-9708-x
[25] A. L. Willingham, L. J. Harrison, E. M. Fèvre and M. E.
Parkhouse, “Inaugural Meeting of the Cysticercosis Work-
ing Group in Europe,” Emerging Infectious Diseases, Vol.
14, No. 12, 2008. doi:10.3201/eid1412.080889
[26] C. Simac, P. Michel, A .Andriantsimahavandy, P. Esterre
and A. Michault, “Use of Enzyme-Linked Immunosor-
bent Assay and Enzyme-Linked Immunoelectrotransfer

The Serological Survey for Human Cysticercosis Prevalence in Mbulu District, Tanzania 66
Blot for the Diagnosis and Monitoring of Neurocysticer-
cosis,” Parasitology Research, Vol. 81, No. 2, 1995, pp.
132-136. doi:10.1007/BF00931618
[27] G. Mwanjali, “Prevalence and Practices Associated with
Human Taenia Solium Infection in Mbozi District, Mbeya
Region,” Dissertation, Muhimbili University of Health
and Allied Sciences (MUHAS), Dar es Salaam, 2010.
[28] E. Newell, F. Vyungimana, S. Geerts, I. Van Kerckhoven,
V. C. W. Tsang and D. Engels, “Prevalence of Cysticer-
cosis in Epileptics and Members of Their Families in Bu-
rundi,” Transactions of the Royal Society of Tropical
Medicine and Hygiene, Vol. 91, No. 4, 1997, pp. 389-391.
doi:10.1016/S0035-9203(97)90251-0
[29] A. Zoli, O. Shey-Njila, E. Assana, J.-P. Nguekam, P. Dorny,
J. Brandt and S. Geerts, “Regional Status, Epidemiology
and Impact of Taenia Solium Cysticercosis in Western
and Central Africa,” Acta Tropica, Vol. 87, No. 1, 2003,
pp. 35-42. doi:10.1016/S0001-706X(03)00053-6
[30] G. Nsengiyumva, M. Druet-Cabanac, B. Ramanankandra-
sana, B. Bouteille, L. Nsizabira and P. M. Preux, “Cy s ti ce r-
cosis as a Major Risk Factor for Epilepsy in Burundi,
East Africa,” Epilepsia, V ol. 44, No. 7, 200 3, pp. 950-
955.
[31] S. H. Vora, D. D. Motghare, A. M. Ferreira, M. S. Kulkan
and S. F. Vaz, “High Prevalence of Human Cysticercosis
in a Rural Village in Western India,” Tropical Medicine
and Health, Vol. 36, No. 3, 2008, pp. 137-138.
[32] URT, “Tanzania country profile,” 2012.
http://www.usaid.gov/