Epidemiological burden of persistent co-transmission of malaria, schistosomiasis, and geohelminthiasis among 3-15 years old children during the dry season in Northern Cameroon

Epidemiological burden of persistent co-transmission of malaria, schistosomiasis, and geohelminthiasis among 3-15 years old children during the dry season in Northern Cameroon | 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 Epidemiological burden of persistent co-transmission of malaria, schistosomiasis, and geohelminthiasis among 3-15 years old children during the dry season in Northern Cameroon Francis N. Nkemngo, Lymen W.G. Raissa, Derrick N. Nebangwa, Asongha M. Nkeng, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1871446/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The double burden of malaria and helminthiasis in children poses an obvious public health challenge particularly in terms of anemia morbidity. While both diseases geographically overlap, most studies focus on mono-infection and general prevalence surveys without molecular analysis. The current study investigated the epidemiological determinants of malaria, schistosomiasis and geohelminthiasis transmission among children in the North Region of Cameroon Methodology: School and pre-school children aged between 3–15 years were enrolled from three communities in March 2021 using a community cross sectional design. Capillary-blood samples were obtained, and each was examined for malaria parasites using RDT, microscopy and PCR while hemoglobin level was measured using a hemoglobinometer. Stool samples were analyzed for Schistosoma mansoni , S. guineensis and STH infections using Kato Katz method and urine samples were assessed for the presence of S. haematobium eggs using the standard urine filtration technique. Result A malaria prevalence of 56% (277/495) was recorded by PCR as opposed to 31.5% (156/495) by microscopy and 37.8% (186/495) by RDT. Similarly, schistosomiasis was observed at prevalence levels of up to 13.3% (66/495) overall [ S. haematobium (8.7%); S. mansoni (3.8%); mixed Sh/Sm (0.6%); mixed Sh/Sm/Sg (0.2%). Both infections were higher in males and the 3–9 years age group. A high frequency of PCR reported P. falciparum mono-infection of 81.9% (227/277) and mixed P. falciparum/P. malariae infection of 17.3% (48/277) was observed. Malaria-helminths co-infections were observed at 13.1% (65/495) with marked variation between P. falciparum / S. haematobium (50.8%, 33/65); P. falciparum /S. mansoni (16.9%, 11/65) and P. falciparum / Ascaris (9.2%, 6/65) ( χ 2 = 17.5, p = 0.00003). Anemia prevalence was 32.9% (163/495), categorically associated with P. falciparum (45.8%, 104/227), and Pf/Sh (11.5%, 26/227) and Pf/Sm (3.9%, 9/227) polyparasitism. Conclusion Polyparasitism with malaria and helminth infections are common in school children despite periodic long lasting insecticide treated nets (LLINs) distribution and regular school-based Praziquantel and Albendazole campaigns. Co-existence of Plasmodium parasites and helminths infections notably Schistosoma species among children may concurrently lead to an increase in the force of Plasmodium infection and an enhanced the risk of anemia, highlighting the necessity of an integrated approach for disease control interventions. Malaria schistosomiasis geohelminthiasis school-age children North Region-Cameroon Figures Figure 1 Figure 2 Figure 3 Introduction Despite the implementation of control measures since the early 2000s, malaria and helminth infections rank as the most prevalent parasitic diseases in Cameroon where they impose a tremendous public health burden particularly on children [ 1 , 2 ]. Malaria was responsible for 6,840,000 cases and more than 3,500 deaths in 2019 with P. falciparum accounting for approximately 95% of the attributed deaths in the country [ 2 , 3 ].In addition, the circulation and expansion of non- P. falciparum species particularly P. malariae [ 4 – 6 ] and P. ovale [ 7 , 8 ], often co-existing with P. falciparum has been reported to widen the force of transmission and increase the magnitude of disease severity with anemia being the most profound outcome [ 9 , 10 ]. The disease exerts a significant impact on morbidity and mortality on children under five (0-5years) due, at least in part to diminished naturally acquired protective immunity [ 3 ]. As such, interventions such as long-lasting insecticide treated nets (LLINs), artemisinin combination therapy (ACTs), intermittent preventive treatment for infants (IPTi), seasonal malaria chemoprevention (SMC) and vaccination programs are concentrated on this group in order to significantly reduce the risk of death [ 3 , 6 , 11 ]. However, beyond the under-five age category, school-aged children (SAC) (5–15 years) represent a relevant demographic group due to ease of accessibility in primary schools although epidemiological data on their malaria burden is lacking [ 12 , 13 ]. Due to repeated exposure to malaria and acquisition of partial immunity to disease in high transmission settings, SAC are frequently subjected to prolonged carriage of untreated asymptomatic parasitemia thereby serving as potential infectious reservoirs for sustaining transmission [ 14 , 15 ]. Moreover, with the changing pattern and dynamics of malaria transmission in Cameroon following the scale-up of control interventions from 2015, monitoring the course in morbidity in the SAC age group remains absolutely fundamental to evaluating the success of control programmes [ 2 , 16 ]. In spite of these, evidence from epidemiological studies has demonstrated that in areas of co-endemicity, children exposed to malaria have a high likelihood to helminth infections [ 10 , 17 ]. Helminthic infections particularly schistosomiasis ( Schistosoma haematobium , S. mansoni and S. guineensis ) and soil-transmitted worms ( Ascaris lumbricoides , Ancylostoma duodenale, Necator americanus and Trichuris trichiura ) are chronic debilitating neglected tropical diseases prevalent in Cameroon, and affecting more than 200,000 people [ 18 , 19 ]. The diseases thrive mostly in poor and rural communities where the vulnerable groups suffer from anemia, reduced productivity and poor psychological development [ 20 ]. Transmission of the diseases is primarily governed by social-ecological factors where access to safe water, poor latrine system, inadequate hygiene and sanitation practices combined with domestic activities predisposes the high-risk groups particularly children to water contacts or infected soils harboring the infective larva forms of the parasites [ 21 – 23 ]. Pathology of these diseases is largely mediated by the eggs which are often excreted in urine or feces to ensure continuity of the parasite life cycle [ 24 ]. The spined-eggs can lodge or persist in internal body organs stimulating immune reactions that lead to complications, particularly the conditions of female and male genital schistosomiasis which are still less recognized pathologies [ 25 , 26 ]. Preventive chemotherapy (PCT) through school based periodic administration of praziquantel (PZQ) and albendazole (ABZ) to school-age children remains the cornerstone of schistosomiasis and STH control respectively in endemic foci in Cameroon [ 19 , 27 ]. While this strategy reduces the egg load and minimizes transmission, it does not prevent infection or re-infection thereby posing concerns on the potential long-term interruption of disease transmission [ 28 – 30 ]. Moreover, the exclusion of infected pre-school children and adults from treatment campaigns implies that these groups continually serve as transmission hotspots and may suffer from serious reproductive and mental health outcomes [ 20 ]. In Cameroon, helminth infections, particularly schistosomiasis, are endemic in the Northern Region due to a complex of human factors, including weak health system and conditions favoring the establishment of the snail intermediate hosts