Intestinal Schistosomiasis in remote areas of Southwest Ethiopia, a target region for large-scale Mass Drug Administration

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From February to April of 2023, 328 students from three primary schools in Southwest Ethiopia participated in an institution-based cross-sectional study in the detection of Schistosoma mansoni . Intestinal schistosomiasis was identified among 242 school children, with a rate of infection of 73.8% (95% CI: (64.8–83.4%)). The rate of infection was higher among study participants aged between 10–13 years [AOR = 1.93, 95% CI: (1.1, 3.44). About 75% of the male participants were infected with Schistosoma mansoni [AOR = 0.83, 95% CI (0.49, 1.41). Nearly half (48.1%) of the S. mansoni infections among study participants were identified as heavy infections. More than half of the male study participants (50.3%) infected with Schistosoma mansoni had heavy infection intensity. Of the total female schoolchildren infected with Schistosoma mansoni , about 44.4% had a heavy infection. The prevalence and intensity of infection of Schistosoma mansoni in the study area are significantly noticeable, raising doubts on either the implementation or effectiveness of the interventional programs in remote areas of southwest Ethiopia. Strategies to end the disease as a public health threat, mainly in remote and endemic areas, should consider novel integrated strategies targeting the life cycle of schistosomes besides the large-scale mass drug administration. Schistosoma mansoni Prevalence Intensity Southwest Ethiopia Schoolchildren Introduction Schistosomiasis is one of the prevalent neglected tropical diseases infecting millions of people globally, with an estimated 140 million individuals infected with a common schistosome species 1 . Sub-saharan Africa is the region with the highest rate of infections with common schistosome species, S. mansoni and S. haematobium , causing intestinal schistosomiasis and urogenital schistosomiasis, respectively 2 . The control approach to schistosomiasis is repeated preventative chemotherapy, which treats a segment of the population usually children, without first requiring a parasitological examination 3 , 4 . Besides preventive chemotherapy, an integrated control mechanism, which targets the life cycle should be done in parallel to mitigate the impact of schistosomiasis 3 . The World Health Organization (WHO) set a program for the year 2021–2030, targeting the elimination of human schistosomiasis as a community problem by 2030 and the interruption of its transmission in endemic areas 5 . However, the absence of precise data regarding the identification of transmission foci (lack of clear geographical boundaries), delays in drug delivery, occurrence of disease outbreaks, and negative perceptions towards the drug in line seen in many developed countries are the existing challenges in prevention of schistosomiasis in endemic areas 6 – 8 . Furthermore, the COVID-19 pandemic in 2021 and efforts to lessen its impacts negatively affected the provision of neglected tropical disease interventions and the treatment coverage for schistosomiasis 5 . Ethiopia is among the Sub-Saharan African nations where schistosomiasis among schoolchildren has been common in the past ten years, with a prevalence rate as high as 89.9% 9,10 . Nonetheless, data from recent research in some parts of the country indicate that Ethiopia is seeing a decline in the prevalence of Schistosomiasis 11 – 13 . This may result from the interventions taken through the MDA program 14 . However, the palliating magnitude of intestinal schistosomiasis in some districts of the country creates a misleading sense of the decreasing burden of schistosomiasis in endemic areas too. Nevertheless, schistosomiasis continues to impact a sizable portion of the children living in endemic regions in Ethiopia 15 . The COVID-19 pandemic 5 , usage of open water bodies for bathing 16 , irrigation programs 17 , insufficient coverage of curative treatment 18 , and socioeconomic status 19 , are the potential causes of extending the torment of the populations in Ethiopia and in turn contributing to delay the WHO strategy to eliminate schistosomiasis as a community problem in endemic areas. Evidence showed that Ethiopia has been implementing a large-scale nationwide MDA program against schistosomiasis since 2015, targeting 17 million schoolchildren 20 . However, the magnitude of S. mansoni infection among schoolchildren in remote areas of the country has not been well elaborated since the implementation of a large-scale MDA program. Additionally, the surveillance program to monitor the effectiveness of the ongoing large-scale nationwide MDA program is not applicable in remote areas. Although some studies were conducted regarding intestinal schistosomiasis among school children 21 , 22 , those studies didn’t consider the resource-limited areas and their focus on large-scale MDA programs is negligible. Hence, there was a clear importance to conducting this study as it overcame the limitations of the previous studies. Therefore, this study was aimed at assessing the burden of S. mansoni among schoolchildren in Southwest Ethiopia, one of the target regions for the large-scale MDA program, to contribute to the progress evaluation of large scale MDA program and supplement the WHO strategy to eliminate schistosomiasis as a public health problem in all endemic areas. Material and methods Study setting Children from three primary schools, Biftu Ayyana, Shimal Tokke, and Urji Oromiya primary schools in remote areas of Southwest Ethiopia; have participated in the study, which was carried out between February and April of 2023. The region has 1450 meters elevation above sea level, with a long dry season from November to April and a rainy season from May to September. It is characterized by a warm climate with mean temperatures between 1138 and 1690 mm. The mean yearly rainfall is ranging between 1138 and 1690 mm. The study area has water sources that the residents frequently use for daily life, which could be a potential risk factor for infection with S. mansoni . Study design and sample size A multi-centered cross-sectional study was carried out to assess the burden of S. mansoni among school children from selected primary schools in the Oromia region; Biftu Ayyana, Shimal Tokke, and Urji Oromiya. The minimum representing sample size was calculated by a single population proportion formula. Considering the 28.7% prevalence of S. mansoni infection from the previous study 11 , a 95% confidence level, and a 5% margin of error the minimum sample size was computed to be 313. With a 5% non-response rate, 328 children made up the final sample. Sampling technique Out of 8 primary schools present in the study area, three schools were randomly selected. The class registrations of all schools having children’s lists from grades 1 through 6, aged from six to seventeen years were used as