Prevalence and determinants of urinary schistosomiasis among school-aged children: a comparative risk analysis of demographic, environmental and water-use factors, in Anambra State

Abstract

BACKGROUND: Urinary schistosomiasis is a neglected tropical disease that remains endemic in much of sub-Saharan Africa, with Nigeria bearing a considerable burden. Despite ongoing mass drug administration, infection continues to affect school-aged children in endemic communities. This study assessed the prevalence of urinary schistosomiasis among school-aged children in parts of Anambra State, Nigeria, and examined demographic, environmental, and water-use behaviours associated with infection. METHODS: A cross-sectional study was conducted between August and November 2025 in rural, semi-urban, and urban communities selected for freshwater use in domestic, agricultural, and recreational activities. Urine samples from 388 children aged 5-14 years were analysed using dipstick and filtration methods, and structured questionnaires were used to assess knowledge, attitudes, and practices. RESULTS: The overall prevalence was 13.1%, with higher rates in rural communities. The infections were mostly light to moderate, with a few heavy cases, and haematuria was uncommon. Knowledge of schistosomiasis was generally poor; however, participants reported relatively positive attitudes and acceptable hygienic practices. Multivariate analysis identified haematuria and mean attitude score as associated factor of infection, with higher attitude scores associated with lower odds of infection. However, this result should be interpreted with caution due to the low internal consistency of the attitude scale. The higher burden in rural communities highlights existing health inequities and the need for geographically targeted, equity-focused control strategies. This underscores the importance of multisectoral collaboration for sustainable control of schistosomiasis, in line with global neglected tropical disease elimination targets and the Sustainable Development Goals. CONCLUSION: The findings highlight persistent transmission driven by behavioural and environmental factors and support the need for combined control strategies that integrate behavioural interventions, improved diagnostics, and environmental management.