that drives disease transmission [ 19 , 31 ]. Moreover, there exist enormous evidence on the prevalence and seasonal transmission of malaria and helminthiasis during the rainy season in the Region with limited available data during the dry season. Despite frequent geographical co-existence of polyparasitism with malaria and helminthiasis, the majority of research efforts still focus on the epidemiology of single infections [ 32 , 33 ] without assessing the epidemiological impact of polyparasitism which often tends to be chronic. This is fundamental as helminth infections particularly schistosomiasis and ascariasis have been implicated to exacerbate and/or suppress P. falciparum infection and impair vaccine efficacy, making it relevant to assess the impact of co-infection on malaria outcome [ 34 – 36 ]. Also, since SAC and pre-school (PSAC) children are often under-represented in infectious diseases community-based cluster surveys, the burden of malaria and helminthiasis respectively in these cohorts remains poorly ascertained. Indeed, information on the co-morbidity and interactions between malaria and helminthiasis would be crucial in disease intervention strategies. Thus, this study sought to provide an update on the prevalence of malaria and helminths infections and to comprehensively assess the risk factors associated with the disease transmission in the North Region of Cameroon. These findings will contribute in the design or improvement of policy decision strategies to concomitantly interrupt malaria and helminths transmission in Cameroon. Materials And Methods Study area This study was conducted in March 2021 during the dry season in three community health districts (HD) of the sudano-guinean climatic zone of the North Region of Cameroon (Fig. 1). These communities mainly dominated by Muslims include Pitoa Centre (9 0 38’95” N, 13 0 50’15” E) and Wouro-kessoum (PWK) (9 0 38’93” N, 13 0 50’14” E) in the Pitoa health district (PHD), Bainga Assoura (9 0 85’35” N, 13 0 95’68” E) and Kola (BAK) (9 0 85’86” N, 13 0 95’94” E) harboring a major touristic feature - Georges de Kola- in the Guider health district (GHD) and Gounougou (GNG) (9°03′00″N, 13°43′59″E) in the Lagdo health district (LHD); with daily temperatures ranging from 28 0 C to 35 0 C. The choice of selected sites was guided by the geo-cardinal positions (Fig.1) combined with the existence of previously available malaria and helminths parasitological data during the rainy season [32, 37]. The climate of these localities is characterized by a short rainy season from May to September (mean annual rainfall of 900 to 1000 mm) and a long dry season from October to April [38]. Farming (cotton and rice cultivation), cattle rearing and fishing are the primary occupation of the inhabitants since these communities are proximal to natural and artificial water bodies including major rivers (e.g., River Benoué), streams and a hydroelectric power plant (Lagdo dam) [39, 40]. These water bodies constitute the principal breeding sites of the snail intermediate host [40]. Poor infrastructure planning with most houses lacking toilets or water system and the common practice of open defecation is the norm in these villages [41]. Moreover, the influx of displaced persons from the Boko-Harram conflict-hit areas in the Far-North Region [42] coupled with conditions of poor personal and environmental sanitation facilities, exacerbates the transmission of diseases like schistosomiasis. Indeed, the general lack of latrines and inadequate potable water supply at the community level compels the population to utilize these water bodies for personal, household and livelihood activities; further risking exposure to Schistosoma cercariae [37]. However, sustained annual preventive chemotherapy-based MDA of PZQ and ABZ to SAC has been ongoing for over 15 years [19]. Furthermore, malaria transmission is seasonal [2] with the peak period ranging from September to October. Anopheles coluzzii and An. arabiensis are the main vectors involved [16, 38] with majority of the households administered a LLIN by the Cameroon National Malaria Control Programme at a coverage of ~ 76% during the 2018 mass distribution campaign [2].. Study design and sample size determination A community-based cross sectional design was utilized to recruit both pre-school (3-4 years) and school aged (5-15 years) children residing in the North Region of Cameroon. The sample size of the study population was calculated based on a previous schistosomiasis prevalence of 38.5% during the rainy season considering that malaria is endemic in this region. The sample size was determined using the Lorenz formula. The total number of samples N is given by: N = Z 2 x P (1-P)/d 2 [43] where Z is the standard normal deviation, Z = 1.96 for the confidence level of 95%, P = 0.385; proportion of schistosomiasis prevalence, d is the error width of the confidence interval (0.05). The minimum estimated sample size calculated was 370. A total of 555 participants were considered for recruitment to anticipate factors like effect size, voluntary withdrawal and for greater precision. Each participant provided the three specimens including blood spot, stool and urine samples. Parents and their respective children were invited by local community leaders to assemble at a major focal point in each of the selected communities for sample collection. Health education talks on preventive measures for these diseases were delivered before each screening exercise. Furthermore, a questionnaire was administered to each participant by a trained research assistant to obtain anthropometric and socio-demographic data. As inclusion criteria, only children who had lived for at least a year in the selected villages and whose parents/guardians consented to participate were enrolled in the study. Those who declined to participate in the study or failed to provide feces or urine samples after the interview were excluded. Administration of questionnaire and clinical assessment: A simple structured questionnaire was used to collect information about each individual based on the following indicators: socio-demographic data (including name, address, age, gender, educational level), clinical data, malaria risk factors (including knowledge on malaria, history of fever, long lasting insecticide treated nets (LLINs) ownership and use, antimalarial intake), schistosomiasis risk factors (including knowledge on schistosomiasis, source of water supply, frequency of water contact, open-air defecation practice, hand washing and hygienic practice, deworming history). A digital thermometer was used to measure the axillary temperature and fever was defined as body temperature ≥ 37.5 °C. Participants’ heights were measured using a stadiometer while a weighing balance of 120 Kg was used to measure the body weight. Sample collection and parasitological examination: Finger prick (capillary) blood sample was collected from each individual to measure hemoglobin (Hb) level using a hemoglobinometer and perform a malaria rapid diagnostic test using the CareStart TM Malaria Pf/Pan (HRP2/pLDH) antigen Combo kit following standard procedures [44]. Blood aliquots were used to prepare thick and thin films on labeled slides to determine the malaria parasite density using the Giemsa staining technique. Slides were observed under X100 objective lens (oil immersion) of light microscope [45]. Each blood film was independently examined under the light microscope by two trained and experienced microscopists, based on established protocols for the detection and identification of Plasmodium parasites. Slides were considered positive when asexual stages (trophozoites and schizonts) or gametocytes were identified. Parasite density was determined on thick blood films by systematic counting of parasite numbers against at least 200 white blood cells (WBCs), assuming a standard WBC count of 8000/µL. If gametocytes