Impact of Praziquantel on Schistosoma mansoni Infection Rates and Associated Factors among Primary School Children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia

Impact of Praziquantel on Schistosoma mansoni Infection Rates and Associated Factors among Primary School Children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Praziquantel on Schistosoma mansoni Infection Rates and Associated Factors among Primary School Children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia Assefa Demsash Abebe, Fentahun Megabiaw, Yenesew Mihret Wondmagegn, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8984516/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Schistosoma mansoni is a significant public health concern worldwide, particularly affecting schoolchildren. The Ethiopian Ministry of Health promotes school-based single-dose praziquantel. However, this extensive implementation of mass drug administration might lead to selective drug resistance. Therefore, periodic assessment of the therapeutic efficacy of praziquantel is vital. Thus, we aimed to evaluate the impact of praziquantel on S. mansoni infection rates and associated factors among Primary School Children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia. Methods A Multicenter cross-sectional study design was conducted in Teda, Koladiba, and Maksegnit Primary Schools from May to July 2024. A total of 657 schoolchildren were selected for the study. Approximately 2 grams of stool samples were collected and examined using the Kato-Katz technique. Children positive for S. mansoni received a single dose of praziquantel, and cure and egg-reduction rates were assessed within 21 days of treatment. The data were analyzed using SPSS. Results Out of 657 screened children, 10.5% (69/657) were infected with S. mansoni , with a higher prevalence among males and older children (56.6%). Sixty-three children were evaluated for praziquantel efficacy, showing a cure rate of 92.1% and an egg reduction rate of 90.1%. Most of the infections were of light intensity. Conclusion The prevalence of S. mansoni among schoolchildren in Teda, Koladiba, and Maksegnit was moderately endemic. The therapeutic efficacy of a single dose of praziquantel was satisfactory. However, health education is crucial for increasing awareness among children to avoid washing and swimming in open freshwater bodies. Efficacy Praziquantel cure rate egg reduction rate Schistosoma mansoni Ethiopia Introduction Figures Figure 1 Introduction Schistosomiasis is an acute and chronic parasitic disease caused by flatworms of the genus Schistosoma (1). Seven species of Schistosoma have been identified as etiological agents of human disease (2).Among these, S. mansoni and S. haematobium are the most prevalent, causing intestinal and urogenital schistosomiasis, respectively (2). While both species pose public health concerns, S. mansoni is the most common (3). It is a leading cause of morbidity and mortality in many developing countries (4). Globally, approximately 780 million people are at risk of infection, with around 240 million cases and 280,000 deaths reported annually across 78 countries (5). Among these, 393 million are suspected cases, 54 million are confirmed cases, and 200,000 are deaths attributed to S. mansoni (6). Significant numbers of cases and deaths have been in the regions of South America, Asia, the Caribbean, and Africa (7). In Ethiopia, approximately 53.3 million people live where the disease is endemic (8). Among these, School Children (SC) account for 12.3 million individuals (9), with an estimated 5.01 million infected (10). The life cycle of schistosomiasis begins when infected individuals release eggs into the water via feces or urine (11). Various factors associated with water contact activities, such as swimming, irrigation, washing clothes, and fishing, can influence the risk of infection in communities (12). The disease most affects SC; these age groups are highly vulnerable due to the habit of frequent water contact (12). Different stages of the Schistosoma parasite play a role in its pathogenesis, but the egg stage is the most pathogenic (13). Long-term complications associated with schistosomiasis can include granuloma formation, periportal fibrosis, renal failure, bladder cancer, urogenital inflammation, as well as anemia and growth stunting (14). To combat this disease, the World Health Organization (WHO) recommends praziquantel (PZQ) as the first-choice anthelminthic therapy due to its safety, cost-effectiveness, minimal adverse effects, and effectiveness against all schistosome species (15). The precise mechanism of action of PZQ is not fully understood (16); however, it is known to stimulate the transient receptor potential ion channel in the worm, leading to muscle contraction and paralysis due to increased calcium ion influx (17). Praziquantel also penetrates the worm's tegument, exposing the parasite to the host's immune response (18) and inhibiting glucose uptake, which immobilizes and can lead to the death of the parasites (19). However, this ability may be affected by several factors, including the host (20), parasitic (21), and drug-related factors (22); the emergence of anthelmintic drug resistance following large-scale mass drug administration (MDA) of PZQ in the global (23). The resistance of S. mansoni to PZQ may indicate that genomic variations in the PQL-1 gene, particularly within the alpha-1 subunit of the tegumental calcium channel, may lead to mutations that inhibit PZQ binding, thereby reducing the drug's efficacy (24). Furthermore, the transient receptor potential melastatin ion channel specific to PZQ in S. mansoni (SmTRPMPZQ) is a vital genomic target for PZQ response. The emergence of resistance to PZQ may be linked to genetic mutations within the PZQ binding pocket of SmTRPMPZQ, resulting in a loss of PZQ activity against S. mansoni (25). Additionally, the drug resistance in S. mansoni includes the efflux of drugs mediated by ATP-binding cassette (ABC) transporter proteins, specifically P-glycoprotein and multidrug resistance-associated proteins (26). These factors challenge controlling and eliminating schistosomiasis transmission within communities (16). In light of these issues, the current study aims to assess the therapeutic efficacy of praziquantel and the factors associated with the prevalence of S. mansoni infection among primary school children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia. Methods and materials Study Design, Setting, and Period A multicenter cross-sectional study was conducted from May to July 2024 in selected areas, specifically Teda, Koladiba, and Maksegnit primary schools, located in Northwest Ethiopia. Koladiba Town is situated in the central Gondar zone of the Amhara Region, 729 km north of Addis Ababa and 35 km from the historic city of Gondar. The altitude in this area ranges from 1750 to 2100 meters above sea level. According to the 2007 Ethiopian census, the population of Koladiba is approximately 263,000 people. The area is close to Lake Tana, and the majority of its residents rely on subsistence farming, particularly through irrigation. While Maksegnit Town, also located in the central Gondar zone of the Amhara Region, is 621 km from Addis Ababa and 40 km from Gondar town. The geographical coordinates of Maksegnit are approximately 12.3° to 13.8° N latitude and 35.3° to 35.7° E longitude, with an elevation of 2,220 meters above sea level. Due to the 2007 census conducted by the Central Statistical Agency of Ethiopia, the district has an estimated population of 222,990. Like Koladiba, Maksegnit is situated near Lake Tana and features primary schools located close to the river. The Teda Town is located 698 km from Addis Ababa, 169 km from Bahir Dar, and 29 km from Gondar. It is positioned at coordinates 11° 20′ 57.93" N latitude and 37° 58′ 42.45" E longitude. According to the 2007 census, Teda has an approximate population of 11,234 residents, with elevations ranging from 1,800 to 2,600 meters above sea level. The annual rainfall in this area varies from 771 mm to 1,160 mm, while temperatures range from 22°C to 29°C. Key water sources include the Megech and Angecha Rivers. These water bodies in the study areas are likely contributors to S. mansoni infections due to their use for bathing, washing, and other daily activities. Source population All school children attending their education in the primary schools in Teda, Koladiba, and Maksegnit were considered the source population for this study. Study population Volunteer children aged 5–15 years who had confirmed S. mansoni infection and attended the selected schools during the study period were considered the study population for this study. Inclusion and Exclusion Criteria Volunteer school children aged 5 to 15 years who can provide the required stool samples and assent to participate in the efficacy assessment. Children who provided insufficient or diarrheal stool samples, those who received anthelminthic treatment within six months of the study, children with severe medical conditions (gastrointestinal diseases), those who vomited within four hours after drug administration, and children co-infected with intestinal helminths were excluded from the study. Sample size determination According to WHO guidelines, to evaluate the efficacy of the anthelminthic drug (PZQ), a minimum of 50 microscopically confirmed S. mansoni -infected children must be included in the study ( 27 ). Based on this guideline, the required sample size was calculated to obtain 50 positive children. The number of children to be screened was determined by considering an 80% compliance rate, and the previously reported S. mansoni prevalence was 10.4% ( 28 ) by using this formula: A total of 662 schoolchildren participated in this study, including 10% of the non-response rate. $$\text{N}\text{u}\text{m}\text{b}\text{e}\text{r}\text{o}\text{f}\text{c}\text{h}\text{i}\text{l}\text{d}\text{r}\text{e}\text{n}\text{t}\text{o}\text{b}\text{e}\text{s}\text{c}\text{r}\text{e}\text{e}\text{n}\text{e}\text{d}=\frac{\text{N}\text{u}\text{m}\text{b}\text{e}\text{r}\text{o}\text{f}\text{i}\text{n}\text{f}\text{e}\text{c}\text{t}\text{e}\text{d}\text{c}\text{h}\text{i}\text{l}\text{d}\text{r}\text{e}\text{n}}{\text{C}\text{o}\text{m}\text{p}\text{l}\text{i}\text{a}\text{n}\text{c}\text{e}\text{r}\text{a}\text{t}\text{e}\text{X}\text{p}\text{r}\text{e}\text{v}\text{a}\text{l}\text{e}\text{n}\text{c}\text{e}}$$ Sampling technique The total sample size was proportionally allocated to each school and grade level based on the number of children enrolled in the selected schools. Therefore, 215 data from Teda, 219 from Maksegnit, and 228 from Koladiba primary schools were collected, respectively. Participants for the initial screening were from each class (Grades 1 to 8) using a systematic random sampling technique, with class rosters serving as the sampling frame. Operational definition Cure rate refers to the percentage of infected individuals who receive a single dose of PZQ and successfully eradicate the parasite after 21 days of treatment ( 29 ). Egg reduction rate the relative reduction in fecal egg counts after treatment of a single dose of PZQ (40mg/kg) compared to the pre-treatment egg count by using KK ( 30 ). S. mansoni infection intensity : light excreted 1–99 parasite eggs per gram (EPG) of feces, moderate between 100–399 eggs per gram of feces, and heavy greater than or equal to 400 eggs per gram of feces ( 31 ). School children children aged 5–15 years, who are eligible to attend primary school ( 31 ). Socio-demographic data and data collection tools Initially, a