sampling frames. The minimum sample size was proportionally allocated to each three primary schools. Accordingly, 149 students from Biftu Ayyana Primary School, 76 students from Shimal Tokke Primary School, and 103 students from Urji Oromiya Primary School were randomly selected. The background of the study was explained to the children and the school directors. Field and laboratory procedures The study participants were given a clean plastic sheet with a wooden applicator stick and requested to provide the stool sample. Two Kato-Katz slides were prepared for each child using a 41.7 mg template and sent to Mattu University's Medical Parasitology Laboratory. The Kato-Katz smear technique was used for the qualitative analysis and the quantification of S. mansoni eggs. The mean number of eggs counted in both Kato-Katz slides was multiplied by 24 to get the intensity of S. mansoni infection. A stool specimen from each subject was deemed positive for S. mansoni infection when an S. mansoni egg was found during a microscopic examination. Conversely, the specimen is considered negative for S. mansoni infection when the microscopic examination didn’t reveal any eggs of S. mansoni . The intensity of infection was determined using WHO criteria 23 . Results Socio-demographic characteristics of study participants A total of 328 schoolchildren (62.2% males and 37.8% females) with ages ranging from 6 up to 17 years have participated in the study. Among these, 45.4% were from Biftu Ayana Primary School, 23.2% were from Shimal Toke Primary School, and 31.4% were from Urji Oromiya Primary School. Most of the study participants, (44.7%), were aged 10–13 years; followed by 14–17 years old (40.5%) and 6–9 years old (16.2%) (Table 1 ). Prevalence of intestinal schistosomiasis Intestinal schistosomiasis was detected among 242 study participants, with a 73.8% rate of infection (95% CI: (64.8–83.4%)). The infection rate was high among study participants aged between 10–13 years [AOR = 1.93, 95% CI: (1.1, 3.44). About 75% of the male participants were found positive for intestinal schistosomiasis [AOR = 0.83, 95% CI (0.49, 1.41). The prevalence is higher among schoolchildren at Biftu Ayana Primary School [AOR = 0.34, 95% CI: (0.17, 0.68)] than the other two primary schools (Table 1 ). Table 1 Prevalence of S.mansoni in age, sex, and school among study participants in remote areas of Southwest Ethiopia (N = 328) Variables Category N S. mansoni infection COR, 95%(CI) AOR, 95%(CI) Positive Prevalence %,(95%CI) Age 6–9 53 37 69.8(45.6–94.0) 1.09(0.54–2.20) 0.81(0.38–1.73) 10–13 142 112 78.8(65.6–91.9) 1.61(0.93–2.77) 1.93(1.1–3.44) 14–17 133 93 69.9(54.6–85.2) 1 1 Gender Male 204 152 75.0(63.3–86.6) 0.88(0.53–1.46) 0.83(0.49–1.41)* Female 124 90 73.4(58.2–88.6) 1 1 Schools Biftu Ayyana 149 107 71.8(57.6–85.9) 0.43(0.23–0.83) 0.34(0.17–0.68)* Shimal Tokke 76 47 61.8(40.4–83.2) 0.29(0.14–0.6) 0.24(0.11–0.51 Urji Oromia 103 88 85.4(72.0-98.7) 1 1 Keys : N, number of study participants; 1, reference category; *, p-value < 0.05; Numbers in bold font represent significant association with S. mansoni infections Abbreviations: CI, Confidence Interval; COR, Crude Odds Ratio; AOR, Adjusted Odds Ratio Intensity of infection of S. mansoni Nearly half (48.1%) of the S. mansoni infections among study participants were identified as heavy infections. Over half of the male study participants (50.3%) infected with S.mansoni had heavy infection intensity. Of the total female schoolchildren infected with S.mansoni , about 44.4% were with a heavy infection. The majority of heavy infections were detected among study participants of Urji Oromia Primary School (52.27%) (Table 2). Table 2 : Infection intensity of S.mansoni among schoolchildren from three primary schools in remote areas of Southwest Ethiopia (N=242) Variables Category Intensity of infection Light n (%) Moderate n (%) Heavy n (%) AM Age 6-9 6 (16.2) 12 (32.4) 19 (51.4) 818.4 10-13 16 (14.3) 43 (38.4) 53 (47.3) 665.6 14-17 15 (16.1) 34 (36.6) 44 (47.3) 682.6 Gender Male 22 (13.5) 54 (35.5) 76 (50) 708.4 Female 14 (15.6) 36 (40) 40 (44.4) 666.7 Schools Biftu Ayyana 17 (15.9) 39 (36.4) 51 (47.7) 590.6 Shimal Tokke 9 (19.2) 19 (40.4) 19 (40.4) 574.5 Urji Oromia 10 (11.4) 32 (36.4) 46 (52.2) 891.2 Overall 36 (14.9) 90 (37.2) 116 (47.9) 694.09 Keys: n, number; N, total number of positive cases Abbreviations: AM, Arithmetic Mean Discussion The timely update on intestinal schistosomiasis in a region where a long-term MDA program targets is substantial in the evaluation of the implementation, coverage, and/or progress of the interventional programs. Hence, this study paid attention to the burden of intestinal schistosomiasis among schoolchildren in remote areas of southwest Ethiopia where a long-term MDA program was supposed to be implemented. The present study revealed the magnitude of S. mansoni among schoolchildren is 73.8%. This finding is consistent with the study conducted in Brazil 24 . However, the magnitude revealed by our study was lower when compared to other studies in Ethiopia; Amhara region (82.8%) 25 , Oromia region, (89.6%) 26 , Northwest Ethiopia (89.9%) 10 . The variations in the study period, coverage of the interventional programs, and the status of intermediate hosts in the area might be the cause of the inconsistency. In contrast, the magnitude of intestinal schistosomiasis from our study was higher as compared with other studies conducted in the country (31.6%-59.9%) 10,24-29 . Similarly, a lower prevalence was reported in other Sub-Saharan countries, 12.2% in Kenya 30 ,15.1% in Tanzania 31 , and 21.2% in Angola 32 . The higher prevalence from this study could be because of the endemicity of the disease in the district, the geographical remoteness of the district which may affect the smooth and regular implementation of the interventions, the presence of aquatic environments in the area that serve as the reservoir of snails, and awareness towards intestinal schistosomiasis among schoolchildren. Additionally, though the long-term nationwide MDA program taking place in the country is targeting the susceptible segment of the population, other community members who are not the target population for the preventive chemotherapy and are infected with S. mansoni could play a role in the life cycle of schistosome and contributes to high prevalence. Additionally, socioeconomic status and other associated factors in line seen in other regions 17-19 , can also be a reason for the high prevalence and intensity of infection registered in the study area. On the other hand, our study revealed that male study participants had higher odds of infection with S. mansoni than females, which is similar to other studies 33,34 . Male students were more commonly known to participate in outdoor activities, increasing the possibility of higher water contact as they are more active and often engage in various agricultural works in developing countries, which is likely linked to