were detected, the count was extended to 500 leukocytes [45]. Malaria parasitemia was categorized as low (≤ 1,000 parasite/μL of blood), moderate (1,000 – 5,000 parasites/μL of blood) and high (> 5,000 parasites/μL of blood). Slides were considered negative after scanning through the entire stained smear [46]. Following the same slide and RDT numerical codes, three drops of capillary blood aliquoted onto an ID labeled Whatman 3 mm filter paper were air-dried, kept in a sealed plastic bag and stored at room temperature for subsequent laboratory analysis. The dried blood spots (DBS) samples were used to detect and identify the malaria parasite species and to determine sub-microscopic Plasmodium infection. Genomic DNA was extracted from the DBS using chelex beads [47, 48] while primary and nested polymerase chain reaction (PCR) assays were run to discriminate the Plasmodium species. The primary PCR was done using a pair of Plasmodium genus-specific primers which amplifies a 1100-base pair (bp) PCR product from the 18S rRNA small subunit gene while the nested primers are specific to the 04 human Plasmodium species ( P. falciparum, P. malariae, P. ovale and P. vivax ) as described by [49-51]. Urine and stool analysis On the day of enrolment, all parents/guardians of children who participated in the questionnaire sampling received two separate 50 mL sterile, wide mouthed; screw capped plastic containers carrying their identification information for urine and stool collection. Considering the circadian pattern of schistosome egg excretion, participants were requested to collect urine samples between 10 am– 2 pm [52]. Upon receipt of urine, hematuria was immediately determined by visual inspection and urine reagent strips (Uric11V, ACCU-ANSWER ® ) following the manufacturers’ instruction. All urine and stool samples were stored in cooling boxes containing air cooler ice packs at temperature of about 4˚C to prevent S . haematobium eggs from hatching and hookworm eggs from degrading during transportation to the laboratory for processing within 12-18 hours of collection. The urine samples were processed using the Nucleopore syringe urine filtration technique and examined microscopically for the presence of S . haematobium infection based on morphology of the ova [30, 41]. Briefly, 10-mL homogenized urine collected using a syringe was forced through a polycarbonate membrane filter (STERLITECH Corporation, USA). The filter was removed from the filter holder, and placed on a glass slide using blunt-ended forceps. The slide template was stained with 1% Lugol’s Iodine Solution, covered with a cover slip and examined microscopically under X10 objective of the light microscope. Terminal-spined eggs characteristic of S . haematobium were identified and counted manually. The infection intensity was defined by the number of eggs per 10 mL of urine, and categorized as light ( < 50 eggs/10 mL of urine) or heavy (≥50 eggs/10ml of urine) infection as defined by the WHO [30]. Similarly, fresh stool samples were analyzed using the Kato Katz technique employing a 41.7 mg template. Briefly, the feces were pressed through a mesh screen to remove large particles. A portion of the sieved sample was then transferred into the template orifice on each slide. After filling the hole, the template was removed and the sample (~ 41.7 mg) was firmly covered with a piece of cellophane soaked overnight in glycerol-malachite green (MG) solution. The glycerol clears the fecal material from around the eggs. The prepared slides were mounted under a Leica® light microscope and observed under X40 objective to identify the presence of S . mansoni , S. guineensis and STH eggs based on identification charts [27]. The fecal smears were examined within 1 hour of preparation to avoid missing hookworm ova. Duplicate smears were prepared for each individual sample and examined by trained and experienced microscopist. The intensity of infection was expressed as eggs/gram of feces (epg) [53]. Data analysis Data collected was entered in MS Excel, imported into and analyzed using GraphPad Prism V8 (GraphPad Software, La Jolla, California USA). Children were categorized into 3-9 and 10-15 years age groups. Continuous variables were summarized into means and standard deviations (SD), and categorical variables reported as frequencies while percentages were used to document descriptive statistics. General and species prevalence of malaria and schistosomiasis were calculated as the proportion of individuals that were identified as positive for the presence of parasites (or species) considering the villages, age group and gender category. Univariate logistic regression was used to assess the association between the prevalence of urogenital schistosomiasis with socio-demographics, KAP and WASH factors. Independent variables with a p-value < 0.25 were subjected to multivariate logistic regression analysis to obtain adjusted odds ratios (aOR). Pearson's chi-square test ( χ 2 ) and their p-value were used for comparisons of proportions. Significant levels were measured at 95 % confidence interval (CI) with statistically acceptable differences set at p < 0.05. Definitions of endpoints Sub-microscopic infection was defined as low-density blood-stage parasitemia that was not detected by the gold-standard microscopy but positive by nested PCR (nPCR). Asymptomatic malaria parasitemia was defined as the presence of Plasmodium parasite by microscopy or nPCR with an axillary temperature of < 37.5 °C and the absence of fever within the past 14 days while clinical malaria parasitemia was considered as the presence of Plasmodium , with an axillary temperature of ≥ 37.5 °C, joint pains, vomiting, headache, diarrhea, chills [54, 55]. Anemia was defined as Hb < 11.0 g/dL and further categorized as severe (Hb < 7.0 g/dL), moderate (Hb level: 7.0 - 10.0 g/dL), and mild (10.1 and < 11 g/dL) [44]. Similarly, non-symptomatic urinary schistosomiasis was defined as the presence of schistosome eggs in urine or stool by microscopy without any visible sign and symptoms of fever, hematuria, abdominal pain, and difficult/painful urination [56, 57] whereas ectopic egg excretion is considered as the presence of S. mansoni eggs in urine or S. haematobium eggs in feces [40, 58] . True positive (TP) – individuals who have the disease and test positive; False positive (FP) – individuals who do not have the disease but test positive; True negative (TN) – individuals who do not have the disease and test negative; False negative (FN) - individuals who have the disease but test negative. Sensitivity (Se) of the test is the ability of the test to identify correctly those who have the disease (true positive rate), usually denoted by Se = TP/ (TP + FN) while Specificity (Sp) of the test is the ability of the test to identify correctly those who do not have the disease (true negative rate), designated by Sp = TN/ (TN + FP). Positive predictive value (PPV) is the probability that a disease is present when the test is positive [PPV = TP/ (TP + FP)]. Negative predictive value (NPV) is the probability that the disease is not present when the test is negative [NPV = TN/ (TN + FN)]. Accuracy (Acc) is the overall probability that a patient will be correctly classified [Acc = (TP + TN)/ (TP + TN + FP + FN)] [59]. Results Baseline characteristics of the study participants A total number of 495 children (3–15 years) who completed questionnaires were enrolled and provided capillary blood, urine and stool samples for this study. The baseline characteristics of the study population are shown in Table 1. Stratification of the age group showed that 62.6 % (310) of the participants were between 3 to 9 years old while 37.4 % (185) were within the 10-15 years range. Among the 495 participants enrolled in this study, 45.5% (225) were females while 54.5% (270) were males. The respective mean age and weight for females of the 3-9 years age