pretested semi-structured questionnaire was developed in English language, translated into the native Amharic, and then back-translated into English to ensure the accuracy of the translation. The questionnaire encompassed various aspects, including the socio-demographic, behavioral, and other health-related data of the participants. The questionnaire was piloted among 5% of children at Tiwld Amare Primary School in Teda town two weeks before data collection. Four data collectors were assigned to the school to survey under the supervision of the principal investigator. This process begins with obtaining written permission from the school directors to recruit children and obtaining verbal assent from the children. Before the interviews, explain the purpose of the study to both the children and their teachers. The demographic and behavioral data were collected by trained health officers and medical laboratory technologists using a structured questionnaire through face-to-face interviews with the children. After the interview, the data collectors asked each participant to collect approximately 2 grams of fresh stool specimens; this collection process was repeated after 21 days of treatment. Children confirmed that S. mansoni had brought their parents or legal guardians to the school and obtained informed consent from the parents or legal guardians. Laboratory method The World Health Organization recommends KK techniques for diagnosing and quantifying the parasite in terms of eggs per gram. This process begins by obtaining written permission from the school directors to recruit children and by obtaining verbal assent from the children. The data collector asked the children for demographic data and created awareness about the stool sample collection process. Each participant received a uniquely labeled, clean, dry, and leak-proof container. They were instructed to collect approximately 2 grams of a fresh stool specimen while at school. This procedure was repeated at the follow-up after treatment. Children who provided insufficient samples were encouraged to submit another. Inadequate and diarrheic samples were rejected at the schools. The collected specimens were properly and promptly transported to the nearby Teda Health Sciences College laboratory for processing. At the laboratory, freshly collected stool samples were sieved through a fine wire mesh with a pore size of 200 µm to remove large particles. The filtered stool remaining on the mesh was scraped off using a plastic spatula. A template was placed on a microscope slide, and the hole was filled with the sieved feces, which accounts for 41.7 milligrams of stool. The template was then removed. The fecal sample was covered and pressed with cellophane soaked in glycerol-malachite green solution overnight. These KK thick smear slides were left to clear for 24 hours. This process facilitates the detection and quantification of S. mansoni eggs, as well as the presence of other intestinal parasites. The examination was conducted using a light microscope. The EPG was calculated by multiplying the number of eggs per slide (EPS) by a correction factor. Drug administration Children who tested positive for S. mansoni were given high-carbohydrate snacks (biscuits) before receiving a single dose of PZQ (40 mg/kg) to enhance drug bioavailability. The drug, branded as Biltricide, was manufactured by Bayer Pharmaceuticals (Batch No. A6c153, expiration date: 03/2027) and purchased from a private pharmacy. The drug administration took place at each school, and the children were monitored under direct observation for approximately four hours to identify potential complications. Follow-up survey Initially, treated children were asked to provide a second stool specimen, which was examined using the KK technique following the same procedures as the baseline after 21 days of post-treatment to assess PZQ efficacy. The children absent from school on the follow-up day were to wait one or two additional days to collect their specimens. Outcome measures The study outcomes were meticulously analyzed, with a primary focus on the prevalence of S. mansoni infection. Additionally, the therapeutic efficacy of PZQ is a secondary outcome. These were measured using the fecal ERE and the CR. The following formulas were used to calculate: $$ERR=(1-\frac{\text{A}\text{r}\text{i}\text{t}\text{h}\text{m}\text{e}\text{t}\text{i}\text{c}\text{m}\text{e}\text{a}\text{n}\text{e}\text{g}\text{g}\text{c}\text{o}\text{u}\text{n}\text{t}\text{s}\text{a}\text{t}\text{f}\text{o}\text{l}\text{l}\text{o}\text{w}\text{u}\text{p}}{\text{A}\text{r}\text{i}\text{t}\text{h}\text{m}\text{e}\text{t}\text{i}\text{c}\text{m}\text{e}\text{a}\text{n}\text{e}\text{g}\text{g}\text{c}\text{o}\text{u}\text{n}\text{t}\text{s}\text{a}\text{t}\text{b}\text{a}\text{s}\text{e}\text{l}\text{i}\text{n}\text{e}})*100$$ $$CR=\frac{\text{N}\text{u}\text{m}\text{b}\text{e}\text{r}\text{o}\text{f}\text{n}\text{e}\text{g}\text{a}\text{t}\text{i}\text{v}\text{e}\text{c}\text{h}\text{i}\text{l}\text{d}\text{r}\text{e}\text{n}\text{a}\text{f}\text{t}\text{e}\text{r}\text{t}\text{r}\text{e}\text{a}\text{t}\text{m}\text{e}\text{n}\text{t}\text{w}\text{h}\text{o}\text{w}\text{e}\text{r}\text{e}\text{p}\text{o}\text{s}\text{i}\text{t}\text{i}\text{v}\text{e}\text{a}\text{t}\text{b}\text{a}\text{s}\text{e}\text{l}\text{i}\text{n}\text{e}}{\text{n}\text{u}\text{m}\text{b}\text{e}\text{r}\text{o}\text{f}\text{p}\text{o}\text{s}\text{i}\text{t}\text{i}\text{v}\text{e}\text{c}\text{h}\text{i}\text{l}\text{d}\text{r}\text{e}\text{n}\text{b}\text{e}\text{f}\text{o}\text{r}\text{e}\text{t}\text{r}\text{e}\text{a}\text{t}\text{m}\text{e}\text{n}\text{t}}*100$$ Quality control and management To ensure the data quality, the data collectors received training, and children were instructed to avoid providing insufficient samples and to ensure that the stool was free from contamination with soil and urine. Each stool sample was cross-checked with its unique identification number and immediately transported to the laboratory using a cold box. Standard operating protocols were strictly followed during the KK tests. All KK reagents, including glycerol and malachite green, were verified for expiration dates before use. Additionally, the packaging of PZQ was inspected for physical damage, storage conditions, and expiration dates before administration. The laboratory technologists independently examined all smears, and 10% of the slides were randomly selected and re-checked by other senior laboratory technologists, ready to manage discordant results. The variance inflation factors were calculated to check multicollinearity among independent variables. Check the normality of data using visual and statistical methods. Data Analysis and interpretation Initially, the data were entered into Epi Data version 4.7 and subsequently exported to the Statistical Package for the Social Sciences (SPSS) version 25 for further analysis. Descriptive statistics were used to summarize the baseline characteristics of study participants. The fecal CR and ERR were employed to evaluate the efficacy of PZQ. The arithmetic mean (AM) was used to express ERR. The Mann-Whitney U test was used to compare the mean eggs per gram of Males vs. Females and age 5–9 vs. 10–15. Pearson’s Chi-square test assessed associations between potential risk factors and CR. Further bivariate logistic regression analysis identified factors associated with S. mansoni infection, including all variables with a p-value < 0.25 in the multivariable logistic regression analysis. A p-value of < 0.05 was deemed statistically significant. Results Baseline characteristics of the study participants At the beginning of the study, 662 schoolchildren were screened to provide stool specimens for assessing the prevalence of S. mansoni infection and the efficacy of a single dose of PZQ. Remarkably, 99.2% of SC provided sufficient fresh stool samples for diagnosing S. mansoni infection using the KK method. According to the KK results, 69 Children (10.5%) have S. mansoni infection. Three weeks post-treatment, 63 participants completed their follow-up for the final PZQ efficacy analysis against S. mansoni infection. Of these, 58 SC (92.1%) were cured (Fig. 1 ). Socio-demographic and behavioral characteristics of the study participants Among the 657 schoolchildren, most were male, 51%. The mean age of the SC was 10.05 ± 2.3 years (mean ± standard deviation). Regarding the behavioral characteristics of the participants, 70.8% reported a habit of swimming, 70.6% washed their clothes in the river, and 59.2% frequently crossed the river barefoot. Both bivariate and multivariable logistic regression analyses revealed that washing and swimming habits were significantly associated with the prevalence of S. mansoni infection (p < 0.05) (Table 1 ). Table 1 Bivariate and multivariable logistic regression analysis of demographic and behavioral characteristics of the study participants in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024 Variables Categories Participants n (%) Bivariate COR (95%, CI) P value Multivariable AOR (95%, CI) P value Sex Male 336 (51.1) 0.78 (0.47–1.29) 0.345 Female 321 (48.9) 1 Age 5–9 313 (47.6) 1 10–15 344 (52.4) 0.83 (0.50–1.16) 0.465 Residence Urban 305 (46.4) 1 Rural 352 (53.6) 0.99 (0.60–1.65) 0.993 Grade level 1–4 336 (51.1) 1 5–8 321 (48.9) 0.76 (0.46–1.25) 0.276 Swimming habit Yes 465 (70.8) 2.47(1.49–4.10) 0.000 * 1.85 (1.03–3.31) 0.039 * No 192 (29.2) 1 Washing clothes in river Yes 464 (70.6) 2.45 (1.48–4.06) 0.001* 1.82 (1.02–3.26) 0.044 * No 193 (29.4) 1 Crossing river on bar foot Yes 389 (59.2) 1.29 (0.78–2.13) 0.319 No 268 (40.8) 1 Parents educational status Literate 337 (51.3) 1 Illiterate 320 (48.7) 0.75 (0.45–1.24) 0.265 Total 657 (100) COR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; 1: reference; *: Significant association at p < 0.05. Prevalence of Schistosoma mansoni and baseline infection intensity Among the total screened SC using the KK technique, 69 participants tested positive for S. mansoni infection; the overall prevalence rate was 10.5%. The prevalence was notably higher (56.6%) among males and older children (Table 2 ). Most school children had light infection intensity, accounting for 47.6%. Table 2 Prevalence of Schistosoma mansoni infection among primary school children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024 Variables Category Frequency Positive n (%) Sex Male 336 39 (11.6) Female 321 30 (9.3) Total 657 69 (10.5) Age 5–9 313 30 (9.6) 10–15 344 39 (11.3) Total 657 69 (10.5) Therapeutic efficacy of a single dose (40 mg/kg) of praziquantel The World Health Organization recommends an evaluation of the therapeutic efficacy of PZQ through parasitological cure and egg reduction rates ( 27 ). Among the total screened participants, 63 S. mansoni- infected SC were enrolled for final analysis. Three weeks after receiving a single dose (40 mg/Kg) of PZQ, five infected children were still microscopically confirmed positive for S. mansoni. The parasite ERR was expressed as the AM among infected participants, with a baseline intensity of 243 ± 196 EPG (mean ± standard deviation). This mean was reduced to 24 EPG three weeks post-treatment. Following treatment, the overall CR and ERR of PZQ among S. mansoni -infected individuals were 92.1% (95% CI: 82.4–97.4) and 90.1% (95% CI: 86.4–93.8), respectively. However, baseline infection intensity with CR and age of the study participants with ERR were significantly associated with p < 0.05 (Table 3 ). Table 3 Praziquantel CR and ERR with associated factors among S. mansoni-infected primary school