Kato-Katz versus Urine Circulating Cathodic Antigen for the Diagnosis of Schistosoma mansoni in Preschool- aged children in Homabay County- Kenya

Abstract The diagnosis of schistosomiasis in preschool-aged children (PSAC) is challenging. Point-of-care circulating cathodic antigen (POC-CCA) assays offer potential improvements in diagnostic access in hard-to-reach areas over the conventional Kato-Katz (KK) test. This study compared the diagnostic accuracy of KK versus POC-CCA in urine and stool samples from PSAC in a S. mansoni endemic hard-to-reach area in Kenya. Using combined positive results of both KK and POC-CCA tests as the ‘gold standard’, the overall sensitivity of KK (57.6%, 95%CI: 49.1-65.8) was significantly lower than that of POC-CCA (73.2%, 95%CI: 65.0-80.4); ꭕ2m = 5.88, p = 0.015. There was moderate agreement between KK and the combined results (k = 0.599, p < 0.001, concordance 80.9%) and a substantial agreement between POC-CCA and the combined results (k = 0.753, p < 0.001, concordance 88.1%). POC-CCA is a more sensitive diagnostic tool for schistosomiasis surveillance in PSAC compared to KK, particularly in hard-to-reach endemic areas and PSAC.