group was 6 years (±1.9) and 23.9 kg alongside 11.5 years (±1.6) and 41.6 kg for the 10 -15 years age group. Similarly, the mean age and weight for males of the 3-9 years group was 5.9 years (±1.8), 24.9 kg with the 10-15 group recording 11.7 years (±1.5), 37.4 kg (Table 1). Females (87.6%) with body temperature ˂ 37.5 °C were more than males ( χ 2 = 17.79, p = 0.021) however no statistical difference was observed across the age groups ( χ 2 = 1.64, p = 0.83). At the time of the survey, 26.2 % of females (59/225) and 25.6 % of males (69/270) were currently not enrolled in the local basic educational system, accounting for the literacy gap observed in this Region, compared to other regional localities in Cameroon. Table 1. Characteristics of study participants by sex and age in the three communities Category Variables Pitoa & Wourokessoum (N = 227) Bainga Assoura & Kola (N = 118) Gounougou (N = 150) Sex Female [41.4 (94)] Male [58.6 (133)] Female [45.8 (54)] Male [54.2 (64)] Female [51.3 (77)] Male [48.7 (73)] Age group (yr) 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 % (n) 56.4 (53) 43.6 (41) 59.4 (79) 40.6 (54) 74.1 (40) 25.9 (14) 62.5 (40) 37.5 (24) 67.5 (52) 32.5 (25) 63 (46) 36.9 (27) Mean age (yr ± SD) 5.9 ± 1.7 11.9 ± 1.7 6.4 ± 1.7 11.8 ± 1.5 6.4 ± 1.8 10.5 ± 0.8 5.7 ± 1.9 11.6 ± 1.5 5.9 ± 2.0 11.3 ± 1.6 5.3 ± 1.7 11.5 ± 1.5 Mean height (m ± SD) 1.2 ± 0.1 1.5 ± 0.1 1.2 ± 0.1 1.4 ± 0.1 1.2 ± 0.2 1.4 ± 0.1 1.1 ± 0.1 1.4 ± 0.1 1.1 ± 0.12 1.4 ± 0.1 1.1 ± 0.1 1.4 ± 0.1 Mean weight (kg ± SD) 26.1 ± 7.5 47.9 ± 11.8 28.5 ± 9.2 39.7 ± 10.9 21 ± 5.1 31.9 ± 6.0 19.7 ± 6.3 34 ± 7.2 24 ± 6.1 36.7 ± 7.1 23.4 ± 5.5 35.9 ± 5.3 Mean body temp ( 0 C) 36.9 36.9 36.8 36.7 36.7 36.7 36.7 36.7 36.8 36.8 36.9 36.7 Mean Hb (g/dL) 11.6 12.4 11.5 11.9 10.8 11.4 10.3 11.8 11.3 12.2 11.1 12.4 School enrollment Yes No 71.7 (38) 28.3 (15) 100 (41) 0 77.2 (61) 22.8 (18) 100 (54) 0 37.5 (15) 62.5 (25) 71.4 (10) 28.6 (4) 42.5 (17) 57.5 (23) 22 (91.7) 8.3 (2) 71.2 (37) 28.8 (15) 100 (25) 0 45.7 (21) 54.3 (25) 96.3 (26) 3.7 (1) Fever No Yes 90.6 (48) 9.4 (5) 97.6 (40) 2.4 (1) 91.1 (72) 9.9 (7) 96.3 (52) 3.7 (2) 85 (34) 15 (6) 92.9 (13) 7.1 (1) 95 (38) 5 (2) 95.8 (23) 4.2 (1) 92.3 (48) 7.7 (4) 88 (22) 12 (3) 93.5 (43) 6.5 (3) 96.3 (26) 3.7 (1) History of fever in the past 3 days Yes No 0 100 (53) 4.9 (2) 95.1 (39) 2.5 (2) 97.5 (77) 7.4 (4) 92.6 (50) 0 100 (40) 0 100 (14) 2.5 (1) 97.5 (39) 0 100 (24) 0 100 (52) 0 100 (25) 0 100 (46) 0 100 (27) Prevalence of malaria and associated risk factors among study participants Out of the 495 participants examined by microscopy, 31.5% (156/495) tested positive for malaria parasites (Table 2). Generally, males (34.8%, 94/270) recorded a higher parasite prevalence than females (27.6%, 62/225) ( χ 2 = 2.99, p = 0.08). Considering the sample size, children of 3-9 years were more infected (30.6%, 95/310) than the 10-15 years (32.9%, 61/185) age group although no significant difference in malaria prevalence was observed ( χ 2 = 0.29, p = 0.59). Among females, the 3-9 years age group had the highest malaria prevalence of 28.9% (42/145). Likewise, for the male gender, 32.1% (53/165) prevalence was observed in the 3-9 years category and 39% (41/105) in the 10–15 age cohort with no significant difference observed ( χ 2 = 1.36, p = 0.24). P. falciparum was the most dominant malaria causative species accounting for 62.1% (59/95) and 72.1% (44/61) of cases in the 3-9 and 10-15 age groups respectively. Mix infection of P. falciparum and P. malariae ( Pf+Pm ) was pronounced in the 3-9 years age group (10.5%, 10/95) and male gender (6.4%, 6/94) ( χ 2 = 13.3, p = 0.04). Mean P. falciparum trophozoite density was higher in males [1351 parasites/μL; (440-13040)] and the 3-9 years age group [1426 parasites/μL; (440-49840)]. Contrary to microscopy, RDT and nPCR reported a malaria prevalence of 37.8% (186) ( χ 2 = 4.02, p = 0.04) and 55.9% (277) ( χ 2 = 60.1, p < 0.0001) respectively as shown in Table 2. The proportion of infected population by gender varied between female [36.9% (83) RDT vs 58.2% (131) nPCR] ( χ 2 = 46.2, p < 0.0001) and male [38.1% (103) RDT vs 54.1% (146) nPCR] ( χ 2 = 29.4, p < 0.0001). Similarly, the 3-9 years age group documented higher prevalence [36.8% (114) RDT vs 56.1% (174) nPCR] ( χ 2 = 43.4, p < 0.0001) than the 10-15 years [38.9% (72) RDT vs 55.7% (103) nPCR] ( χ 2 = 30.5, p < 0.0001) (Fig. 2). PCR assay revealed that majority of the asymptomatic malaria infections among children were due to P. falciparum mono-infections accounting for a prevalence of 81.9% (227); with a substantial proportion [17.3% (48)] of P. falciparum + P. malariae mix infection. The 3-9 age structure [ Pf : 83.9% (146); Pf+Pm : 14.9% (26)] and the male sex [ Pf : 78.8% (115); Pf+Pm : 20.5% (30)] recorded the highest prevalence for both species (Fig. 2). While a single case of triple Pf+Pm+Po was observed, no infection with P. vivax was detected (Fig. 2). Table 2. Malaria prevalence, parasitemia indices and associated risk factors by study communities Category Variables Pitoa & Wourokessoum (N = 227) Bainga Assoura & Kola (N = 118) Gounougou (N = 150) Sex Female [41.4 (94)] Male [58.6 (133)] Female [45.8 (54)] Male [54.2 (64)] Female [51.3 (77)] Male [48.7 (73)] Age (yr) 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 % (n) 56.4 (53) 43.6 (41) 59.4 (79) 40.6 (54) 74.1 (40) 25.9 (14) 62.5 (40) 37.5 (24) 67.5 (52) 32.5 (25) 63.0 (46) 36.9 (27) Malaria prevalence RDTs Microscopy PCR 22.6 (12) 28.3 (15) 26.4 (14) 24.4 (10) 24.4 (10) 19.5 (8) 29.1 (23) 30.4 (24) 34.2 (27) 27.8 (15) 46.3 (25) 35.2 (19) 52.5 (21) 37.5 (15) 75 (30) 78.6 (11) 35.7 (5) 92.9 (13) 70 (28) 47.5 (19) 72.5(29) 66.7 (16) 29.2 (7) 87.5 (21) 34.6 (18) 23.1 (12) 80.8 (42) 44 (11) 20 (5) 96 (24) 26.1 (12) 21.7 (10) 69.6 (32) 33.3 (9) 33.3 (9) 66.7 (18) Prevalence of Plasmodium species Microscopy P. falciparum P. malariae P.f/P.m 86.7 (13) 13.3 (2) 0.0 (0) 90.0 (9) 10.0 (1) 0.0 (0) 83.3 (20) 12.5 (3) 4.2 (1) 76.0 (19) 20.0 (5) 4.0 (1) 33.3 (5) 33.3 (5) 33.3 (5) 60.0 (3) 40.0 (2) 0.0 (0) 42.1 (8) 42.1 (8) 15.8 (3) 57.1 (4) 28.6 (2) 14.3 (1) 41.7 (5) 50 (6) 8.3 (1) 40.0 (2) 60.0 (3) 0.0 (0) 80.0 (8) 20.0 (2) 0.0 (0) 77.8 (7) 22.2 (2) 0.0 (0) PCR P. falciparum P. malariae P.f/P.m P.f/P.m/P.o 100 (14) 0.0 (0) 0.0 (0) 0.0 (0) 87.5 (7) 0.0 (0) 12.5 (1) 0.0 (0) 88.9 (24) 0.0 (0) 11.1 (3) 0.0 (0) 84.2 (16) 0.0 (0) 15. (3) 0.0 (0) 76.7 (23) 3.3 (1) 20.0 (6) 0.0 (0) 76.9 (10) 0.0 (0) 23.1 (3) 0.0 (0) 69 (20) 0.0 (0) 31.0 (9) 0.0 (0) 61.9 (13) 0.0 (0) 38.1 (8) 0.0 (0) 90.5 (38) 0.0 (0) 9.5 (4) 0.0 (0) 83.3 (20) 0.0 (0) 16.7 (4) 0.0 (0) 84.4 (27) 0.0 (0) 12.5 (4) 3.1 (1) 83.3 (15) 0.0 (0) 16.7 (3) 0.0 (0) Geometric mean trophozoite (trophozoite/ µL) P. falciparum 1154.8 1350.9 1389.8 1124.3 1596.9 1005.3 1255.6 908.6 1275.8 1213.3 2417.3 1605.3 P. malariae 2380.6 375.2 424.4 537.2 451.7 1156.6 666.7 762.6 661.9 603.4 1534.7 3115.9 The prevalence of schistosomiasis, geohelminthiasis and intensity of infection In this study, 13.3% (66/495) of participants were positive for schistosomiasis comprising of 9.5% (47/495) urogenital and 3.8% (19/495) intestinal forms. Generally, males [69.7% (46/66)] documented significantly higher infection prevalence than females [30.3% (20/66)] ( χ 2 = 11.5, p = 0.0007). Likewise, the 3-9 years category [75.8% (50/66)] was remarkably infected than the 10-15 years [24.2% (16/66)] ( χ 2 = 16.8, p < 0.0001) (Fig. 2). The age-related and sex-related prevalence of both urogenital and intestinal schistosomiasis are presented on Table 3. The 3-9 years age group recorded a high prevalence of 72.3% (34/47) S. haematobium only infection compared to 19.1% (9/47) of the 10-15 group in the urogenital schistosomiasis cohort ( χ 2 = 29.1, p < 0.0001). Males (59.6%, 28/47) were more infected than females (31.9%, 15/47) ( χ 2 = 15.1, p = 0.0003). Similarly, for intestinal schistosomiasis, S. mansoni egg infection rate was higher in the 3-9 years