children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024 Cure rate and Egg reduction rate Variables Categories Total n (%) Cured n (%) χ 2 P - value ERR (%) P - value Sex Male 37 (58.7) 34 (91.9) 0.004 0.952 91.0 0.056 Female 26 (41.3) 24 (92.3) 88.54 Total 63 (100) 58 (92.1) 90.1 Age 5–9 24 (38.1) 22 (91.7) 88.46 10–15 39 (61.9) 36 (92.3) 0.008 0.927 90.9 0.039 Total 63 (100) 58 (92.1) 90.1 Baseline infection intensity Light 30(47.6) 30 (100) Moderate 23(36.5) 23 (100) Heavy 10(15.9) 5 ( 50 ) 28.784 0.000 Total 63(100) 58 (92.1) ERR: egg reduction rate; χ 2 : chi-square test. Discussion Schistosomiasis is the most prevalent helminthic disease in Ethiopia. Particularly affecting schoolchildren ( 4 ). The prevalence of S. mansoni infection among SC in our study areas was 10.5% (95% CI: 8.3–13.1). These findings were in line with studies conducted in western Côte d’Ivoire (9.5%) ( 32 ), Southwest Nigeria (9%) ( 33 ), Tanzania (8.7%) ( 34 ), and Southwest Ethiopia (8.4%) ( 35 ). However, it was higher than reports from Rwanda (6.5%) ( 36 ), South Sudan (6.1%) ( 37 ), and Debre Tabor (1.8%) ( 38 ). Variations in prevalence can be attributed to geographical factors and climate conditions ( 39 ). For example, Debre Tabor, located at an elevation of 2,706 meters and with an average temperature of 14.8°C, has less favorable conditions for the intermediate host (snails) compared to our study areas, which have an average temperature of 25°C and ongoing irrigation projects that promote snail breeding ( 40 ). Additionally, a previous study noted that the national neglected tropical disease control program was established in Rwanda in 2007, eight years before Ethiopia (2015). The earlier implementation in Rwanda may have led to an underestimation of disease transmission ( 41 ). Sustainable community-based interventions in South Sudan could further help reduce prevalence rates compared to our study area ( 37 ). Compared to other regions, our prevalence findings were lower than those reported from Ghana (46.9%), Uganda (18.7%), and various parts of Ethiopia, such as Northwest and Southwest Ethiopia (28.7% and 37.9%). These differences may be due to active deworming campaigns targeting SC in Teda, Koladiba, and Maksegnit primary schools, where health extension workers provide education on schistosomiasis prevention and promote proper sanitation practices (Source: Teda, Koladiba, and Maksegnit Health Center). Variations in sample size and diagnostic methods also contribute to differences in prevalence rates. Studies with larger sample sizes can better represent the population. For example, a study in the Mayuge district, Uganda, with 1,617 participants, reported a higher prevalence of S. mansoni ( 42 ). Additionally, previous studies using double KK smears per individual child likely reported higher prevalence rates than our study, which utilized single smears ( 43 ). Our findings indicated that S. mansoni infections were more prevalent among males and older children aged 10 to 15, although sex and age were not statistically associated with infection rates. This aligns with studies from Tanzania ( 34 ), Egypt ( 44 ), and Ethiopia ( 7 , 23 , 45 , 46 ). The male and older ( 10 – 15 ) aged SC had the opportunity to contact freshwater bodies because they were old enough to support their families in outdoor activities like agriculture (irrigation). They also have greater freedom to engage in recreational activities, including swimming and washing, which may increase their exposure to the parasite ( 12 ). In contrast, female children spend less time near bodies of water, as they often remain home to fulfill household duties under family supervision. When they come into contact with water, females mostly use soap for washing, which has a molluscicidal effect that may reduce the risk of infection ( 47 ). This might necessitate gender-targeted health promotion initiatives to raise awareness about the potential dangers of schistosomiasis associated with contact with fresh water. Children who swam in rivers exhibited a higher prevalence of S. mansoni. Water-contact activities can increase the risk of infection, with those who washed or swam in rivers being 1.8 times more likely to be infected. This finding is consistent with other studies demonstrating a significant correlation between infection rates and interactions with freshwater bodies ( 1 , 46 ). The administration of a single dose (40mg/kg) of PZQ had a satisfactory effect on the clearance of fecal eggs among S. mansoni -infected individuals after three weeks of treatment. The overall CR of PZQ was 92.1% (95% CI: 82.4–97.4). This result is consistent with studies conducted in northeast and northwest Ethiopia, which reported CRs of 91.7% and 90%, respectively ( 45 , 48 ). However, it is lower than findings from Rwanda (97.9%) and Southwest Ethiopia (99.1%) ( 23 ), while higher than reports from Tanzania (81.2%) ( 49 ) and various regions in Ethiopia (73.6% and 80.9%) ( 50 , 51 ). Factors influencing PZQ efficacy include parasite factors, host characteristics, drug dosage, and diagnostic methods ( 52 ). In Rwanda, a higher CR was observed due to a predominance of light infections ( 36 ). In contrast, high infection intensities can reduce PZQ effectiveness ( 49 – 51 ). Our study indicated that younger children had a lower CR than older children, although the difference was not statistically significant. This aligns with previous studies that found lower CRs among younger age groups, likely due to lower drug dosages based on weight ( 53 ). Interestingly, CR among females was slightly higher than among males (92.3% vs. 91.9%); this may be due to a higher proportion of light infections among females. The variation in CR and ERR may also be attributed to differences in the brands of praziquantel used. A study conducted by Haile in 2012 indicated that the CR of PZQ was lower due to the use of the Distocide brand of the drug. Additionally, the children did not receive a diet before the drug administration, which may have further affected the treatment outcomes by decreasing the drug’s bioavailability ( 50 ). Higher CR and ERR were observed with subsequent doses of PZQ, likely due to the initial dose's limited activity against immature worms. However, subsequent doses administered effectively targeted the worms as they matured into adulthood ( 29 ). This concept is supported by studies in Uganda and Egypt, indicating that double dosing improves efficacy ( 44 , 54 ). The post-treatment duration for measuring CR also impacts the results. A longer duration may allow for reinfection or maturation of juvenile schistosomes into adults, leading to egg production and lower CR. Previous studies reported CR of 89.1% and 87.5% at four and eight weeks post-treatment, respectively ( 7 ). The KK technique's lower sensitivity in detecting eggs, especially in low worm burdens, may contribute to overestimating CR ( 55 ). A study in Côte d'Ivoire demonstrated significant differences in CR when using various diagnostic methods, highlighting the need for more sensitive techniques ( 56 ). In addition to CR, ERR is a critical indicator of PZQ efficacy. Our study showed a significant reduction in parasite load. Specifically, the average egg count of S. mansoni in stool samples decreased from 243 EPG at baseline to 24 EPG three weeks post-treatment. The overall ERR was 90.1% (95% CI: 86.4–93.8), slightly higher than the WHO minimal threshold ( 27 ). This outcome is consistent with earlier reports from Ethiopia, which reported ERR of 86.8% and 93.5% ( 3 , 53 ). However, it is higher than findings from the Amhara region, which reported an ERR of 79.46% in Senbetie ( 57 ) and 78.3% in Sanja ( 19 ). Variations in ERR may be due to initial infection intensity. Studies reporting higher ERR involved a significant proportion of light infections, which respond better to treatment ( 58 ). Our study found that younger children had a lower ERR than older children. This outcome is consistent with a prospective cohort study in southern Ethiopia ( 49 ). On the other hand, the current finding of ERR was lower compared to other studies performed in Tanzania (95%) ( 49 ), Jimma (99.9%) ( 23 ), and Sanja (99.5%) ( 45 ). These variations may be due to differences in initial infection intensity, the diagnostic techniques employed, and extended follow-up time after treatment, which could account for the discrepancies between the current and previous studies ( 49 ). Limitations of the study Our study used a multicenter cross-sectional study design, which may lead to either an overestimation or underestimation of prevalence because it represents the current situation and may not sufficiently consider changes over time. Additionally, relying on a single sample and the KK technique for baselines and post-treatment S. mansoni egg counts may lead to an underestimation of light-intensity infections (prevalence) and an overestimation of the CR and ERR. Conclusion and recommendation Based on KK results, the prevalence of S. mansoni infection was a significant public health challenge. The therapeutic efficacy of a single dose (40mg/kg) of PZQ, as measured by CR and ERR, was satisfactory for treating S. mansoni , meeting the WHO threshold. Several factors complicate efforts for elimination and control, such as washing and swimming habits, which are linked to exposure to infected water sources and may significantly contribute to the increasing prevalence. To effectively combat S. mansoni infections, we recommend that the Ethiopian Ministry of Health maintain a deworming program. The Megech Dam project poses a future risk of increased snail reproduction and schistosomiasis transmission. Comprehensive interventions (including promoting hygiene practices) and multisectoral efforts are crucial to improving health outcomes before the dam becomes operational. Future research should employ sensitive diagnostic techniques and community-based studies to assess the prevalence. Additionally, ongoing evaluations of drug efficacy, particularly regarding PZQ resistance genes, are vital for managing drug resistance and controlling S. mansoni infections at the community level. Abbreviations CR: Cure Rate EPG: Eggs per gram ERR: Egg Reduction Rate KK: Kato Katz MDA: Mass Drug Administration MoH: Ministry of Health NTDs: Neglected Tropical Diseases PZQ: Praziquantel SC: School Children WHO: World Health Organization Declarations We, the authors, confirm that this manuscript is our original work and has neither been submitted for publication nor published elsewhere. Furthermore, all authors have read and approved the final version of the manuscript, had full access to all of the data in this study, and take complete responsibility for the integrity of the data and accuracy of the data analysis. Ethical consideration The research and ethics committee of the University of Gondar reviewed and approved the study protocol (Ref. No. SBMLS/741/2024). Written permission was obtained from the school directors. Study participants, along with their guardians or parents, were informed about the aims of the study and data collection procedures. Each participant voluntarily participated in the study and had the right to withdraw their consent at any time. Additionally, verbal assent was obtained from the children, while signed informed consent was secured from their parents or legal guardians. Every child infected with S. mansoni received a single dose (40 mg/kg body weight) of PZQ as treatment by a health officer. Children infected with other parasites, those who vomited during drug administration, and those who were positive at follow-up, received appropriate drugs through the