Contextualizing Schistosoma haematobium transmission in Ghana: Assessment of diagnostic techniques and individual and community water-related risk factors

Objectives: The study assessed associations between Schistosoma haematobium infection (presence of parasite eggs in urine or hematuria) and self-reported metrics (macrohematuria, fetching surface water, or swimming) to evaluate their performance as proxies of infection in presence of regular preventive chemotherapy. It also examined community water characteristics (safe water access, surface water access, and groundwater quality) to provide context for schistosomiasis transmission in different types of communities and propose interventions.

Methods: Logistic regression was used to assess the associations between the various measured and self-reported metrics in a sample of 897 primary school children in 30 rural Ghanaian communities. Logistic regression was also used to assess associations between community water characteristics, self-reported water-related behaviors and S. haematobium infection. Communities were subsequently categorized as candidates for three types of interventions: provision of additional safe water sources, provision of groundwater treatment, and health education about water-related disease risk, depending on their water profile.

Results: Microhematuria presence measured with a reagent strip was a good proxy of eggs in urine at individual (Kendall's τ_b = 0.88, p < 0.001) and at school-aggregated (Spearman's r_s = 0.96, p < 0.001) levels. Self-reported macrohematuria and swimming were significantly associated (p < 0.05) with egg presence, but self-reported fetching was not. Of the community water characteristics, greater surface water access and presence of groundwater quality problems were significantly associated with increased likelihood of fetching, swimming, and S. haematobium infection. Access to improved water sources did not exhibit an association with any of these outcomes.

Conclusions: The study illustrates that in presence of regular school-based treatment with praziquantel, microhematuria assessed via reagent strips remains an adequate proxy for S. haematobium infection in primary schoolchildren. Community water profiles, in combination with self-reported water-related behaviors, can help elucidate reasons for some endemic communities continuing to experience ongoing transmission and tailor interventions to these local contexts to achieve sustainable control.