the higher frequency and higher intensity of infection. Additionally, the majority of infections were detected among schoolchildren aged 10-13, which is consistent with the studies in northern Ethiopia 29,35 , southwest Ethiopia 36 , and Tanzania 31 . This might be because of a lack of awareness regarding intestinal schistosomiasis as compared to higher age groups and frequent contact with aquatic environments as compared to lower age group children. The odds of infection with intestinal schistosomiasis are higher among Biftu Ayana Primary Schools than the rest two primary schools. The possible reason behind this can be the proximity of Biftu Ayana Primary Schools to the aquatic environment harboring intermediate hosts. This study also revealed nearly half of the schoolchildren found positive for intestinal schistosomiasis were with a heavy infection intensity. However, this finding has a variation as compared to other studies conducted in southwest Ethiopia 37 , Kenya 30 , Tanzania 38 , and Madagascar 39 where light intensity of infection has been detected. The disparity in infection intensity between various studies could be because of the distance of water bodies from residential areas, which determines the frequency of contact with aquatic environments, variation in water-contact behavior, awareness of the schoolchildren, and level of effectiveness and applicability of the deworming program in the district. Limitations of the study The study couldn’t identify the possible risk factors behind the high prevalence of intestinal schistosomiasis in the study area because of the nature of the study design. Conclusion and recommendation It has been elucidated by this study that about three-quarters of schoolchildren were positive for intestinal schistosomiasis and a significant infection intensity was documented in the preventive chemotherapy era, which counteracts the WHO strategy to eliminate the parasite in 2030. The palliating prevalence of Schistosoma mansoni in some districts of the country also created a false sense of the reduced burden of intestinal schistosomiasis in endemic areas. The high prevalence of Intestinal schistosomiasis in the study area raises doubts on either the implementation or effectiveness of the interventional programs in remote areas of southwest Ethiopia. Therefore, it indicates the need for further consideration of the novel preventive interventions targeting the life cycle of schistosomes accompanied by environmental sanitation and intermediate host management to be extended to remote areas in addition to the preventive chemotherapy. Moreover, any interventional program should better consider all age groups of the community for complete curative and preventive management of intestinal schistosomiasis. Declarations Data Availability The datasets used and analyzed in the study are available from the corresponding author upon reasonable request. Acknowledgments It is with great pleasure that we thank Mattu University’s Office of the Research Affairs Directorate for their technical support of this project. Data collectors and study participants also owed a debt of gratitude for their participation in the study. School directors and teachers should be thanked delightedly for their priceless collaboration. Authors’ contribution All authors made an immense contribution to the study. Conceptualization, Y.N., T.B., and S.T.; Data curation, T.D., A.M., and A.G.; Formal analysis, T.D., A.M., A.G., and W.G.; Funding acquisition, O.G.; Investigation, O.G.; Methodology, B.E., T.S.; Re-sources, G.T; Supervision, D.O., and M.B.; Writing – original draft, Y.N., and T.B.; Writing – re-view & editing, Y.N., T.B., E.C., and D.G. Competing Interest The authors declare no competing interests in this work. Ethics declaration Mattu University’s College of Health Sciences Institutional Review Board granted the study approval and ethical clearance with a Ref. No: CHS/157/23. The study protocol was conducted according to the Declaration of Helsinki. Study participants and school teachers were provided with overviews of the study. Then, for children below 16 years old, informed consent was taken from their legal guardian before assent was taken directly from the child. On the other hand informed consent was taken directly from children above 16 years regarding sociodemographic and clinical data collection. The positive cases are then linked to the nearest health facilities for appropriate drug administration and better treatment. References James, S. L. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. 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Cite Share Download PDF Status: Published Journal Publication published 16 Jan, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 24 Oct, 2024 Reviews received at journal 24 Oct, 2024 Reviews received at journal 09 Oct, 2024 Reviewers agreed at journal 01 Oct, 2024 Reviewers agreed at journal 11 Sep, 2024 Reviews received at journal 08 Aug, 2024 Reviewers agreed at journal 01 Aug, 2024 Reviewers agreed at journal 31 Jul, 2024 Reviewers agreed at journal 30 Jul, 2024 Reviewers invited by journal 30 Jul, 2024 Editor assigned by journal 30 Jul, 2024 Editor invited by journal 25 Jul, 2024 Submission checks completed at journal 25 Jul, 2024 First submitted to journal 20 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4772815","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":342890881,"identity":"7fea712a-524c-470b-8ed3-c5208ccc8232","order_by":0,"name":"Yared 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Chilo","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Eshetu","middleName":"","lastName":"Chilo","suffix":""},{"id":342890884,"identity":"5b848ca3-399c-459a-8239-45e2f98f917e","order_by":3,"name":"Sisay Teferi","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Sisay","middleName":"","lastName":"Teferi","suffix":""},{"id":342890885,"identity":"546cae07-1b12-42a4-b766-7ec840d47e70","order_by":4,"name":"Dereje Oljira","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Dereje","middleName":"","lastName":"Oljira","suffix":""},{"id":342890886,"identity":"4a1c3898-dfdf-435a-8c6b-ae5016eb7323","order_by":5,"name":"Dereje Gemeda","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Dereje","middleName":"","lastName":"Gemeda","suffix":""},{"id":342890887,"identity":"282744e0-7e87-4085-a2f1-935859b65734","order_by":6,"name":"Tefera Darge","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Tefera","middleName":"","lastName":"Darge","suffix":""},{"id":342890888,"identity":"2aae3193-b801-4598-ae05-1fe57298d6b1","order_by":7,"name":"Abeza Mitiku","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Abeza","middleName":"","lastName":"Mitiku","suffix":""},{"id":342890889,"identity":"c50520df-ca0b-4f97-b9e5-678b605aa565","order_by":8,"name":"Abdi Geda","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Abdi","middleName":"","lastName":"Geda","suffix":""},{"id":342890890,"identity":"dc70ca8c-5480-40f5-b54c-55e4496a2bc7","order_by":9,"name":"Tadesse