referral link with Teda, Koladiba, and Maksegnit Health Center. The study was conducted in accordance with the Declaration of Helsinki. Clinical trial Not applicable Consent for publication Not applicable Availability of data and material The data supporting the findings of this study are not deposited into the publicly available repository. The data used in this study are available from the corresponding author and will be accessible upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this study. Authors' contributions Conceptualization: Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere Data curation: Assefa Demsash Abebe, Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie Data analysis: Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere Investigation: Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere, and Yenesew Mihret Wondmagegn Methodology: Assefa Demsash Abebe, Mebratu Tamir, Mengistu Tesfa Alula, and Marye Wondimnew Tefera Software: Assefa Demsash Abebe, Tena Cherkos, and Nega Dessie Supervision: Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere Validation: Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere Visualization: Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie Writing– original draft: Assefa Demsash Abebe Writing– review & editing: Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere, Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie Acknowledgements The authors would like to thank the University of Gondar for funding the project. Moreover, we would like to thank all research participants, data collectors, and study school directors. We would like to extend our sincere gratitude to Mr. Amare Kiflie and Mr. Wondemu Tesfa for providing the essential Kato Katz kit and materials. Supplementary information SI Table: Variable assessment questionnaire (PDF) References Bekana T, Berhe N, Eguale T, Aemero M, Medhin G, Tulu B et al (2021) Prevalence and factors associated with intestinal schistosomiasis and human fascioliasis among school children in Amhara Regional State, Ethiopia. Trop Med Health 49:1–11 Alemu A, Tegegne Y, Damte D, Melku M (2016) Schistosoma mansoni and soil-transmitted helminths among preschool-aged children in Chuahit, Dembia district, Northwest Ethiopia: prevalence, intensity of infection and associated risk factors. 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Assessing the efficacy of anthelminthic drugs against schistosomiasis and soil-transmitted helminthiases (2013) Available from: https://www.who.int (accessed 2024) Tarekegn D, Birhanie M, Lemma W (2022) Impact of Intestinal Helminth Infections on Malnutrition and Haematological Indices of School-Age Children in Gondar Town, Ethiopia. Int J Nutr 7(1):16–29 Olliaro PL, Vaillant M, Diawara A, Coulibaly JT, Garba A, Keiser J et al (2015) Toward measuring Schistosoma response to praziquantel treatment with appropriate descriptors of egg excretion. PLoS Negl Trop Dis 9(6):e0003821 Moser W, Keiser J, Speich B, Sayasone S, Knopp S, Hattendorf J (2020) One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. PLoS Negl Trop Dis 14(4):e0008185 Organization WH (2022) WHO guideline on control and elimination of human schistosomiasis. World Health Organization Assaré RK, N’Tamon RN, Bellai LG, Koffi JA, Mathieu T-BI, Ouattara M et al (2020) Characteristics of persistent hotspots of Schistosoma mansoni in western Côte d’Ivoire. Parasites vectors 13:1–16 Ojo JA, Adedokun SA, Akindele AA, Olorunfemi AB, Otutu OA, Ojurongbe TA et al (2021) Prevalence of urogenital and intestinal schistosomiasis among school children in South-west Nigeria. PLoS Negl Trop Dis 15(7):e0009628 Mazigo HD, Zinga MM, Kepha S, Yard E, McRee-Mckee K, Kabona G et al (2022) Precision and geographical prevalence mapping of schistosomiasis and soil-transmitted helminthiasis among school-aged children in selected districts of north-western Tanzania. Parasites vectors 15(1):492 Workineh L, Kiros T, Damtie S, Andualem T, Dessie B (2020) Prevalence of Soil-Transmitted Helminth and Schistosoma mansoni Infection and Their Associated Factors among Hiruy Abaregawi Primary School Children, Rural Debre Tabor, North West Ethiopia: A Cross‐Sectional Study. J Parasitol Res 2020(1):2521750 Kabatende J, Ntirenganya L, Mugisha M, Barry A, Ruberanziza E, Bienvenu E et al (2023) Efficacy of Single-Dose Praziquantel for the Treatment of Schistosoma mansoni Infections among School Children in Rwanda. Pathogens 12(9):1170 Senkwe MN, Berta KK, Yibi SM, Sube J, Bidali A, Abe A et al (2022) Prevalence and factors associated with transmission of schistosomiasis in school-aged children in South Sudan: a cross-sectional study. Pan Afr Med J ;42(Suppl 1) Tazebew B, Temesgen D, Alehegn M, Salew D, Tarekegn M (2022) Prevalence of S. mansoni Infection and Associated Risk Factors among School Children in Guangua District, Northwest Ethiopia. J Parasitol Res 2022(1):1005637 McCreesh N, Nikulin G, Booth M (2015) Predicting the effects of climate change on Schistosoma mansoni transmission in eastern Africa. Parasites vectors 8:1–9 Gebremichael S, Yismaw E, Tsegaw B (2020) Assessing the socio-demographic, economic and water source types that influences households drinking water supply in Debre tabor town, north-west Ethiopia. MOJ Public Health 9(3):63–74 ken. Home - Rwanda Biomedical Centre - Healthy People, Wealthy Nation (2023) Available from: https://rbc.gov.rw (accessed 2024) Kim ES, Adriko M, Oseku KC, Lokure D, Webb EL, Sabapathy K (2024) Factors associated with hookworm and Schistosoma mansoni infections among school-aged children in Mayuge district, Uganda. BMC Public Health 24(1):1620 Enk MJ, Lima ACL, Drummond SC, Schall VT, Coelho PMZ (2008) The effect of the number of stool samples on the observed prevalence and the infection intensity with Schistosoma mansoni among a population in an area of low transmission. Acta Trop 108(2–3):222–228 Ghazy RM, Tahoun MM, Abdo SM, El-Badry AA, Hamdy NA (2021) Evaluation of praziquantel effectivenss after decades of prolonged use in an endemic area in Egypt. Acta Parasitol 66:81–90 Woldegerima E, Bayih AG, Tegegne Y, Aemero M, Jejaw Zeleke A (2019) Prevalence and reinfection rates of Schistosoma mansoni and praziquantel efficacy against the parasite among primary school children in Sanja Town, Northwest Ethiopia. J Parasitol Res 2019(1):3697216 Workineh L, Yimer M, Gelaye W, Muleta D (2019) The magnitude of Schistosoma mansoni and its associated risk factors among Sebatamit primary school children, rural Bahir Dar, Northwest Ethiopia: a cross-sectional study. BMC Res Notes 12:1–6 World Health Organization. Transmission of Schistosomiasis (2023) Available from: https://www.who.int(accessed 2024) World Health Organization. Monitoring of drug efficacy in large scale treatment (2008) Available from: https://www.who.int (accessed 2024) Mnkugwe RH, Minzi OS, Kinung’hi SM, Kamuhabwa AA, Aklillu E (2019) Efficacy and safety of praziquantel for treatment of Schistosoma mansoni infection among school children in Tanzania. Pathogens 9(1):28 Haile S, Golassa L, Mekonnen Z (2012) Prevalence of Schistosoma mansoni and effectiveness of Praziquantel in school children in Finchaa valley, Ethiopia. J Parasitol Vector Biology 4(3):25–30 Erko B, Degarege A, Tadesse K, Mathiwos A, Legesse M (2012) Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia. Asian Pac J Trop Biomed 2(3):235–239 Fukushige M, Chase-Topping M, Woolhouse ME, Mutapi F (2021) Efficacy of praziquantel has been maintained over four decades (from 1977 to 2018): A systematic review and meta-analysis of factors influence its efficacy. PLoS Negl Trop Dis 15(3):e0009189 Berhanu MS, Atnafie SA, Ali TE, Chekol AA, Kebede HB (2022) Efficacy of praziquantel treatment and Schistosoma mansoni infection among primary school children in Kemisse Town, Northeast Ethiopia. Ethiop J Health Sci ;32(3) Nalugwa A, Nuwaha F, Tukahebwa EM, Olsen A (2015) Single versus double dose praziquantel comparison on efficacy and Schistosoma mansoni re-infection in preschool-age children in Uganda: a randomized controlled trial. PLoS Negl Trop Dis 9(5):e0003796 Mazigo HD, Fuss A, Mueller A (2021) High Egg Reduction Rate but poor clearance of Circulating Cathodic Antigen three weeks after Praziquantel treatment among school children on Ijinga Island, north-western Tanzania. Acta Trop 218:105871 Hoekstra PT, Casacuberta-Partal M, van Lieshout L, Corstjens PL, Tsonaka R, Assaré RK et al (2022) Limited efficacy of repeated praziquantel treatment in Schistosoma mansoni infections as revealed by highly accurate diagnostics, PCR and UCP-LF CAA (RePST trial). PLoS Negl Trop Dis 16(12):e0011008 Reta B, Erko B (2013) Efficacy and side effects of praziquantel in the treatment for S chistosoma mansoni infection in school children in S enbete T own, northeastern E thiopia. Tropical Med Int Health 18(11):1338–1343 Utzinger J, N'goran EK, N'dri A, Lengeler C, Tanner M (2000) Efficacy of praziquantel against Schistosoma mansoni with particular consideration for intensity of infection. Tropical Med Int Health 5(11):771–778 Additional Declarations No competing interests reported. Supplementary Files Supplementaryinformation.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 12 Mar, 2026 Editor assigned by journal 04 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 27 Feb, 2026 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-8984516","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":605077614,"identity":"576383b3-58d0-4295-be10-726e26e46d1c","order_by":0,"name":"Assefa Demsash 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participant enrolment for the Impact of Praziquantel on \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eSchistosoma mansoni\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e Infection Rates.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8984516/v1/b40f7ee7262987d3cb13660f.png"},{"id":105034389,"identity":"2cf387f6-6098-42fc-b5f4-612038988b9d","added_by":"auto","created_at":"2026-03-20 07:23:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1432595,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8984516/v1/b855dcf6-8033-41d1-bc81-0164f4020a54.pdf"},{"id":104867654,"identity":"ab55e684-0876-40e8-8d6b-fe9a1d8a5223","added_by":"auto","created_at":"2026-03-18 07:13:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":248430,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8984516/v1/e0344df55919c41cb0cb64e7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Praziquantel on Schistosoma mansoni Infection Rates and Associated Factors among Primary School Children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchistosomiasis is an acute and chronic parasitic disease caused by flatworms of the genus Schistosoma (1). Seven species of Schistosoma have been identified as etiological agents of human disease (2).Among these, \u003cem\u003eS. mansoni\u003c/em\u003e and \u003cem\u003eS. haematobium\u003c/em\u003e are the most prevalent, causing intestinal and urogenital schistosomiasis, respectively (2). While both species pose public health concerns, \u003cem\u003eS. mansoni\u003c/em\u003e is the most common (3). It is a leading cause of morbidity and mortality in many developing countries (4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGlobally, approximately 780 million people are at risk of infection, with around 240 million cases and 280,000 deaths reported annually across 78 countries (5). Among these, 393 million are suspected cases, 54 million are confirmed cases, and 200,000 are deaths attributed to \u003cem\u003eS. mansoni\u0026nbsp;\u003c/em\u003e(6). Significant numbers of cases and deaths have been in the regions of South America, Asia, the Caribbean, and Africa (7). In Ethiopia, approximately 53.3 million people live where the disease is endemic (8). Among these, School Children (SC) account for 12.3 million individuals (9), with an estimated 5.01 million infected (10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe life cycle of schistosomiasis begins when infected individuals release eggs into the water via feces or urine (11). Various factors associated with water contact activities, such as swimming, irrigation, washing clothes, and fishing, can influence the risk of infection in communities (12). The disease most affects SC; these age groups are highly vulnerable due to the habit of frequent water contact (12).