Abstract
Despite growing evidence that infants and very young children can be infected with schistosomes, the epidemiological features and risk factors are not well described in this age group. We aimed to assess the prevalence of S. mansoni infection in children under two years of age from a population with a known high burden of infection in school-aged children and adults and thus inform the need for interventions in this potentially vulnerable age group. In a cross-sectional study in Mbita Sub-county, along the east coast of Lake Victoria, Western Kenya, we enrolled 361 children aged 6–23 months. The prevalence of S. mansoni infection was detected using the Kato-Katz stool examination and a point-of-care test for urinary circulating cathodic antigen (POC-CCA) (Rapid Medical Diagnostics, Pretoria, South Africa). Three-hundred and five (305) children had complete data of whom 276 (90.5%, 95%CI: 86.6–93.5) children were positive for S. mansoni by the POC-CCA test, while 11 (3.6%, 95%CI: 1.8–6.4) were positive by the Kato-Katz method. All Kato-Katz positive cases were also positive by the POC-CCA test. In multivariable analysis, only geographical area, Rusinga West (AOR = 7.1, 95%CI: 1.4–35.2, P = 0.02), was associated with S. mansoni infection using Kato-Katz test. Independent associations for POC-CCA positivity included age, (12–17 months vs 6–11 months; AOR = 7.8, 95%CI: 1.8–32.6, P = 0.002) and breastfeeding in the previous 24 hours (AOR = 3.4, 95%CI: 1.3–9.0, P = 0.009).We found a potentially very high prevalence of S. mansoni infection among children under two years of age based on POC-CCA test results in Mbita Sub-county, Kenya, which if confirmed strongly supports the need to include infants in public health strategies providing universal prophylactic treatment in high burden settings. Further research is required to determine the accuracy of diagnostic tools to detect light infection among very young children and possible long-term health impacts.
Highlights
Schistosomiasis is a human parasitic disease predominant in tropical and subtropical areas with limited access to safe water and adequate sanitation
We found extremely high prevalence of schistosomiasis (90.5%) when using a new, simple, rapid, point-of-care test which detects the presence of a schistosome glycoprotein (circulating cathodic antigen (CCA)) in urine samples, but a much lower prevalence (3.6%) when using the traditional method of stool microscopy for detecting the presence of schistosome eggs
Area of residence was associated with schistosomiasis determined by Kato-Katz, whereas age and breastfeeding in the past 24 hours were independently associated with schistosomiasis by the point-of-care CCA test
Summary
Schistosomiasis is a human parasitic disease predominant in tropical and subtropical areas with limited access to safe water and adequate sanitation. More than 200 million people, 111 million school-aged children (SAC) and 95 million adults, are estimated to be at risk of infection [1]. Schistosomiasis is classified as one of 20 neglected tropical diseases (NTDs) prioritized for a global response and targeted for elimination as a public health problem by 2025 [2]. Intestinal schistosomiasis is mainly caused by three species, Schistosoma mansoni, Schistosoma japonicum, and Schistosoma mekongi and primarily affects intestine and liver through acute and chronic inflammation against parasite eggs produced by adult worms [3,4,5]. Mass drug administration (MDA) with praziquantel for at-risk populations, targeting school-aged children, has been the prime strategy used to control and eliminate schistosomiasis [6,7]. Evidence is growing to support extension of MDA programmes to other age and population groups, including preschool-aged children [8,9,10]
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