Sime","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Tadesse","middleName":"","lastName":"Sime","suffix":""},{"id":342890892,"identity":"d7170eeb-fde3-4cc7-be0b-38a8075200e6","order_by":10,"name":"Wubishet Gezimu","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Wubishet","middleName":"","lastName":"Gezimu","suffix":""},{"id":342890894,"identity":"9a3aa8ff-f50d-430a-859f-3dffa0def868","order_by":11,"name":"Oda Gizaw","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Oda","middleName":"","lastName":"Gizaw","suffix":""},{"id":342890895,"identity":"8040eef4-b77f-4e74-816c-b4dc53c2738c","order_by":12,"name":"Gemechu Tadila","email":"","orcid":"","institution":"Mattu University","correspondingAuthor":false,"prefix":"","firstName":"Gemechu","middleName":"","lastName":"Tadila","suffix":""},{"id":342890900,"identity":"6735620e-71a6-46ec-bd94-e41d9672dbbc","order_by":13,"name":"Miressa Bekana","email":"","orcid":"","institution":"Aklilu Lemma Institute of Pathobiology, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Miressa","middleName":"","lastName":"Bekana","suffix":""},{"id":342890901,"identity":"83b1d6fb-f1dc-42e6-8f55-eadd6569fbbd","order_by":14,"name":"Berhanu Erko","email":"","orcid":"","institution":"Aklilu Lemma Institute of Pathobiology, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Berhanu","middleName":"","lastName":"Erko","suffix":""}],"badges":[],"createdAt":"2024-07-20 11:09:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4772815/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4772815/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-84987-9","type":"published","date":"2025-01-16T15:57:46+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":74285732,"identity":"a5a2113a-bcb6-4436-bbbf-aa17034a6ad9","added_by":"auto","created_at":"2025-01-20 16:14:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":846013,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4772815/v1/e3001156-9f3f-4a5e-b1dd-2002776ca4c2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intestinal Schistosomiasis in remote areas of Southwest Ethiopia, a target region for large-scale Mass Drug Administration","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchistosomiasis is one of the prevalent neglected tropical diseases infecting millions of people globally, with an estimated 140\u0026nbsp;million individuals infected with a common schistosome species \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Sub-saharan Africa is the region with the highest rate of infections with common schistosome species, \u003cem\u003eS. mansoni\u003c/em\u003e and \u003cem\u003eS. haematobium\u003c/em\u003e, causing intestinal schistosomiasis and urogenital schistosomiasis, respectively \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe control approach to schistosomiasis is repeated preventative chemotherapy, which treats a segment of the population usually children, without first requiring a parasitological examination \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Besides preventive chemotherapy, an integrated control mechanism, which targets the life cycle should be done in parallel to mitigate the impact of schistosomiasis \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) set a program for the year 2021\u0026ndash;2030, targeting the elimination of human schistosomiasis as a community problem by 2030 and the interruption of its transmission in endemic areas \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, the absence of precise data regarding the identification of transmission foci (lack of clear geographical boundaries), delays in drug delivery, occurrence of disease outbreaks, and negative perceptions towards the drug in line seen in many developed countries are the existing challenges in prevention of schistosomiasis in endemic areas \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Furthermore, the COVID-19 pandemic in 2021 and efforts to lessen its impacts negatively affected the provision of neglected tropical disease interventions and the treatment coverage for schistosomiasis \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEthiopia is among the Sub-Saharan African nations where schistosomiasis among schoolchildren has been common in the past ten years, with a prevalence rate as high as 89.9% \u003csup\u003e9,10\u003c/sup\u003e. Nonetheless, data from recent research in some parts of the country indicate that Ethiopia is seeing a decline in the prevalence of Schistosomiasis \u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. This may result from the interventions taken through the MDA program\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. However, the palliating magnitude of intestinal schistosomiasis in some districts of the country creates a misleading sense of the decreasing burden of schistosomiasis in endemic areas too. Nevertheless, schistosomiasis continues to impact a sizable portion of the children living in endemic regions in Ethiopia \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The COVID-19 pandemic \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, usage of open water bodies for bathing \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, irrigation programs \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, insufficient coverage of curative treatment \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and socioeconomic status \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, are the potential causes of extending the torment of the populations in Ethiopia and in turn contributing to delay the WHO strategy to eliminate schistosomiasis as a community problem in endemic areas.\u003c/p\u003e \u003cp\u003eEvidence showed that Ethiopia has been implementing a large-scale nationwide MDA program against schistosomiasis since 2015, targeting 17\u0026nbsp;million schoolchildren \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, the magnitude of \u003cem\u003eS. mansoni\u003c/em\u003e infection among schoolchildren in remote areas of the country has not been well elaborated since the implementation of a large-scale MDA program. Additionally, the surveillance program to monitor the effectiveness of the ongoing large-scale nationwide MDA program is not applicable in remote areas. Although some studies were conducted regarding intestinal schistosomiasis among school children \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, those studies didn\u0026rsquo;t consider the resource-limited areas and their focus on large-scale MDA programs is negligible. Hence, there was a clear importance to conducting this study as it overcame the limitations of the previous studies. Therefore, this study was aimed at assessing the burden of \u003cem\u003eS. mansoni\u003c/em\u003e among schoolchildren in Southwest Ethiopia, one of the target regions for the large-scale MDA program, to contribute to the progress evaluation of large scale MDA program and supplement the WHO strategy to eliminate schistosomiasis as a public health problem in all endemic areas.