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDifferent stages of the Schistosoma parasite play a role in its pathogenesis, but the egg stage is the most pathogenic (13). Long-term complications associated with schistosomiasis can include granuloma formation, periportal fibrosis, renal failure, bladder cancer, urogenital inflammation, as well as anemia and growth stunting (14). To combat this disease, the World Health Organization (WHO) recommends praziquantel (PZQ) as the first-choice anthelminthic therapy due to its safety, cost-effectiveness, minimal adverse effects, and effectiveness against all schistosome species (15).\u003c/p\u003e\n\u003cp\u003eThe precise mechanism of action of PZQ is not fully understood (16); however, it is known to stimulate the transient receptor potential ion channel in the worm, leading to muscle contraction and paralysis due to increased calcium ion influx (17). Praziquantel also penetrates the worm's tegument, exposing the parasite to the host's immune response (18) and inhibiting glucose uptake, which immobilizes and can lead to the death of the parasites (19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this ability may be affected by several factors, including the host (20), parasitic (21), and drug-related factors (22); the emergence of anthelmintic drug resistance following large-scale mass drug administration (MDA) of PZQ in the global (23). The resistance of \u003cem\u003eS. mansoni\u003c/em\u003e to PZQ may indicate that genomic variations in the PQL-1 gene, particularly within the alpha-1 subunit of the tegumental calcium channel, may lead to mutations that inhibit PZQ binding, thereby reducing the drug's efficacy (24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFurthermore, the transient receptor potential melastatin ion channel specific to PZQ in \u003cem\u003eS. mansoni\u003c/em\u003e (SmTRPMPZQ) is a vital genomic target for PZQ response. The emergence of resistance to PZQ may be linked to genetic mutations within the PZQ binding pocket of SmTRPMPZQ, resulting in a loss of PZQ activity against \u003cem\u003eS. mansoni\u003c/em\u003e (25). Additionally, the drug resistance in \u003cem\u003eS. mansoni\u003c/em\u003e includes the efflux of drugs mediated by ATP-binding cassette (ABC) transporter proteins, specifically P-glycoprotein and multidrug resistance-associated proteins (26).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese factors challenge controlling and eliminating schistosomiasis transmission within communities (16). In light of these issues, the current study aims to assess the therapeutic efficacy of praziquantel and the factors associated with the prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection among primary school children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design, Setting, and Period\u003c/h2\u003e \u003cp\u003eA multicenter cross-sectional study was conducted from May to July 2024 in selected areas, specifically Teda, Koladiba, and Maksegnit primary schools, located in Northwest Ethiopia. Koladiba Town is situated in the central Gondar zone of the Amhara Region, 729 km north of Addis Ababa and 35 km from the historic city of Gondar. The altitude in this area ranges from 1750 to 2100 meters above sea level. According to the 2007 Ethiopian census, the population of Koladiba is approximately 263,000 people. The area is close to Lake Tana, and the majority of its residents rely on subsistence farming, particularly through irrigation.\u003c/p\u003e \u003cp\u003eWhile Maksegnit Town, also located in the central Gondar zone of the Amhara Region, is 621 km from Addis Ababa and 40 km from Gondar town. The geographical coordinates of Maksegnit are approximately 12.3\u0026deg; to 13.8\u0026deg; N latitude and 35.3\u0026deg; to 35.7\u0026deg; E longitude, with an elevation of 2,220 meters above sea level. Due to the 2007 census conducted by the Central Statistical Agency of Ethiopia, the district has an estimated population of 222,990. Like Koladiba, Maksegnit is situated near Lake Tana and features primary schools located close to the river.\u003c/p\u003e \u003cp\u003eThe Teda Town is located 698 km from Addis Ababa, 169 km from Bahir Dar, and 29 km from Gondar. It is positioned at coordinates 11\u0026deg; 20\u0026prime; 57.93\" N latitude and 37\u0026deg; 58\u0026prime; 42.45\" E longitude. According to the 2007 census, Teda has an approximate population of 11,234 residents, with elevations ranging from 1,800 to 2,600 meters above sea level. The annual rainfall in this area varies from 771 mm to 1,160 mm, while temperatures range from 22\u0026deg;C to 29\u0026deg;C. Key water sources include the Megech and Angecha Rivers. These water bodies in the study areas are likely contributors to \u003cem\u003eS. mansoni\u003c/em\u003e infections due to their use for bathing, washing, and other daily activities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSource population\u003c/h2\u003e \u003cp\u003eAll school children attending their education in the primary schools in Teda, Koladiba, and Maksegnit were considered the source population for this study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eVolunteer children aged 5\u0026ndash;15 years who had confirmed \u003cem\u003eS. mansoni\u003c/em\u003e infection and attended the selected schools during the study period were considered the study population for this study.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eVolunteer school children aged 5 to 15 years who can provide the required stool samples and assent to participate in the efficacy assessment. Children who provided insufficient or diarrheal stool samples, those who received anthelminthic treatment within six months of the study, children with severe medical conditions (gastrointestinal diseases), those who vomited within four hours after drug administration, and children co-infected with intestinal helminths were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eAccording to WHO guidelines, to evaluate the efficacy of the anthelminthic drug (PZQ), a minimum of 50 microscopically confirmed \u003cem\u003eS. mansoni\u003c/em\u003e-infected children must be included in the study (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Based on this guideline, the required sample size was calculated to obtain 50 positive children. The number of children to be screened was determined by considering an 80% compliance rate, and the previously reported \u003cem\u003eS. mansoni\u003c/em\u003e prevalence was 10.4% (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) by using this formula: A total of 662 schoolchildren participated in this study, including 10% of the non-response rate.\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\text{N}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\text{o}\\text{f}\\text{c}\\text{h}\\text{i}\\text{l}\\text{d}\\text{r}\\text{e}\\text{n}\\text{t}\\text{o}\\text{b}\\text{e}\\text{s}\\text{c}\\text{r}\\text{e}\\text{e}\\text{n}\\text{e}\\text{d}=\\frac{\\text{N}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\text{o}\\text{f}\\text{i}\\text{n}\\text{f}\\text{e}\\text{c}\\text{t}\\text{e}\\text{d}\\text{c}\\text{h}\\text{i}\\text{l}\\text{d}\\text{r}\\text{e}\\text{n}}{\\text{C}\\text{o}\\text{m}\\text{p}\\text{l}\\text{i}\\text{a}\\text{n}\\text{c}\\text{e}\\text{r}\\text{a}\\text{t}\\text{e}\\text{X}\\text{p}\\text{r}\\text{e}\\text{v}\\text{a}\\text{l}\\text{e}\\text{n}\\text{c}\\text{e}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eThe total sample size was proportionally allocated to each school and grade level based on the number of children enrolled in the selected schools. Therefore, 215 data from Teda, 219 from Maksegnit, and 228 from Koladiba primary schools were collected, respectively. Participants for the initial screening were from each class (Grades 1 to 8) using a systematic random sampling technique, with class rosters serving as the sampling frame.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOperational definition\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCure rate\u003c/strong\u003e \u003cp\u003erefers to the percentage of infected individuals who receive a single dose of PZQ and successfully eradicate the parasite after 21 days of treatment (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEgg reduction rate\u003c/strong\u003e \u003cp\u003ethe relative reduction in fecal egg counts after treatment of a single dose of PZQ (40mg/kg) compared to the pre-treatment egg count by using KK (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eS. mansoni\u003c/b\u003e \u003cb\u003einfection intensity\u003c/b\u003e: light excreted 1\u0026ndash;99 parasite eggs per gram (EPG) of feces, moderate between 100\u0026ndash;399 eggs per gram of feces, and heavy greater than or equal to 400 eggs per gram of feces (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSchool children\u003c/strong\u003e \u003cp\u003echildren aged 5\u0026ndash;15 years, who are eligible to attend primary school (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSocio-demographic data and data collection tools\u003c/h3\u003e\n\u003cp\u003eInitially, a pretested semi-structured questionnaire was developed in English language, translated into the native Amharic, and then back-translated into English to ensure the accuracy of the translation. The questionnaire encompassed various aspects, including the socio-demographic, behavioral, and other health-related data of the participants. The questionnaire was piloted among 5% of children at Tiwld Amare Primary School in Teda town two weeks before data collection. Four data collectors were assigned to the school to survey under the supervision of the principal investigator. This process begins with obtaining written permission from the school directors to recruit children and obtaining verbal assent from the children. Before the interviews, explain the purpose of the study to both the children and their teachers. The demographic and behavioral data were collected by trained health officers and medical laboratory technologists using a structured questionnaire through face-to-face interviews with the children. After the interview, the data collectors asked each participant to collect approximately 2 grams of fresh stool specimens; this collection process was repeated after 21 days of treatment. Children confirmed that \u003cem\u003eS. mansoni\u003c/em\u003e had brought their parents or legal guardians to the school and obtained informed consent from the parents or legal guardians.