range [78.9% (15/19)] and the male gender [78.9% (15/19)]. Interestingly, mixed-species infection of S. haematobium + S. mansoni and S. haematobium + S. mansoni + S. guineensis were observed in urine samples of infected individuals at a frequency of 6.4% (3/47) and 2.1% (1/47) respectively (Fig. 2). Gender disparity data showed that males [62.1% (41/66)] had higher schistosome egg infection rate than females [37.9% (25/66)] with the former scoring a prevalence of 57.4% (27/47) S. haematobium mono-and 78.9% (15/19) S. mansoni mono-infections than the later [ S. haematobium : 34.0% (16/47) and S. mansoni : 21.1% (4/19)]. The disparity in excretion of S. haematobium only eggs reveal that 27.9% (12/43) had heavy infection (HI: ≥50 eggs/10ml of urine) while 72.1% (31/43) had light infection (LI: < 50 eggs/10ml of urine). The geometric mean load was 211.1 (range: 76-1079) and 11.0 (range: 2-48) eggs per 10ml of urine for heavy and light infections respectively. Generally, high mean egg loads were observed in males and the 3-9 years group. Egg shedding varied between female [HI = 22.2% (4/18); LI = 77.8% (14/18); mean egg count = 25.5 (range: 3-384)] and male [HI = 31.0% (9/29); LI = 68.9% (20/29); mean egg count = 34.4 (range: 2-1079)] and among the different age groups including the 3 – 9 years [HI = 32.4% (11/34); LI = 67.6% (23/34); mean egg count = 19.9 (range: 2-384)] and 10 – 15 category [HI = 22.2% (2/9); LI = 77.8% (7/9); mean egg count = 69.1 (range: 3-1079)]. Similarly, S. mansoni egg excretion was reported for 28.8% (19/66) infected children categorized as 10.5% (2/19) heavy; 42.1% (8/19) moderate and 47.4% (9/19) light infections. The geometric mean egg counts were 605.9 (range: 510 – 720), 211.9 (range: 264 – 384) and 55.1 (range: 24 – 96) eggs per gram of stool for heavy (HI: ≥400), moderate (MI: 100-399) and light (LI: 1-99) infections respectively. Egg expulsion differed between male [HI = 13.3% (2/15); MI = 40% (6/15); LI = 46.7% (7/15); mean egg count = 128 (range: 24-1254)] and female [MI = 50% (2/4); LI = 50% (2/4); mean egg count = 80.7 (range: 24-192)] and among the 3 – 9 age group [HI = 20% (3/15); MI = 40% (6/15); LI = 40% (6/15); mean egg count = 102.4 (range: 24-384)] and 10 – 15 years cluster [MI = 25% (1/4); LI = 75% (3/4); mean egg count = 106.4 (range: 24-720)].Variation in S. haematobium + S. mansoni infection prevalence between gender and age groups reveals that males [66.7% (2/3); MEC = 17.9% were more infected than females [33.3% (1/3); MEC = 6]. Similarly, only the 3-9 years [88.9% (8/9); MEC = 23.7%] documented infection. Triple mixed S. haematobium + S. mansoni + S. guineensis eggs were observed only in males [25% (1/4); MEC = 53.2] with no apparent difference between age groups. Table 3. Prevalence and intensity of Schistosoma spp and STHs infections Category Variables Pitoa & Wourokessoum (N = 227) Bainga Assoura & Kola (N = 118) Gounougou (N = 150) Sex Female [41.4 (94)] Male [58.6 (133)] Female [45.8 (54)] Male [54.2 (64)] Female [51.3 (77)] Male [48.7 (73)] Age (yr) 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 3-9 10-15 % (n) 56.4 (53) 43.6 (41) 59.4 (79) 40.6 (54) 74.1 (40) 25.9 (14) 62.5 (40) 37.5 (24) 67.5 (52) 32.5 (25) 63 (46) 36.9 (27) Schistosomiasis prevalence Positive; % (n) 9.4 (5) 4.9 (2) 15.2 (12) 7.4 (4) 15.0 (6) 14.3 (2) 37.5 (15) 12.5 (3) 5.8 (3) 8.0 (2) 19.6 (9) 11.1 (3) Prevalence of Schistosoma species; % (n) S. haematobium 60.0 (3) 50 (1) 58.3 (7) 25 (1) 83.3 (5) 50.0 (1) 46.7 (7) 33.3 (1) 100 (3) 100 (2) 100 (9) 100 (3) S. mansoni 20.0 (1) 50 (1) 33.3 (4) 75 (3) 16.7 (1) 50.0 (1) 40.0 (6) 66.7 (2) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) S.h/S.m 1 20.0 (1) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 13.3 (2) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) S.h/S.m/S.g 1 0.0 (0) 0.0 (0) 8.3 (1) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) Prevalence of STHs A. lumbricoides 5.7 (3) 2.4 (1) 5.1 (4) 5.6 (3) 2.5 (1) 0.0 (0) 7.5 (3) 8.3 (2) 1.9 (1) 0.0 (0) 4.4 (2) 0.0 (0) Hookworms 0.0 (0) 0.0 (0) 0.0 (0) 1.9 (1) 0.0 (0) 0.0 (0) 2.5 (1) 0.0 (0) 1.9 (1) 0.0 (0) 0.0 (0) 0.0 (0) T. trichuris 0.0 (0) 0.0 (0) 1.3 (1) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) Intensity of helminths eggs S. haematobium 113.0 71.4 163.3 87.5 91.7 46.6 127 76.3 99.3 43.3 326.1 52.4 S. mansoni 141.5 24.0 118.4 71.6 176.0 48 160.3 96.0 63.0 21.0 91.7 24.0 S. guineensis 0.0 0.0 19.0 48.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Ascaris 206.8 424.2 538.8 408.5 345.2 0.0 504.0 251.7 166.3 0.0 528.0 0.0 Hookworm 0.0 0.0 0.0 24.0 0.0 0.0 48.0 0.0 24.0 0.0 0.0 0.0 Trichuris 0.0 0.0 24.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Key: Sh = S. haematobium ; Sm = S. mansoni ; Sg = S. guineensis ; 1 Presence of mixed Schistosoma species in urine There was significant correlation (r = 0.8) between microhematuria (prevalence: 10.3%) and nucleopore urine filtration in the diagnosis of urogenital schistosomiasis with a marked difference ( χ 2 = 279.7, p < 0.0001) between infected (MH + NUF + = 38) and un-infected (MH - NUF - = 435) individuals as highlighted in Table 4. Microhematuria exhibited a sensitivity and specificity of 80.9% and 97.1%. Among the STHs, A. lumbricoides was the most common [4.0% (20/495); 3 - 9 years: 70% (14); male: 65% (13)]; Hookworms [0.6% (3/495)] and Trichuiris [0.2% (1/495)]. Table 4. Pairwise comparison between microhematuria and nucleopore urine filtration in urogenital schistosomiasis diagnosis Category: Age/Sex Microhematuria (MH) Positive Negative Total Nucleopore Urine filtration (NUF) Positive 38 9 47 Negative 13 435 448 Total 51 444 495 Association between KAP, WaSH, Praziquantel (PZQ) intake and schistosomiasis outcome among the study participants There was a significant match between the determinants of risk factors of schistosomiasis and disease outcome. The most important factors associated with infection in the study areas were age and gender. Association factors such as poor knowledge, insufficient WaSH practices and frequent absence of consuming PZQ during school-based treatment campaigns were relatively higher in children between 3 – 9 years and strongly correlate with high schistosomiasis prevalence. Similarly, higher schistosomiasis prevalence was recorded in males exhibiting high risk factor scores including KAP, WaSH and PZQ intake as shown in Table S1. In Table 5, the univariate logistic data presents key determinants associated with the risk of schistosomiasis. Higher prevalence values correlated with lower class levels [unregistered to class (I-III): 86.4%]; poor knowledge on the cause of bilharzia (82.2%); absence of community water source (36.4%); bathing in streams (100%); use of streams as daily water source (77.1%); absence of communal toilets (73.7%); absence of individual house toilets (7.6%); open-air defecation and use of stream as excretion site (69.5%); lack of functional health club in school (88.1%); unawareness about periodic school deworming program (67.8%) and tendency of missing PZQ administration in school by teacher (55.9%). Table 5. Schistosomiasis risk factors analysis with age and sex Category Schistosomiasis risk factor score: % (n) Age (years) Sex Combined χ 2 [p-value] 3 – 9 10 – 15 F M Class level: unregistered to class (I-III) 84.8 (39) 55 (11) 64 (16) 82.9 (34) 75.8 (50) 12.9 [< 0.0001]** Poor knowledge on schistosomiasis 93.5 (43) 70 (14) 84 (21) 87.8 (36) 86.4 (57) 7.9 [0.005]* Absence of communal pipe-borne water 23.9 (11) 15 (3) 20 (5) 21.9 (9) 21.2 (14) 2.3 [0.13] Bathing in streams 89.1 (41) 100 (20) 88 (22) 95.1 (39) 92.4 (61) 9.5 [0.002]* Use of stream as daily water source 86.9 (40) 100 (20) 76 (19) 100 (41) 90.9 (60) 16.1 [< 0.0001]*** Absence of communal toilets 91.3 (42) 80 (16) 80 (20) 92.7 (38) 87.9 (58) 11.2 [0.0008]* Absence of household toilets 36.9 (17) (35) 7 36 (9) 36.6 (15) 36.4 (24) 3 [0.08] Open air defecation and excrete in