Schistosomiasis mansoni-alcoholism comorbidity: prevalence and risk factors among adults in Makenene, Cameroon
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Background
Alcohol consumption in Cameroon is approximately twice the African average, and Makenene is a hotspot of Schistosoma mansoni infection in the country. Considering that both schistosomiasis mansoni and alcoholism induced liver pathology and are public health concerns, this study aimed to investigate the prevalence and risk factors of S. mansoni and alcoholism comorbidity in Makenene, Cameroon.
Methodology/Principal findings
A cross-sectional survey was conducted in Makenene, including 431 adults from four neighborhoods. Schistosoma mansoni was diagnosed using Kato-Katz (KK) and point-of-care circulating cathodic antigen (POC-CCA) tests. The Alcohol Use Disorders Identification Test (AUDIT) was used to determine the alcohol dependence score (ADS). Sociodemographic, behavioral, and environmental factors were also recorded. The prevalence of S. mansoni was 19.6% (95% CI: 15.7–24.0) by KK and 66.1% (95% CI: 58.8–73.3) by POC-CCA, yielding an overall prevalence of 34.6% (95% CI: 30.2 – 39.0). Diagnostic concordance between KK and POC-CCA was moderate (κ = 0.458; p < 0.001). Alcohol misuse prevalence was 54.3% (95% CI: 49.4–58.7) and schistosomiasis–alcoholism comorbidity prevalence was 17.4% (95% CI: 13.9 – 21.1). Independent predictors of infection included being 18–39 years old (AOR = 2.01; p = 0.001), residing in the Baloua neighborhood (AOR = 2.64; p < 0.001), and regularly performing domestic chores at transmission sites (AOR = 1.83; p = 0.006). Risk factors for alcoholism were male sex (AOR = 2.48; p = 0.002), regular consumption of adulterated whisky (AOR = 26.84; p = 0.005) and beer (AOR = 5.81; p < 0.001) and motivational factors, including conformity (AOR = 4.80; p < 0.001), coping (AOR = 3.06; p = 0.005), and social motives (AOR = 2.33; p = 0.002).
Conclusion/significance
This study confirms S. mansoni endemicity in Makenene and reveals a high prevalence of alcohol misuse, highlighting the comorbidity. These findings call for integrated interventions targeting both schistosomiasis transmission and harmful alcohol use.
Author Summary
This study presents, for the first time, documented data on the comorbidity between Schistosoma mansoni infection and alcoholism in a rural area of Cameroon. Through parasitological, sociodemographic, and behavioral approaches, it revealed the prevalence of schistosomiasis and alcohol abuse comorbidity in Makenene. The risk factors for S. mansoni infection included younger age (18–39 years), residence in the nearest riverine community, and frequent performance of domestic chores at transmission sites. In parallel, alcohol misuse was strongly associated with male sex and with the regular consumption of adulterated whisky and beer, two widely available and low-cost beverages. The primary motivations for alcohol abuse were the pursuit of social acceptance, the facilitation of social interactions, and the alleviation of psychological distress. The co-occurrence of these two major health problems highlights the urgent need for integrated strategies that address alcohol abuse within schistosomiasis control programs. These findings provide a basis for developing targeted interventions to simultaneously reduce the burden of schistosomiasis and alcohol abuse in semi-rural and rural settings.