\u003c/p\u003e\n\u003ch3\u003eLaboratory method\u003c/h3\u003e\n\u003cp\u003eThe World Health Organization recommends KK techniques for diagnosing and quantifying the parasite in terms of eggs per gram. This process begins by obtaining written permission from the school directors to recruit children and by obtaining verbal assent from the children. The data collector asked the children for demographic data and created awareness about the stool sample collection process. Each participant received a uniquely labeled, clean, dry, and leak-proof container. They were instructed to collect approximately 2 grams of a fresh stool specimen while at school. This procedure was repeated at the follow-up after treatment. Children who provided insufficient samples were encouraged to submit another. Inadequate and diarrheic samples were rejected at the schools.\u003c/p\u003e \u003cp\u003eThe collected specimens were properly and promptly transported to the nearby Teda Health Sciences College laboratory for processing. At the laboratory, freshly collected stool samples were sieved through a fine wire mesh with a pore size of 200 \u0026micro;m to remove large particles. The filtered stool remaining on the mesh was scraped off using a plastic spatula. A template was placed on a microscope slide, and the hole was filled with the sieved feces, which accounts for 41.7 milligrams of stool. The template was then removed. The fecal sample was covered and pressed with cellophane soaked in glycerol-malachite green solution overnight. These KK thick smear slides were left to clear for 24 hours. This process facilitates the detection and quantification of \u003cem\u003eS. mansoni\u003c/em\u003e eggs, as well as the presence of other intestinal parasites. The examination was conducted using a light microscope. The EPG was calculated by multiplying the number of eggs per slide (EPS) by a correction factor.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDrug administration\u003c/h2\u003e \u003cp\u003eChildren who tested positive for \u003cem\u003eS. mansoni\u003c/em\u003e were given high-carbohydrate snacks (biscuits) before receiving a single dose of PZQ (40 mg/kg) to enhance drug bioavailability. The drug, branded as Biltricide, was manufactured by Bayer Pharmaceuticals (Batch No. A6c153, expiration date: 03/2027) and purchased from a private pharmacy. The drug administration took place at each school, and the children were monitored under direct observation for approximately four hours to identify potential complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFollow-up survey\u003c/h2\u003e \u003cp\u003eInitially, treated children were asked to provide a second stool specimen, which was examined using the KK technique following the same procedures as the baseline after 21 days of post-treatment to assess PZQ efficacy. The children absent from school on the follow-up day were to wait one or two additional days to collect their specimens.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cp\u003eThe study outcomes were meticulously analyzed, with a primary focus on the prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection. Additionally, the therapeutic efficacy of PZQ is a secondary outcome. These were measured using the fecal ERE and the CR. The following formulas were used to calculate:\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$ERR=(1-\\frac{\\text{A}\\text{r}\\text{i}\\text{t}\\text{h}\\text{m}\\text{e}\\text{t}\\text{i}\\text{c}\\text{m}\\text{e}\\text{a}\\text{n}\\text{e}\\text{g}\\text{g}\\text{c}\\text{o}\\text{u}\\text{n}\\text{t}\\text{s}\\text{a}\\text{t}\\text{f}\\text{o}\\text{l}\\text{l}\\text{o}\\text{w}\\text{u}\\text{p}}{\\text{A}\\text{r}\\text{i}\\text{t}\\text{h}\\text{m}\\text{e}\\text{t}\\text{i}\\text{c}\\text{m}\\text{e}\\text{a}\\text{n}\\text{e}\\text{g}\\text{g}\\text{c}\\text{o}\\text{u}\\text{n}\\text{t}\\text{s}\\text{a}\\text{t}\\text{b}\\text{a}\\text{s}\\text{e}\\text{l}\\text{i}\\text{n}\\text{e}})*100$$\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Equc\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equc\" name=\"EquationSource\"\u003e\n$$CR=\\frac{\\text{N}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\text{o}\\text{f}\\text{n}\\text{e}\\text{g}\\text{a}\\text{t}\\text{i}\\text{v}\\text{e}\\text{c}\\text{h}\\text{i}\\text{l}\\text{d}\\text{r}\\text{e}\\text{n}\\text{a}\\text{f}\\text{t}\\text{e}\\text{r}\\text{t}\\text{r}\\text{e}\\text{a}\\text{t}\\text{m}\\text{e}\\text{n}\\text{t}\\text{w}\\text{h}\\text{o}\\text{w}\\text{e}\\text{r}\\text{e}\\text{p}\\text{o}\\text{s}\\text{i}\\text{t}\\text{i}\\text{v}\\text{e}\\text{a}\\text{t}\\text{b}\\text{a}\\text{s}\\text{e}\\text{l}\\text{i}\\text{n}\\text{e}}{\\text{n}\\text{u}\\text{m}\\text{b}\\text{e}\\text{r}\\text{o}\\text{f}\\text{p}\\text{o}\\text{s}\\text{i}\\text{t}\\text{i}\\text{v}\\text{e}\\text{c}\\text{h}\\text{i}\\text{l}\\text{d}\\text{r}\\text{e}\\text{n}\\text{b}\\text{e}\\text{f}\\text{o}\\text{r}\\text{e}\\text{t}\\text{r}\\text{e}\\text{a}\\text{t}\\text{m}\\text{e}\\text{n}\\text{t}}*100$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQuality control and management\u003c/h2\u003e \u003cp\u003eTo ensure the data quality, the data collectors received training, and children were instructed to avoid providing insufficient samples and to ensure that the stool was free from contamination with soil and urine. Each stool sample was cross-checked with its unique identification number and immediately transported to the laboratory using a cold box. Standard operating protocols were strictly followed during the KK tests. All KK reagents, including glycerol and malachite green, were verified for expiration dates before use.\u003c/p\u003e \u003cp\u003eAdditionally, the packaging of PZQ was inspected for physical damage, storage conditions, and expiration dates before administration. The laboratory technologists independently examined all smears, and 10% of the slides were randomly selected and re-checked by other senior laboratory technologists, ready to manage discordant results. The variance inflation factors were calculated to check multicollinearity among independent variables. Check the normality of data using visual and statistical methods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis and interpretation\u003c/h2\u003e \u003cp\u003eInitially, the data were entered into Epi Data version 4.7 and subsequently exported to the Statistical Package for the Social Sciences (SPSS) version 25 for further analysis. Descriptive statistics were used to summarize the baseline characteristics of study participants. The fecal CR and ERR were employed to evaluate the efficacy of PZQ. The arithmetic mean (AM) was used to express ERR. The Mann-Whitney U test was used to compare the mean eggs per gram of Males vs. Females and age 5\u0026ndash;9 vs. 10\u0026ndash;15. Pearson\u0026rsquo;s Chi-square test assessed associations between potential risk factors and CR. Further bivariate logistic regression analysis identified factors associated with \u003cem\u003eS. mansoni\u003c/em\u003e infection, including all variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in the multivariable logistic regression analysis. A p-value of \u0026lt;\u0026thinsp;0.05 was deemed statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics of the study participants\u003c/h2\u003e \u003cp\u003eAt the beginning of the study, 662 schoolchildren were screened to provide stool specimens for assessing the prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection and the efficacy of a single dose of PZQ. Remarkably, 99.2% of SC provided sufficient fresh stool samples for diagnosing \u003cem\u003eS. mansoni\u003c/em\u003e infection using the KK method. According to the KK results, 69 Children (10.5%) have \u003cem\u003eS. mansoni\u003c/em\u003e infection. Three weeks post-treatment, 63 participants completed their follow-up for the final PZQ efficacy analysis against \u003cem\u003eS. mansoni\u003c/em\u003e infection. Of these, 58 SC (92.1%) were cured (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic and behavioral characteristics of the study participants\u003c/h2\u003e \u003cp\u003eAmong the 657 schoolchildren, most were male, 51%. The mean age of the SC was 10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation). Regarding the behavioral characteristics of the participants, 70.8% reported a habit of swimming, 70.6% washed their clothes in the river, and 59.2% frequently crossed the river barefoot. Both bivariate and multivariable logistic regression analyses revealed that washing and swimming habits were significantly associated with the prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (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\u003eBivariate and multivariable logistic regression analysis of demographic and behavioral characteristics of the study participants in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024\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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables Categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBivariate\u003c/p\u003e \u003cp\u003eCOR (95%, CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003cp\u003eAOR (95%, CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\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\u003e336 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 (0.47\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003e321 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e313 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e344 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.83 (0.50\u0026ndash;1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e305 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e352 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99 (0.60\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGrade level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (51.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e321 (48.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.76 (0.46\u0026ndash;1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwimming habit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e465 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.47(1.49\u0026ndash;4.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.85 (1.03\u0026ndash;3.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWashing clothes in river\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e464 (70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.45 (1.48\u0026ndash;4.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.82 (1.02\u0026ndash;3.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193 (29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCrossing river on bar foot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389 (59.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29 (0.78\u0026ndash;2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268 (40.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParents educational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e337 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320 (48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75 (0.45\u0026ndash;1.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e657 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eCOR: crude odds ratio; AOR: adjusted odds ratio; CI: confidence interval; 1: reference;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*: Significant association at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Schistosoma mansoni and baseline infection intensity\u003c/h2\u003e \u003cp\u003eAmong the total screened SC using the KK technique, 69 participants tested positive for \u003cem\u003eS. mansoni\u003c/em\u003e infection; the overall prevalence rate was 10.5%. The prevalence was notably higher (56.6%) among males and older children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Most school children had light infection intensity, accounting for 47.6%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of Schistosoma mansoni infection among primary school children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (11.6)\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=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (9.