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy setting\u003c/h2\u003e \u003cp\u003e Children from three primary schools, Biftu Ayyana, Shimal Tokke, and Urji Oromiya primary schools in remote areas of Southwest Ethiopia; have participated in the study, which was carried out between February and April of 2023. The region has 1450 meters elevation above sea level, with a long dry season from November to April and a rainy season from May to September. It is characterized by a warm climate with mean temperatures between 1138 and 1690 mm. The mean yearly rainfall is ranging between 1138 and 1690 mm. The study area has water sources that the residents frequently use for daily life, which could be a potential risk factor for infection with \u003cem\u003eS. mansoni\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and sample size\u003c/h2\u003e \u003cp\u003eA multi-centered cross-sectional study was carried out to assess the burden of \u003cem\u003eS. mansoni\u003c/em\u003e among school children from selected primary schools in the Oromia region; Biftu Ayyana, Shimal Tokke, and Urji Oromiya. The minimum representing sample size was calculated by a single population proportion formula. Considering the 28.7% prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection from the previous study \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, a 95% confidence level, and a 5% margin of error the minimum sample size was computed to be 313. With a 5% non-response rate, 328 children made up the final sample.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eOut of 8 primary schools present in the study area, three schools were randomly selected. The class registrations of all schools having children\u0026rsquo;s lists from grades 1 through 6, aged from six to seventeen years were used as sampling frames. The minimum sample size was proportionally allocated to each three primary schools. Accordingly, 149 students from Biftu Ayyana Primary School, 76 students from Shimal Tokke Primary School, and 103 students from Urji Oromiya Primary School were randomly selected. The background of the study was explained to the children and the school directors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eField and laboratory procedures\u003c/h2\u003e \u003cp\u003eThe study participants were given a clean plastic sheet with a wooden applicator stick and requested to provide the stool sample. Two Kato-Katz slides were prepared for each child using a 41.7 mg template and sent to Mattu University's Medical Parasitology Laboratory. The Kato-Katz smear technique was used for the qualitative analysis and the quantification of \u003cem\u003eS. mansoni\u003c/em\u003e eggs. The mean number of eggs counted in both Kato-Katz slides was multiplied by 24 to get the intensity of \u003cem\u003eS. mansoni\u003c/em\u003e infection. A stool specimen from each subject was deemed positive for \u003cem\u003eS. mansoni\u003c/em\u003e infection when an \u003cem\u003eS. mansoni\u003c/em\u003e egg was found during a microscopic examination. Conversely, the specimen is considered negative for \u003cem\u003eS. mansoni\u003c/em\u003e infection when the microscopic examination didn\u0026rsquo;t reveal any eggs of \u003cem\u003eS. mansoni\u003c/em\u003e. The intensity of infection was determined using WHO criteria \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics of study participants\u003c/h2\u003e \u003cp\u003eA total of 328 schoolchildren (62.2% males and 37.8% females) with ages ranging from 6 up to 17 years have participated in the study. Among these, 45.4% were from Biftu Ayana Primary School, 23.2% were from Shimal Toke Primary School, and 31.4% were from Urji Oromiya Primary School. Most of the study participants, (44.7%), were aged 10\u0026ndash;13 years; followed by 14\u0026ndash;17 years old (40.5%) and 6\u0026ndash;9 years old (16.2%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of intestinal schistosomiasis\u003c/h2\u003e \u003cp\u003eIntestinal schistosomiasis was detected among 242 study participants, with a 73.8% rate of infection (95% CI: (64.8\u0026ndash;83.4%)). The infection rate was high among study participants aged between 10\u0026ndash;13 years [AOR\u0026thinsp;=\u0026thinsp;1.93, 95% CI: (1.1, 3.44). About 75% of the male participants were found positive for intestinal schistosomiasis [AOR\u0026thinsp;=\u0026thinsp;0.83, 95% CI (0.49, 1.41). The prevalence is higher among schoolchildren at Biftu Ayana Primary School [AOR\u0026thinsp;=\u0026thinsp;0.34, 95% CI: (0.17, 0.68)] than the other two primary schools (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of \u003cem\u003eS.mansoni\u003c/em\u003e in age, sex, and school among study participants in remote areas of Southwest Ethiopia (N\u0026thinsp;=\u0026thinsp;328)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003eS. mansoni infection\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR, 95%(CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR, 95%(CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003cp\u003e%,(95%CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.8(45.6\u0026ndash;94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.09(0.54\u0026ndash;2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.81(0.38\u0026ndash;1.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.8(65.6\u0026ndash;91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.61(0.93\u0026ndash;2.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.93(1.1\u0026ndash;3.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026ndash;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.9(54.6\u0026ndash;85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.0(63.3\u0026ndash;86.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.88(0.53\u0026ndash;1.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.83(0.49\u0026ndash;1.41)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.4(58.2\u0026ndash;88.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSchools\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiftu Ayyana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.8(57.6\u0026ndash;85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43(0.23\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.34(0.17\u0026ndash;0.68)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShimal Tokke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.8(40.4\u0026ndash;83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.29(0.14\u0026ndash;0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24(0.11\u0026ndash;0.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrji Oromia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.4(72.0-98.