Adam's rib awry? Women and schistosomiasis

The present paper reviews the literature to determine whether there are predisposing factors which influence the transmission, prevalence, intensity of infection and morbidity of schistosomiasis in women. The review suggests that: (1) the higher prevalence rates observed in males, in most endemic areas, are not due to sex per se, but to the greater opportunities afforded to males for exposure; (2) cultural and social practices often determine occupational roles and, in some circumstances, these practices may protect women from exposure; (3) when women assume typical 'male' roles, their risk and prevalence of infection increases; (4) in Muslim societies, women's exposure to water is restricted and infection rates are usually lower; (5) morbidity does not appear to be influenced by sex; and (6) the most important impact of schistosomiasis on women is its possible disruption of maternal functions, such as pregnancy, and its role in maternal, infant and child mortality and fetal wastage. Suggestions are also made for expanding existing research and for new studies concerning factors which may influence infection and disease in women.