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (10.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39 (11.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (10.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTherapeutic efficacy of a single dose (40 mg/kg) of praziquantel\u003c/h2\u003e \u003cp\u003eThe World Health Organization recommends an evaluation of the therapeutic efficacy of PZQ through parasitological cure and egg reduction rates (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Among the total screened participants, 63 \u003cem\u003eS. mansoni-\u003c/em\u003einfected SC were enrolled for final analysis. Three weeks after receiving a single dose (40 mg/Kg) of PZQ, five infected children were still microscopically confirmed positive \u003cem\u003efor S. mansoni.\u003c/em\u003e The parasite ERR was expressed as the AM among infected participants, with a baseline intensity of 243\u0026thinsp;\u0026plusmn;\u0026thinsp;196 EPG (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation). This mean was reduced to 24 EPG three weeks post-treatment. Following treatment, the overall CR and ERR of PZQ among \u003cem\u003eS. mansoni\u003c/em\u003e-infected individuals were 92.1% (95% CI: 82.4\u0026ndash;97.4) and 90.1% (95% CI: 86.4\u0026ndash;93.8), respectively. However, baseline infection intensity with CR and age of the study participants with ERR were significantly associated with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePraziquantel CR and ERR with associated factors among S. mansoni-infected primary school children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eCure rate and Egg reduction rate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables Categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCured n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eERR (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSex\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\u003e37 (58.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (91.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.056\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\u003e26 (41.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBaseline infection intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeavy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eERR: egg reduction rate; χ\u003csup\u003e2\u003c/sup\u003e: chi-square test.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSchistosomiasis is the most prevalent helminthic disease in Ethiopia. Particularly affecting schoolchildren (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e). The prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection among SC in our study areas was 10.5% (95% CI: 8.3–13.1). These findings were in line with studies conducted in western Côte d’Ivoire (9.5%) (\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e), Southwest Nigeria (9%) (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e), Tanzania (8.7%) (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e), and Southwest Ethiopia (8.4%) (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e). However, it was higher than reports from Rwanda (6.5%) (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e), South Sudan (6.1%) (\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e), and Debre Tabor (1.8%) (\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVariations in prevalence can be attributed to geographical factors and climate conditions (\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e). For example, Debre Tabor, located at an elevation of 2,706 meters and with an average temperature of 14.8°C, has less favorable conditions for the intermediate host (snails) compared to our study areas, which have an average temperature of 25°C and ongoing irrigation projects that promote snail breeding (\u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e). Additionally, a previous study noted that the national neglected tropical disease control program was established in Rwanda in 2007, eight years before Ethiopia (2015). The earlier implementation in Rwanda may have led to an underestimation of disease transmission (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e). Sustainable community-based interventions in South Sudan could further help reduce prevalence rates compared to our study area (\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared to other regions, our prevalence findings were lower than those reported from Ghana (46.9%), Uganda (18.7%), and various parts of Ethiopia, such as Northwest and Southwest Ethiopia (28.7% and 37.9%). These differences may be due to active deworming campaigns targeting SC in Teda, Koladiba, and Maksegnit primary schools, where health extension workers provide education on schistosomiasis prevention and promote proper sanitation practices (Source: Teda, Koladiba, and Maksegnit Health Center).\u003c/p\u003e \u003cp\u003eVariations in sample size and diagnostic methods also contribute to differences in prevalence rates. Studies with larger sample sizes can better represent the population. For example, a study in the Mayuge district, Uganda, with 1,617 participants, reported a higher prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e (\u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e). Additionally, previous studies using double KK smears per individual child likely reported higher prevalence rates than our study, which utilized single smears (\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings indicated that \u003cem\u003eS. mansoni\u003c/em\u003e infections were more prevalent among males and older children aged 10 to 15, although sex and age were not statistically associated with infection rates. This aligns with studies from Tanzania (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e), Egypt (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e), and Ethiopia (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e). The male and older (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e) aged SC had the opportunity to contact freshwater bodies because they were old enough to support their families in outdoor activities like agriculture (irrigation). They also have greater freedom to engage in recreational activities, including swimming and washing, which may increase their exposure to the parasite (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn contrast, female children spend less time near bodies of water, as they often remain home to fulfill household duties under family supervision. When they come into contact with water, females mostly use soap for washing, which has a molluscicidal effect that may reduce the risk of infection (\u003cspan class=\"CitationRef\"\u003e47\u003c/span\u003e). This might necessitate gender-targeted health promotion initiatives to raise awareness about the potential dangers of schistosomiasis associated with contact with fresh water. Children who swam in rivers exhibited a higher prevalence of \u003cem\u003eS. mansoni.\u003c/em\u003e Water-contact activities can increase the risk of infection, with those who washed or swam in rivers being 1.8 times more likely to be infected. This finding is consistent with other studies demonstrating a significant correlation between infection rates and interactions with freshwater bodies (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe administration of a single dose (40mg/kg) of PZQ had a satisfactory effect on the clearance of fecal eggs among \u003cem\u003eS. mansoni\u003c/em\u003e-infected individuals after three weeks of treatment. The overall CR of PZQ was 92.1% (95% CI: 82.4–97.4). This result is consistent with studies conducted in northeast and northwest Ethiopia, which reported CRs of 91.7% and 90%, respectively (\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e48\u003c/span\u003e). However, it is lower than findings from Rwanda (97.9%) and Southwest Ethiopia (99.1%) (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e), while higher than reports from Tanzania (81.2%) (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e) and various regions in Ethiopia (73.6% and 80.9%) (\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFactors influencing PZQ efficacy include parasite factors, host characteristics, drug dosage, and diagnostic methods (\u003cspan class=\"CitationRef\"\u003e52\u003c/span\u003e). In Rwanda, a higher CR was observed due to a predominance of light infections (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e). In contrast, high infection intensities can reduce PZQ effectiveness (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e–\u003cspan class=\"CitationRef\"\u003e51\u003c/span\u003e). Our study indicated that younger children had a lower CR than older children, although the difference was not statistically significant. This aligns with previous studies that found lower CRs among younger age groups, likely due to lower drug dosages based on weight (\u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInterestingly, CR among females was slightly higher than among males (92.3% vs. 91.9%); this may be due to a higher proportion of light infections among females. The variation in CR and ERR may also be attributed to differences in the brands of praziquantel used. A study conducted by Haile in 2012 indicated that the CR of PZQ was lower due to the use of the Distocide brand of the drug. Additionally, the children did not receive a diet before the drug administration, which may have further affected the treatment outcomes by decreasing the drug’s bioavailability (\u003cspan class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHigher CR and ERR were observed with subsequent doses of PZQ, likely due to the initial dose's limited activity against immature worms. However, subsequent doses administered effectively targeted the worms as they matured into adulthood (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). This concept is supported by studies in Uganda and Egypt, indicating that double dosing improves efficacy (\u003cspan class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e54\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe post-treatment duration for measuring CR also impacts the results. A longer duration may allow for reinfection or maturation of juvenile schistosomes into adults, leading to egg production and lower CR. Previous studies reported CR of 89.1% and 87.5% at four and eight weeks post-treatment, respectively (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). The KK technique's lower sensitivity in detecting eggs, especially in low worm burdens, may contribute to overestimating CR (\u003cspan class=\"CitationRef\"\u003e55\u003c/span\u003e). A study in Côte d'Ivoire demonstrated significant differences in CR when using various diagnostic methods, highlighting the need for more sensitive techniques (\u003cspan class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to CR, ERR is a critical indicator of PZQ efficacy. Our study showed a significant reduction in parasite load. Specifically, the average egg count of \u003cem\u003eS. mansoni\u003c/em\u003e in stool samples decreased from 243 EPG at baseline to 24 EPG three weeks post-treatment. The overall ERR was 90.1% (95% CI: 86.4–93.8), slightly higher than the WHO minimal threshold (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). This