streams 86.9 (40) 15 (3) 44 (11) 78.1 (32) 65.2 (43) 20.5 [< 0.0001]*** Lack of functional health club in school 76.1 (35) 45 (9) 68 (17) 65.9 (27) 66.7 (44) 4.5 [0.03]* Unaware of periodic school deworming 58.7 (27) 35 (7) 40 (10) 58.5 (24) 51.5 (34) 11.5 [0.007]** Missed taking PZQ regularly 67.4 (31) 80 (16) 52 (13) 82.9 (34) 71.2 (47) 18.8 [< 0.0001]*** Significant: * = p < 0.05, ** = p < 0.001, *** = p < 0.0001) Prevalence of malaria and schistosome co-infection (polyparasitism) and impact on anemia level The prevalence of malaria/schistosomiasis and malaria/STHs polyparasitism was 11.9% (59/495) and 1.2% (6/495) respectively with the predominance of P. falciparum / S. haematobium co-infection followed by P. falciparum/S. mansoni . The overall anemia prevalence was 32.9% (163/495) with a greater proportion categorized as moderate. A positive association (r = 0.9; p < 0.01) between P. falciparum prevalence and schistosome infection was observed. Notably, children infected with S. mansoni had significantly higher P. falciparum parasite density compared to S. haematobium/Plasmodium spp co-infection or P. falciparum mono-infection implying that S. mansoni may influence the severity of malaria and the malaria parasite density. P. falciparum / S. haematobium- infected children had lower mean parasite density than their P. falciparum only counterpart with a reduction in hemoglobin concentration. Similarly, mixed P. falciparum + P. malariae infection with S. mansoni was associated with a two-fold higher malaria parasite load than the S. haematobium equivalent. Contrarily, P. falciparum and Ascaris infection was negatively correlated although a significantly higher mean trophozoite density compared to P. falciparum mono-infection was observed for the few co-infected cases as shown in Table 6. Table 6. Association between Plasmodium species and helminths worms and impact on mean parasite density and Hb level Category Prevalence: % (n) + Geometric mean parasite density (parasites/μL) Anemia status: Hb level [% (n)] Age (years) χ 2 [p-value] Sex χ 2 [p-value] 3 – 9 10 – 15 F M * Pf only 62.8 (174) 1263.8 10.2 [46.6 (81)] 10.4 [13.2 (23)] 64.7 [0.0000]* 10.4 [36.2 (63)] 10.2 [23.6 (41)] 9.3 [0.002]* * Pf + Pm only 13.4 (37) 806.1 9.6 [51.4 (19)] 10.4 [ 27.0 (10)] 5.6 [0.02]* 9.9 [45.9 (17)] 9.6 [32.4 (12)] 1.7 [0.18] Pf/Sh 55.9 (33) 1072.9 9.9 [63.6 (21)] 10.1 [ 15.2 (5)] 19.6 [0.0009]* 10.2 [30.3 (10)] 10.5 [48.5 (16)] 2.8 [0.09] Pf/Sm 18.6 (11) 2249.9 10.3 [72.7 (8)] 10.8 [9.1 (1)] 10.9 [0.001]* 10.6 [27.3 (3)] 10.4 [54.5 (6)] 2 [0.16] Pf/Sh + Sm 5.1 (3) 160 10.5 [ 100 (3)] 0 6 [0.01]* 0 10.4 [100 (3)] 6 [0.01]* Pf + Pm/Sh 11.9 (7) 415.7 9.6 [71.4 (5)] 0 10 [0.002]* 10.3 [42.9 (3)] 10. 4[28.6 (2)] 0.4 [0.53] Pf + Pm/Sm 6.8 (4) 784.1 10.3 [75 (3)] 0 6 [0.01]* 10.5 [25 (1)] 10.2 [50 (2)] 0.67 [0.41] Pf/Ascaris 30 (6) 2287.5 10.2 [ 50 (3)] 10.5 [ 16.7 (1)] 2 [0.15] 10.3 [33.3 (2)] 10.6 [33.3 (2)] 0.19 [0.66] *Prevalence of Pf and Pm was inferred from PCR; + Mean Parasite density was computed from microscopy/PCR true positives. Significant p<0.05; Key: Pf = P. falciparum ; Pm = P. malariae ; Sh = S. haematobium ; Sm = S. mansoni ; Hb = Hemoglobin Discussion Malaria and helminths infection are responsible for a significant burden of morbidity and mortality in children across many parts of the world. Dependent on Anopheles mosquito and snail intermediate host (notably for schistosomiasis) for complete life-cycle propagation, Plasmodium and schistosome parasites respectively encounter a remarkable challenge during the dry season in regions where the absence of rain limits the vector or intermediate host abundance and survival for several months [ 60 , 61 ]. Moreover, the social, ecological and environmental drivers facilitating transmission of these diseases are significantly lessened during the dry season. While the majority of malaria and helminthiasis cases are predominant during the wet season, clinically silent asymptomatic P. falciparum and helminths infections can persist through the dry season and constitute an important reservoir for transmission during the advent of the next rainy season. This study therefore investigated the prevalence and factors driving sustained malaria and helminths transmission despite regular delivery of long-lasting insecticide treated nets and systematic PZQ/ALB preventive chemotherapy campaigns by control programs. Whilst there has been a sizeable reduction in malaria burden among children ˂ 5 years in the North Region of Cameroon from 2000 to 2020; [ 2 ] the current study reports a high Plasmodium prevalence in children notably between 5 and 10 years. This epidemiological shift in malaria prevalence from younger preschool children (˂ 5 years) who constitute the primary at-risk group to school-age children (5–15 years) is attributed to the massive implementation of various control strategies that have largely contributed in protecting the under-five vulnerable populations [ 11 , 14 , 62 ]. Compared with younger children, SAC often experience mild clinical disease, usually harboring infections that go untreated. Also, their reduced likelihood of utilizing malaria prevention methods such as insecticide treated bed nets further predisposes them to infectious mosquito bites that facilitate transmission. This is contrary to the preschool where the scale-up of LLINs and ACTs has led to a decline of malaria prevalence in this age group although mean parasite density is often high owing to low-level acquired immunity [ 15 , 63 ]. A high prevalence of P. falciparum asymptomatic malaria in the SAC group was observed at a prevalence of 46.9%, lower than 91.6% recorded during the rainy season in this Region by a previous study [ 32 ]. These asymptomatic infections may affect the performance of epidemiological diagnostic tools such that detection of these parasites becomes difficult and are missed by traditional microscopy and RDTs [ 54 , 64 ]. Males recorded a higher Plasmodium infection prevalence and mean parasite density than their female counterpart probably because of the tendency to participate in outdoor activities for longer periods without protection and the non-adherent to sleeping under LLINs. Co-infection of P. falciparum and P. malariae in children was responsible for anemia (10.5%, 29/277) probably as a result of the double impact on RBC lysis, further contributing to the substantial morbidity burden. On the other hand, the epidemiology and transmission of schistosomiasis in the North Region is governed by a nexus of human behavior, cultural factors, socio-economic status, and ecology which cooperate to spur the biological interaction between the human and snail host life cycle stages of the parasite and establishes the relevance for community monitoring and evaluation of prevalence and intensity of infection in order to document the impact of treatment success and to optimize control programme outputs [ 52 ]. Schistosomiasis presents a public health challenge in this Region where a majority of the inhabitant population relies on water networks of the Geoges de Kola and Lagdo dam for daily activities that constitutes the source of schistosome infection particularly in the BAK and Gounougou communities [ 31 , 37 ]. This may also be influenced by the population influx from the Boko Haram conflict-hit zones which further imposes a huge reliance on water bodies for daily activities and facilitates the contamination of these waters with urine or stool-infected schistosome eggs that enhances infection of the snail intermediate host [ 31 , 42 ]. This study therefore highlights the sympatric transmission of persistent urogenital and intestinal schistosomiasis in three communities characterized by a high prevalence, risk and severity of infection in the 3–9 years age cohort and males than their respective counterparts despite fifteen years of regular PZQ and ABZ school-based mass deworming