High Schistosomiasis Prevalence in Urban and Rural Primary School Children from Kimpese Health District, Democratic Republic of the Congo

Background

Schistosomiasis is a parasitic disease caused by flatworms known as schistosomes. The infection cycle starts when people shed eggs through the stool or the urine. Larva infects freshwater snails to later infect humans through the skin during water based activities. Schistosomiasis is commonly associated with rural areas. In this study, we wanted to see if the schistosomiasis distribution is different in rural and urban areas, along with potential risk factors associated with schistosomiasis distribution.

Methodology

Fresh urine samples were collected from 1,699 school-aged children (5 – 15 years old) in urban and rural sites in the Kimpese health district. Prevalence of haematobium and mansoni schistosomiasis was determined using, respectively, the urine sedimentation and the Point-of-Care Circulating Cathodic Antigen test with a quantitative estimate of infection intensity obtained with an RDT-Reader. Collected risk factors were tested for association with schistosomiasis infection and its intensity.

Results

The overall prevalence of schistosomiasis found in urban and rural areas was 75% and 82% respectively, with higher prevalence of S. mansoni in rural schools, and higher S. haematobium prevalence in urban schools. The difference in total prevalence between schools in urban and rural areas was significant, X ² (1, N = 1699) = 13.03, p = .0003. S. mansoni intensity of infection was also higher in rural children (mean = 162 mV) compared to those in urban areas (mean = 76 mV) (p < 2e-16).

Male gender, washing dishes in the river, and swimming were associated with schistosomiasis in urban areas. Age, Springs, and rivers were significant factors in rural sites. Age, river, and washing dishes in the river were factors associated with the intensity of infection.

Conclusion

Our results showed very high prevalence in both rural and urban areas, which implies that control programs should consider them with the same interest and also revise control strategies.

Author Summary

Schistosomiasis is a common but often overlooked parasitic disease that affects millions of people around the world. More than 290 million people are at risk of becoming infected. The disease is mainly spread when people come into contact with freshwater sources, such as rivers and streams, that contain infected snails carrying the parasite.

In this study, we tested 1,699 schoolchildren aged 5 to 15 years living in both urban and rural communities of the Kimpese district in Kongo Central Province, Democratic Republic of the Congo. Using a rapid diagnostic test (POC-CCA), we found that schistosomiasis was very common in both settings, affecting about 75% of children in urban areas and 82% in rural areas.

Intestinal schistosomiasis was more common in rural communities, while urinary schistosomiasis was found more frequently in urban communities. Factors such as being male, age, and activities involving river water, especially swimming and washing dishes, were linked to a higher risk of infection.

These findings show that schistosomiasis is not only a rural health problem. Even in urban areas where access to safer water may be better, people remain at risk if they continue to have regular contact with rivers and other freshwater sources that contain the parasite.