outcome is consistent with earlier reports from Ethiopia, which reported ERR of 86.8% and 93.5% (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e53\u003c/span\u003e). However, it is higher than findings from the Amhara region, which reported an ERR of 79.46% in Senbetie (\u003cspan class=\"CitationRef\"\u003e57\u003c/span\u003e) and 78.3% in Sanja (\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e). Variations in ERR may be due to initial infection intensity. Studies reporting higher ERR involved a significant proportion of light infections, which respond better to treatment (\u003cspan class=\"CitationRef\"\u003e58\u003c/span\u003e). Our study found that younger children had a lower ERR than older children. This outcome is consistent with a prospective cohort study in southern Ethiopia (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e). On the other hand, the current finding of ERR was lower compared to other studies performed in Tanzania (95%) (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e), Jimma (99.9%) (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e), and Sanja (99.5%) (\u003cspan class=\"CitationRef\"\u003e45\u003c/span\u003e). These variations may be due to differences in initial infection intensity, the diagnostic techniques employed, and extended follow-up time after treatment, which could account for the discrepancies between the current and previous studies (\u003cspan class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eOur study used a multicenter cross-sectional study design, which may lead to either an overestimation or underestimation of prevalence because it represents the current situation and may not sufficiently consider changes over time. Additionally, relying on a single sample and the KK technique for baselines and post-treatment \u003cem\u003eS. mansoni\u003c/em\u003e egg counts may lead to an underestimation of light-intensity infections (prevalence) and an overestimation of the CR and ERR.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion and recommendation","content":"\u003cp\u003eBased on KK results, the prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e infection was a significant public health challenge. The therapeutic efficacy of a single dose (40mg/kg) of PZQ, as measured by CR and ERR, was satisfactory for treating \u003cem\u003eS. mansoni\u003c/em\u003e, meeting the WHO threshold. Several factors complicate efforts for elimination and control, such as washing and swimming habits, which are linked to exposure to infected water sources and may significantly contribute to the increasing prevalence.\u003c/p\u003e\u003cp\u003eTo effectively combat \u003cem\u003eS. mansoni\u003c/em\u003e infections, we recommend that the Ethiopian Ministry of Health maintain a deworming program. The Megech Dam project poses a future risk of increased snail reproduction and schistosomiasis transmission. Comprehensive interventions (including promoting hygiene practices) and multisectoral efforts are crucial to improving health outcomes before the dam becomes operational. Future research should employ sensitive diagnostic techniques and community-based studies to assess the prevalence. Additionally, ongoing evaluations of drug efficacy, particularly regarding PZQ resistance genes, are vital for managing drug resistance and controlling \u003cem\u003eS. mansoni\u003c/em\u003e infections at the community level.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCR: Cure Rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEPG: Eggs per gram\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eERR: Egg Reduction Rate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKK: Kato Katz\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMDA: Mass Drug Administration\u003c/p\u003e\n\u003cp\u003eMoH: Ministry of Health\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNTDs: Neglected Tropical Diseases\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePZQ: Praziquantel\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSC: School Children\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eWe, the authors, confirm that this manuscript is our original work and has neither been submitted for publication nor published elsewhere. Furthermore, all authors have read and approved the final version of the manuscript, had full access to all of the data in this study, and take complete responsibility for the integrity of the data and accuracy of the data analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research and ethics committee of the University of Gondar reviewed and approved the study protocol (Ref. No. SBMLS/741/2024). Written permission was obtained from the school directors. Study participants, along with their guardians or parents, were informed about the aims of the study and data collection procedures. Each participant voluntarily participated in the study and had the right to withdraw their consent at any time. Additionally, verbal assent was obtained from the children, while signed informed consent was secured from their parents or legal guardians. Every child infected with \u003cem\u003eS. mansoni\u003c/em\u003e received a single dose (40 mg/kg body weight) of PZQ as treatment by a health officer. Children infected with other parasites, those who vomited during drug administration, and those who were positive at follow-up, received appropriate drugs through the referral link with Teda, Koladiba, and Maksegnit Health Center. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eClinical trial\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are not deposited into the publicly available repository. The data used in this study are available from the corresponding author and will be accessible upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation:\u003c/strong\u003e Assefa Demsash Abebe, Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere, and Yenesew Mihret Wondmagegn\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e Assefa Demsash Abebe, Mebratu Tamir, Mengistu Tesfa Alula, and Marye Wondimnew Tefera\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSoftware:\u003c/strong\u003e Assefa Demsash Abebe, Tena Cherkos, and Nega Dessie\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, and Aberham Abere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidation:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVisualization:\u003c/strong\u003e Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting\u0026ndash; original draft:\u003c/strong\u003e Assefa Demsash Abebe\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting\u0026ndash; review \u0026amp; editing:\u003c/strong\u003e Assefa Demsash Abebe, Fentahun Megabiaw, Aberham Abere, Yenesew Mihret Wondmagegn, Mebratu Tamir, Mengistu Tesfa Alula, Marye Wondimnew Tefera, Tena Cherkos, and Nega Dessie\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the University of Gondar for funding the project. Moreover, we would like to thank all research participants, data collectors, and study school directors. We would like to extend our sincere gratitude to Mr. Amare Kiflie and Mr. Wondemu Tesfa for providing the essential Kato Katz kit and materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary information \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSI Table: Variable assessment questionnaire (PDF)\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBekana T, Berhe N, Eguale T, Aemero M, Medhin G, Tulu B et al (2021) Prevalence and factors associated with intestinal schistosomiasis and human fascioliasis among school children in Amhara Regional State, Ethiopia. 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Tropical Med Int Health 5(11):771\u0026ndash;778\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"parasitology-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pare","sideBox":"Learn more about [Parasitology Research](http://link.springer.com/journal/436)","snPcode":"436","submissionUrl":"https://submission.nature.com/new-submission/436/3","title":"Parasitology Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Efficacy, Praziquantel, cure rate, egg reduction rate, Schistosoma mansoni, Ethiopia Introduction","lastPublishedDoi":"10.21203/rs.3.rs-8984516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8984516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSchistosoma mansoni\u003c/em\u003e is a significant public health concern worldwide, particularly affecting schoolchildren. The Ethiopian Ministry of Health promotes school-based single-dose praziquantel. However, this extensive implementation of mass drug administration might lead to selective drug resistance. Therefore, periodic assessment of the therapeutic efficacy of praziquantel is vital. Thus, we aimed to evaluate the impact of praziquantel on \u003cem\u003eS. mansoni\u003c/em\u003e infection rates and associated factors among Primary School Children in Teda, Koladiba, and Maksegnit towns, Northwest Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA Multicenter cross-sectional study design was conducted in Teda, Koladiba, and Maksegnit Primary Schools from May to July 2024. A total of 657 schoolchildren were selected for the study. Approximately 2 grams of stool samples were collected and examined using the Kato-Katz technique. Children positive for \u003cem\u003eS. mansoni\u003c/em\u003e received a single dose of praziquantel, and cure and egg-reduction rates were assessed within 21 days of treatment. The data were analyzed using SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 657 screened children, 10.5% (69/657) were infected with \u003cem\u003eS. mansoni\u003c/em\u003e, with a higher prevalence among males and older children (56.6%). Sixty-three children were evaluated for praziquantel efficacy, showing a cure rate of 92.1% and an egg reduction rate of 90.1%. Most of the infections were of light intensity.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of \u003cem\u003eS. mansoni\u003c/em\u003e among schoolchildren in Teda, Koladiba, and Maksegnit was moderately endemic. The therapeutic efficacy of a single dose of praziquantel was satisfactory. However, health education is crucial for increasing awareness among children to avoid washing and swimming in open freshwater bodies.\u003c/p\u003e","manuscriptTitle":"Impact of Praziquantel on Schistosoma mansoni Infection Rates and Associated Factors among Primary School Children in Teda, Koladiba, and Maksegnit Towns, Northwest Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-18 07:12:46","doi":"10.21203/rs.3.rs-8984516/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-12T08:22:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-04T07:20:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-04T02:40:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Parasitology Research","date":"2026-02-27T06:51:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"parasitology-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pare","sideBox":"Learn more about [Parasitology Research](http://link.springer.com/journal/436)","snPcode":"436","submissionUrl":"https://submission.nature.com/new-submission/436/3","title":"Parasitology Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7da2d47c-7f0d-4060-959f-4407068d9b62","owner":[],"postedDate":"March 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-18T07:12:46+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-18 07:12:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8984516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8984516","identity":"rs-8984516","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}