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eKeys\u003c/b\u003e: N, number of study participants; 1, reference category; *, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Numbers in bold font represent significant association with \u003cem\u003eS. mansoni\u003c/em\u003e infections\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eAbbreviations:\u0026nbsp;\u003c/strong\u003eCI, Confidence Interval; COR, Crude Odds Ratio; AOR, Adjusted Odds Ratio\u003c/p\u003e\n\u003ch2\u003eIntensity of infection of S. mansoni\u003c/h2\u003e\n\u003cp\u003eNearly half (48.1%) of the \u003cem\u003eS. mansoni\u003c/em\u003e infections among study participants were identified as heavy infections. Over half of the male study participants (50.3%) infected with \u003cem\u003eS.mansoni\u003c/em\u003e had heavy infection intensity. Of the total female schoolchildren infected with \u003cem\u003eS.mansoni\u003c/em\u003e, about 44.4% were with a heavy infection. The majority of heavy infections were detected among study participants of Urji Oromia Primary School (52.27%) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Infection intensity of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eS.mansoni\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;among schoolchildren from three primary schools in remote areas of Southwest Ethiopia (N=242)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"582\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.542955326460481%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.463917525773196%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"71.99312714776632%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntensity of infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.83732057416268%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLight n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.401913875598087%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.401913875598087%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeavy n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.358851674641148%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.564543889845094%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\" valign=\"top\"\u003e\n \u003cp\u003e6-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.588640275387263%\" valign=\"top\"\u003e\n \u003cp\u003e6 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e12 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e19 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.244406196213426%\" valign=\"top\"\u003e\n \u003cp\u003e818.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.716535433070867%\" valign=\"top\"\u003e\n \u003cp\u003e10-13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25984251968504%\" valign=\"top\"\u003e\n \u003cp\u003e16 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e43 (38.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e53 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.866141732283463%\" valign=\"top\"\u003e\n \u003cp\u003e665.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.716535433070867%\" valign=\"top\"\u003e\n \u003cp\u003e14-17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25984251968504%\" valign=\"top\"\u003e\n \u003cp\u003e15 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e34 (36.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e44 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.866141732283463%\" valign=\"top\"\u003e\n \u003cp\u003e682.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.564543889845094%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.588640275387263%\" valign=\"top\"\u003e\n \u003cp\u003e22 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e54 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e76 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.244406196213426%\" valign=\"top\"\u003e\n \u003cp\u003e708.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.716535433070867%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25984251968504%\" valign=\"top\"\u003e\n \u003cp\u003e14 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e36 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e40 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.866141732283463%\" valign=\"top\"\u003e\n \u003cp\u003e666.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.564543889845094%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSchools\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.49053356282272%\" valign=\"top\"\u003e\n \u003cp\u003eBiftu Ayyana\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.588640275387263%\" valign=\"top\"\u003e\n \u003cp\u003e17 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e39 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e51 (47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.244406196213426%\" valign=\"top\"\u003e\n \u003cp\u003e590.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.716535433070867%\" valign=\"top\"\u003e\n \u003cp\u003eShimal Tokke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25984251968504%\" valign=\"top\"\u003e\n \u003cp\u003e9 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e19 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e19 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.866141732283463%\" valign=\"top\"\u003e\n \u003cp\u003e574.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.716535433070867%\" valign=\"top\"\u003e\n \u003cp\u003eUrji Oromia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.25984251968504%\" valign=\"top\"\u003e\n \u003cp\u003e10 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e32 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.078740157480315%\" valign=\"top\"\u003e\n \u003cp\u003e46 (52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.866141732283463%\" valign=\"top\"\u003e\n \u003cp\u003e891.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.055077452667813%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.588640275387263%\" valign=\"top\"\u003e\n \u003cp\u003e36 (14.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e90 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.555938037865747%\" valign=\"top\"\u003e\n \u003cp\u003e116 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.244406196213426%\" valign=\"top\"\u003e\n \u003cp\u003e694.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eKeys:\u003c/strong\u003e n, number; N, total number of positive cases\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e AM, Arithmetic Mean\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe timely update on intestinal schistosomiasis in a region where a long-term MDA program targets is substantial in the evaluation of the implementation, coverage, and/or progress of the interventional programs. Hence, this study paid attention to the burden of intestinal schistosomiasis among schoolchildren in remote areas of southwest Ethiopia where a long-term MDA program was supposed to be implemented.