Prevalence and associated factors of schistosomiasis among children and adolescents visiting Chitokoloki Mission Hospital of Zambezi District

TL;DR

This study finds a high prevalence of urogenital schistosomiasis among children and adolescents in Zambia and identifies key factors like lack of deworming and lower hemoglobin levels.

Contribution

The study provides new data on schistosomiasis prevalence and risk factors in a specific Zambian region, emphasizing the role of deworming and anemia in infection.

Findings

25.8% of children and adolescents had schistosomiasis, with haematuria strongly associated with infection.

Only 3.6% of dewormed children were infected, compared to 49.2% of non-dewormed children.

Lower hemoglobin levels were independently linked to a higher risk of schistosomiasis.

Abstract

Urogenital schistosomiasis remains a major public health challenge among children and adolescents in sub-Saharan Africa. Data on prevalence and associated factors in Zambia are scarce. This study assessed the burden of Schistosoma haematobium infection and its correlates among 271 children and adolescents attending the outpatient department of Chitokoloki Mission Hospital, Northwestern Province.

We conducted a retrospective cross-sectional study of clinical records from January to March 2025. Systematic random sampling of files for participants aged 5–18 years captured sociodemographic data, water-contact behaviours, haematuria, haematological indices (haemoglobin, MCV, MCHC), deworming history, and prior schistosomiasis. Urine microscopy for S. haematobium eggs defined infection status. Categorical variables were compared by chi-squared test and medians by Wilcoxon rank-sum. Multivariable logistic regression identified independent predictors of infection (p < 0.05).

The median age was 13 years (IQR: 12–15); 58.3% were male. Overall prevalence of schistosomiasis was 25.8% (n = 70). Haematuria was present in 80.2% of infected versus 0.5% of uninfected participants (p < 0.0001). Infected children had lower median haemoglobin (11.3 g/dL vs. 11.9 g/dL; p = 0.0067) and MCHC (30.9 g/dL vs. 32.1 g/dL; p = 0.0022). Only 3.6% of previously dewormed children were infected compared with 49.2% of non-dewormed peers (p < 0.0001). In adjusted odds ratio (aOR) analyses, absence of deworming (aOR 37.8; 95% CI 5.78–247.4), absence of haematuria (aOR 0.0014; 95% CI 0.0001–0.011), and lower haemoglobin (aOR 0.69 per g/dL; 95% CI 0.48–0.99) remained independently associated with infection.

There is a significant burden of urogenital schistosomiasis among school-aged children and adolescents attending Chitokoloki Mission Hospital in Zambezi District, Zambia. Targeted praziquantel distribution, cost-effective school-based urine screening in high endemic areas, awareness campaigns to sensitize the community on transmission and reinfections and the integration of nutritional and anaemia management strategies are critical components for effective disease control. Strengthening these interventions is essential to advance progress toward achieving the World Health Organization’s 2030 schistosomiasis elimination targets in Zambia.

Not applicable (N/A).

Figures