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present study revealed the magnitude of \u003cem\u003eS. mansoni\u003c/em\u003e among schoolchildren is 73.8%. This finding is consistent with the study conducted in Brazil\u0026nbsp;\u003csup\u003e24\u003c/sup\u003e. However, the magnitude revealed by our study was lower when compared to other studies in Ethiopia; Amhara region (82.8%)\u0026nbsp;\u003csup\u003e25\u003c/sup\u003e, Oromia region, (89.6%)\u0026nbsp;\u003csup\u003e26\u003c/sup\u003e, Northwest Ethiopia (89.9%)\u0026nbsp;\u003csup\u003e10\u003c/sup\u003e. The variations in the study period, coverage of the interventional programs, and the status of intermediate hosts in the area might be the cause of the inconsistency.\u003c/p\u003e\n\u003cp\u003eIn contrast, the magnitude of intestinal schistosomiasis from our study was higher as compared with other studies conducted in the country (31.6%-59.9%)\u0026nbsp;\u003csup\u003e10,24-29\u003c/sup\u003e. Similarly, a lower prevalence was reported in other Sub-Saharan countries, 12.2% in Kenya\u0026nbsp;\u003csup\u003e30\u003c/sup\u003e,15.1% in Tanzania\u0026nbsp;\u003csup\u003e31\u003c/sup\u003e, and \u0026nbsp; 21.2% in Angola\u0026nbsp;\u003csup\u003e32\u003c/sup\u003e. The higher prevalence from this study could be because of the endemicity of the disease in the district, the geographical remoteness of the district which may affect the smooth and regular implementation of the interventions, the presence of aquatic environments in the area that serve as the reservoir of snails, and awareness towards intestinal schistosomiasis among schoolchildren. Additionally, though the long-term nationwide MDA program taking place in the country is targeting the susceptible segment of the population, other community members who are not the target population for the preventive chemotherapy and are infected with \u003cem\u003eS. mansoni\u003c/em\u003e could play a role in the life cycle of schistosome and contributes to high prevalence. Additionally, socioeconomic status and other associated factors in line seen in other regions\u0026nbsp;\u003csup\u003e17-19\u003c/sup\u003e, can also be a reason for the high prevalence and intensity of infection registered in the study area.\u003c/p\u003e\n\u003cp\u003eOn the other hand, our study revealed that male study participants had higher odds of infection with \u003cem\u003eS. mansoni\u003c/em\u003e than females, which is similar to other studies\u0026nbsp;\u003csup\u003e33,34\u003c/sup\u003e. Male students were more commonly known to participate in outdoor activities, increasing the possibility of higher water contact as they are more active and often engage in various agricultural works in developing countries, which is likely linked to the higher frequency and higher intensity of infection.\u003c/p\u003e\n\u003cp\u003eAdditionally, the majority of infections were detected among schoolchildren aged 10-13, which is consistent with the studies in northern Ethiopia\u0026nbsp;\u003csup\u003e29,35\u003c/sup\u003e, southwest Ethiopia\u0026nbsp;\u003csup\u003e36\u003c/sup\u003e, and Tanzania\u0026nbsp;\u003csup\u003e31\u003c/sup\u003e. This might be because of a lack of awareness regarding intestinal schistosomiasis as compared to higher age groups and frequent contact with aquatic environments as compared to lower age group children.\u003c/p\u003e\n\u003cp\u003eThe odds of infection with intestinal schistosomiasis are higher among Biftu Ayana Primary Schools than the rest two primary schools. The possible reason behind this can be the proximity of Biftu Ayana Primary Schools to the aquatic environment harboring intermediate hosts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also revealed nearly half of the schoolchildren found positive for intestinal schistosomiasis were with a heavy infection intensity. However, this finding has a variation as compared to other studies conducted in southwest Ethiopia\u0026nbsp;\u003csup\u003e37\u003c/sup\u003e, Kenya\u0026nbsp;\u003csup\u003e30\u003c/sup\u003e, Tanzania\u0026nbsp;\u003csup\u003e38\u003c/sup\u003e, and Madagascar\u0026nbsp;\u003csup\u003e39\u003c/sup\u003e where light intensity of infection has been detected. The disparity in infection intensity between various studies could be because of the distance of water bodies from residential areas, which determines the frequency of contact with aquatic environments, variation in water-contact behavior, awareness of the schoolchildren, and level of effectiveness and applicability of the deworming program in the district.\u003c/p\u003e\n\u003ch1\u003eLimitations of the study\u003c/h1\u003e\n\u003cp\u003eThe study couldn\u0026rsquo;t identify the possible risk factors behind the high prevalence of intestinal schistosomiasis in the study area because of the nature of the study design.\u003c/p\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eIt has been elucidated by this study that about\u0026nbsp;three-quarters of schoolchildren were positive for intestinal schistosomiasis and a significant infection intensity was documented in the preventive chemotherapy era, which counteracts the WHO strategy to eliminate the parasite in 2030. The palliating prevalence of \u003cem\u003eSchistosoma mansoni\u003c/em\u003e in some districts of the country\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ealso created a false sense of the reduced burden of intestinal schistosomiasis in endemic areas. The high prevalence of Intestinal schistosomiasis in the study area raises doubts on either the implementation or effectiveness of the interventional programs in remote areas of southwest Ethiopia. Therefore, it indicates the need for further consideration of the novel preventive interventions targeting the life cycle of schistosomes accompanied by environmental sanitation and intermediate host management to be extended to remote areas in addition to the preventive chemotherapy. Moreover, any interventional program should better consider all age groups of the community for complete curative and preventive management of intestinal schistosomiasis.\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed in the study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eIt is with great pleasure that we thank Mattu University\u0026rsquo;s Office of the Research Affairs Directorate for their technical support of this project. Data collectors and study participants also owed a debt of gratitude for their participation in the study. School directors and teachers should be thanked delightedly for their priceless collaboration.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contribution\u003c/p\u003e\n\u003cp\u003eAll authors made an immense contribution to the study. Conceptualization, Y.N., T.B., and S.T.; Data curation, T.D., A.M., and A.G.; Formal analysis, T.D., A.M., A.G., and W.G.; Funding acquisition, O.G.; Investigation, O.G.; Methodology, B.E., T.S.; Re-sources, G.T; Supervision, D.O., and M.B.; Writing \u0026ndash; original draft, Y.N., and T.B.; Writing \u0026ndash; re-view \u0026amp; editing, Y.N., T.B., E.C., and D.G.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting Interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests in this work.\u003c/p\u003e\n\u003cp\u003eEthics declaration\u003c/p\u003e\n\u003cp\u003eMattu University\u0026rsquo;s\u0026nbsp;College of Health Sciences Institutional Review Board granted the study approval and ethical clearance with a Ref. No: CHS/157/23.\u0026nbsp;The study protocol was conducted according to the Declaration of Helsinki. Study participants and school teachers were provided with overviews of the study. Then, for children below 16 years old, informed consent was taken from their legal guardian before assent was taken directly from the child. On the other hand informed consent was taken directly from children above 16 years regarding sociodemographic and clinical data collection. The positive cases are then linked to the nearest health facilities for appropriate drug administration and better treatment.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJames, S. L.\u003cem\u003e et al.\u003c/em\u003e Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u0026ndash;2017: a systematic analysis for the Global Burden of Disease Study 2017. \u003cem\u003eThe Lancet\u003c/em\u003e \u003cstrong\u003e392\u003c/strong\u003e, 1789-1858 (2018).\u003c/li\u003e\n\u003cli\u003eAdenowo, A. F., Oyinloye, B. E., Ogunyinka, B. 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Prevalence and intensity of \u003cem\u003eSchistosoma\u003c/em\u003e \u003cem\u003emansoni\u003c/em\u003e infections among schoolchildren attending primary schools in an urban setting in Southwest, Ethiopia. \u003cem\u003eBMC Research Notes\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 677 (2017). https://doi.org:10.1186/s13104-017-3023-9\u003c/li\u003e\n\u003cli\u003eMugono, M.\u003cem\u003e et al.\u003c/em\u003e Intestinal schistosomiasis and geohelminths of Ukara Island, North-Western Tanzania: prevalence, intensity of infection and associated risk factors among school children. \u003cem\u003eParasites \u0026amp; vectors\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 1-9 (2014).\u003c/li\u003e\n\u003cli\u003eSpencer, S. A.\u003cem\u003e et al.\u003c/em\u003e High burden of \u003cem\u003eSchistosoma\u003c/em\u003e \u003cem\u003emansoni\u003c/em\u003e infection in school-aged children in Marolambo District, Madagascar. \u003cem\u003eParasites \u0026amp; Vectors\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 307 (2017). https://doi.org:10.1186/s13071-017-2249-7\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schistosoma mansoni, Prevalence, Intensity, Southwest Ethiopia, Schoolchildren","lastPublishedDoi":"10.21203/rs.3.rs-4772815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4772815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAs 2030 approaches, the World Health Organization's due date for ending intestinal schistosomiasis as a public health problem in all endemic areas, understanding the current trends in the burden of \u003cem\u003eSchistosomiasis\u003c/em\u003e among schoolchildren in endemic areas is critical for monitoring the progress, identifying areas for improvement, and developing strategies to plan for instant response to mitigate the burden of \u003cem\u003eSchistosomiasis\u003c/em\u003e. From February to April of 2023, 328 students from three primary schools in Southwest Ethiopia participated in an institution-based cross-sectional study in the detection of \u003cem\u003eSchistosoma mansoni\u003c/em\u003e. Intestinal schistosomiasis was identified among 242 school children, with a rate of infection of 73.8% (95% CI: (64.8\u0026ndash;83.4%)). The rate of infection was higher among study participants aged between 10\u0026ndash;13 years [AOR\u0026thinsp;=\u0026thinsp;1.93, 95% CI: (1.1, 3.44). About 75% of the male participants were infected with \u003cem\u003eSchistosoma mansoni\u003c/em\u003e [AOR\u0026thinsp;=\u0026thinsp;0.83, 95% CI (0.49, 1.41). Nearly half (48.1%) of the \u003cem\u003eS. mansoni\u003c/em\u003e infections among study participants were identified as heavy infections. More than half of the male study participants (50.3%) infected with \u003cem\u003eSchistosoma mansoni\u003c/em\u003e had heavy infection intensity. Of the total female schoolchildren infected with \u003cem\u003eSchistosoma mansoni\u003c/em\u003e, about 44.4% had a heavy infection. The prevalence and intensity of infection of \u003cem\u003eSchistosoma mansoni\u003c/em\u003e in the study area are significantly noticeable, raising doubts on either the implementation or effectiveness of the interventional programs in remote areas of southwest Ethiopia. Strategies to end the disease as a public health threat, mainly in remote and endemic areas, should consider novel integrated strategies targeting the life cycle of schistosomes besides the large-scale mass drug administration.\u003c/p\u003e","manuscriptTitle":"Intestinal Schistosomiasis in remote areas of Southwest Ethiopia, a target region for large-scale Mass Drug Administration","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-21 16:54:12","doi":"10.21203/rs.3.rs-4772815/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-24T08:15:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-24T06:37:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-09T13:08:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332566198919861577387097918400141321815","date":"2024-10-01T05:39:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9307896844906399845003056774817115799","date":"2024-09-11T06:21:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-08T13:53:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90559456391073474205879375339890450745","date":"2024-08-01T07:50:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127325175777019480281193951890725487130","date":"2024-07-31T23:39:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82099086532074749830839934274715715512","date":"2024-07-30T12:53:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-30T07:43:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-30T07:38:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-25T06:30:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-25T06:28:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-07-20T11:07:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7e43fcb-c604-48dc-b8d2-9b0f30c0b142","owner":[],"postedDate":"August 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:10:36+00:00","versionOfRecord":{"articleIdentity":"rs-4772815","link":"https://doi.org/10.1038/s41598-024-84987-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-01-16 15:57:46","publishedOnDateReadable":"January 16th, 2025"},"versionCreatedAt":"2024-08-21 16:54:12","video":"","vorDoi":"10.1038/s41598-024-84987-9","vorDoiUrl":"https://doi.org/10.1038/s41598-024-84987-9","workflowStages":[]},"version":"v1","identity":"rs-4772815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4772815","identity":"rs-4772815","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}