campaigns. However, due to the constrained 2020 COVID pandemic wave, PZQ and ABZ MDA campaigns were not implemented in this Region. Age and gender were two key predictive determinants of infection. Children in the age groups 3–9 years were twice more likely to be at risk of schistosomiasis infection than the 10–15 years. This younger age group exhibits high frequency of contact with water sources for domestic purposes such as bathing, laundry, fishing and drinking. Also, since PZQ does not prevent reinfection of the immature worm stages, parasite transmission could not be interrupted [ 28 ]. However, besides PZQ administration, the contribution of age-acquired immunity to (re)infection accounts for a decrease in infection prevalence for the older 10–15 years children regardless of their enormous water contact habits [ 61 ]. The intensity of both S. haematobium and S. mansoni egg excretion was significantly lower in the older aged children compared to their counterpart. Although an important element, behavioral differences in exposure alone are insufficient to account for the significant reduction in intensity of infection with age, especially post-PZQ treatment. Indeed, the intensity of egg excretion is largely influenced by age mediated immunity to a reduction in worm fecundity and egg load [ 65 , 66 ]. This well documented inverse relationship between prevalence, infection intensity and increasing age could be explained by the direct effect of parasite metabolic regulation and host mediated innate resistance to infection that drives a strong protective immunity associated with increased hormonal levels during puberty [ 61 ]. Additionally, the wide access and use of ACTs may have also contributed in the observed reduction in egg intensity [ 67 ]. As predicted, sex variation in prevalence and intensity of egg excretion was significantly higher in the male gender due to prolonged exposure to cercariaeted-snail infested streams during swimming and fishing activities which are more common amongst males than females as highlighted by several studies [ 68 , 69 ]. However, this differs with other studies reporting females as the predominantly infected gender probably owing to the frequent water contact tendencies involved during laundry activities. The observed intensity of egg infection in both males and females poses a high risk of male genital (MGS) and female genital schistosomiasis (FGS) respectively; amplified by the high frequency of unawareness (58.5% males; 64% females) about schistosomiasis risk factors and transmission routes in primary school children of these villages as also observed with similar studies across Africa [ 25 , 26 ]. The presence of S. haematobium eggs in urine with the verbal reports of females experiencing hematuria, dysuria and itchy urination may suggest the occurrence of genital schistosomiasis infection that poses a serious yet neglected disease burden in women. Caused by the deposition of eggs in the female reproductive tract, this condition often leads to chronic fibrosis and scarring with irreversible long term consequence on sexual dysfunction aggravated by genital ulcers and infertility problems [ 52 ]. Moreover, a low frequency of mixed schistosome infections ( S. haematobium , S. mansoni and S. guineensis) were identified in infected children owing to the focal distribution of the snail intermediate hosts and substantial human mobility between transmission sites [ 70 ]. Also, Leger & Webstar (2016) [ 77 ] previously revealed evidence of mating between distantly related schistosome species notably S. haematobium males and S. mansoni female adult worms in Central Africa leading to the deposition and excretion of hybrid eggs through the urogenital tract thereby aggravating the outcome of urogenital schistosomiasis and associated pathologies [ 70 ]. This consequently has an impact both on the nature of disease morbidity and the success of MDA control programmes. Infection load, defined by egg count was generally low with 9.5% shedding eggs in urine characterized by a majority (72.3%) of light infection intensity status (< 50 eggs/10 ml urine). This could be attributed to a shrink in the network of factors favoring schistosomiasis transmission and infection intensity among the study population including age, minimal water contact, drying-up of temporal water bodies, marked reduction in snail population density during the dry season and concomitant immunity as a consequence of past infections or poly-parasitism [ 61 ]. In particular, the geographical distribution and abundance of the snail intermediate host ( Bulinus spp or Biomphalaria spp ) is a principal determinant, accounting to a large extent for variation in seasonal transmission of the disease. Indeed, during the dry season, the adult snails die while the younger snail population aestivates under the soil to ensure adaptation and survival during the next rainy season [ 71 , 72 ]. This may explain the reason for the decreased prevalence compared to previous studies conducted during the rainy season in this Region. This study also assessed the association between schistosomiasis infection, school attendance, KAP and water, sanitation and hygiene (WaSH) practice among children. The observed schistosomiasis prevalence aligns with the high prevalence of children who are unenrolled and do not attend school regularly; further leading to poor therapeutic compliance outcome. Previous studies have indicated that intensity of S. haematobium infection which is often associated with hematuria negatively impacts school attendance with high cognitive and psychological mental health consequences on the infected children [ 73 ]. The generally observed low primary school attendance in the study localities hinders the non-school enrolled SAC and PSAC from treatment campaign benefits, further reiterating the necessity to effectively include this neglected group. In line with the current WHO guidelines on schistosomiasis control and elimination [ 30 ], this study therefore emphasizes the opinion of a treatment scale-up from the school-centered approach to an intensified community-based preventive chemotherapy strategy inclusively targeting all at risk groups (SAC, PSAC, occupation-related, pregnant women) to reduce disease morbidity [ 30 , 74 ]. Furthermore, the lack of comprehension about the factors associated with schistosomiasis transmission even after several years of school system based PZQ campaigns reflects the limited public health knowledge about the disease combined with the high level of illiteracy. Indeed, many of the older children (9–15 years) usually accompany their parents for cattle breeding activities during school periods; further contributing to the poor knowledge gap and reduced treatment uptake [ 61 ]. Also, the co-utilization of streams for cattle rearing may increase the risk of bovine schistosomiasis transmission [ 72 ]. Moreover, the absence of functional health education clubs in primary schools of these communities is also contributing to the disease knowledge gap. Emphasis must be directed towards strengthening health education through the promotion and implementation of local language-based comic cartoons in schools of endemic areas as a complementary intervention for reducing morbidity and transmission. This will boost the local social and behavioral change communication practices in communities. However, in spite of the fundamental role of health education in disease prevention, improvement of community water supply is imperative to limit frequent contact with streams and reduce the incidence of diarrhea possibly caused by cryptosporidiosis or Rotavirus infection [ 23 ]. Furthermore, in this study, the reliability of urine reagent strips as an indicator for detecting infection was 80.9% agreeing with a previous meta-analysis that reported a sensitivity and specificity of 81% and 89% respectively [ 75 ]. However, the observed “non-symptomatic” urinary schistosomiasis in the older age group may be attributed to the combined effect of immune response and low egg infection intensity leading to possibly undetected microhematuria by urine strips which was otherwise identified by the more sensitive urine filtration technique. Importantly, the biologically significant minority hotspot of high egg shedding individuals in these localities poses concern in sustaining disease transmission necessitating further investigation on the genetic determinants predisposing such reservoir super-spreaders. As expected, STHs were not common in these localities, similar to the previous study by [ 27 ]. Although replicate slides of a single individual fecal sample may be adequate at baseline in moderate to high endemic zones, the Kato-Katz technique may have a low sensitivity for S. mansoni and STHs diagnosis. In addition to mono-parasite infections, this study demonstrated the common occurrence of polyparasitism whereby 13.1% of children were simultaneously co-infected with mixed Plasmodium species and helminths worms. Bivariate analysis revealed a positive association between schistosomiasis and malaria attributed to schistosome-mediated polarized Th2/Treg immunomodulation that leads to increase susceptibility to Plasmodium infection and may increase the risk of malaria transmission in areas of co-endemicity, in line with numerous published findings [ 34 , 35 , 76 ] but contrary to [ 77 , 78 ].Notably, while S. mansoni infection was an important predictor of malaria parasite density, S. haematobium infection was a significant predictor of anemia and malaria prevalence. However, this correlation was negatively skewed for Ascaris infections probably due to the arid eco-epidemiological limitations of factors that favor the seasonal transmission of the parasite in these settings. Previous studies have shown the protective effect of Ascaris worms on P. falciparum infection [ 34 , 79 ]. This observation should be interpreted with caution since only six cases of Ascaris/P. falciparum prevalence were documented. On the other hand, concomitant Ascaris/P. falciparum infection was associated with a high geometric mean asexual P. falciparum trophozoite carriage than P. falciparum mono-infection. This shows that the association between malaria and helminthic infections may depend on the host age and specific type of worm infection and therefore underscores for further investigation [ 10 , 34 ]. Both Plasmodium parasite and Plasmodium -helminth infection types were associated with moderate anemia as indicated by the mean hemoglobin score. This may probably be explained by the “light” majority of helminth infections observed supported by the fact that anemia caused by helminths is dependent on the intensity of infection [ 10 ]. In agreement with other studies, lower Hb levels and anemia correlated with single and multi-parasitic infections [ 34 , 80 ]. In rural settings, malnutrition and parasitic infections are the major causes of anemia. The anemia level of children in this study sources from destruction of infected red blood cells and alteration of hematopoiesis by Plasmodium parasites in addition to the pathology of chronic blood loss by the spined-eggs of schistosome infections [ 81 ]. This observation reveals that synergistic interaction between multiple parasite infections increases the risk and clinical outcome of anemia particularly in children. The cross-sectional design of this study being a limitation implies that a longitudinal characterization involving a higher sample size of children in these localities will provide fine insights on the biology, interaction and transmission dynamics of malaria, schistosomiasis and STHs. Similarly, this study focused on quantifying schistosomiasis prevalence only in mostly school-age children without including other high risk groups including pre-school, pregnant women and occupation-related inhabitants. Also, schistosomiasis diagnosis was based on parasitological capture that employed only a single collection of urine and stool samples instead of the standard three consecutive samples and this may have underestimated the prevalence by missing patent infection. Likewise, malacological and ecological surveys including snail population bionomics and cercariae infection in mollusks which constitute key targets in schistosomiasis control were not done. However, the current findings provide a situational prevalence of these diseases during the dry season. Conclusion These findings demonstrate that despite regular LLINs distribution and over fifteen years of preventive chemotherapy campaigns, multiple parasite infections are frequent in children who constitute hidden reservoirs of asymptomatic malaria infections and epidemiological carriers of schistosome worms. This suggests that malaria control must prioritize targeting asymptomatic cases through sensitive diagnostic testing strategies and expanded treatment interventions. Likewise, interruption of schistosomiasis transmission in these villages requires multisectoral health system strengthening efforts involving high-level PZQ/ALB geographic coverage and therapeutic compliance of all at-risk groups, unlimited access to WASH facilities and community-driven health education programs structured towards improving behavioral change. This study also highlights that schistosomiasis enhances the susceptibility to Plasmodium infection and increases the risk of malaria and anemia in school children. Moreover, the study provides further evidence that optimizing helminth control interventions in children dually contribute to reducing the malaria and anemia burden in endemic areas where both diseases geographically overlap. Declarations Ethics approval and consent to participate The study received institutional approvals (2021/1250-10/UB/SG/IRB/FHS) and (N0 2020/05/1234/CE/CNERSH/SP) from the Ethics Review Board of the Faculty of Health Sciences, University of Buea and the Cameroon National Committee on Ethics for Human Health Research respectively. Administrative authorization was sought from the North Regional Delegations of Public Health and Basic Education, Garoua, Cameroon. The study was conducted in conformity with the World Medical Association (WMA) guidelines as highlighted in the Declaration of Helsinki. Sensitization of the population was done in the various communities prior to the study. The purpose, risk and benefits of the study was explained to the parents and guardians of children both in French and the local dialect (Fulfulde) and written informed consent was obtained from all the parents/guardians whose children were enrolled in the study. By signing the form, the participants agreed to answer a questionnaire and to provide finger-prick blood, urine and stool samples for parasitological analysis. Confidentiality was respected as participants responded to the questionnaire and even during data processing and analyses, as well as during data sharing. Participation was voluntary, and individuals could freely terminate involvement in the study at any time, even without prior notice. Children positive for malaria were administered first line treatment as recommended by the national treatment guideline policy. However, children positive for schistosomiasis and worm infections were referred to the local district hospital where free Praziquantel (40 mg/kg body weight) and Albendazole (400 mg) treatments were respectively given in accordance with the Cameroon Schistosomiasis Control Program (PNLSHI) [28, 30]. Availability of data and materials: All relevant data are within the paper and its supplementary files. Competing interests: The authors have declared that no competing interests exist. Funding: FNN received a Joint Royal Society of Tropical Medicine & Hygiene (RSTMH) and National Institute of Health Research (NIHR) early career research grant (https://rstmh.org/grants/grant-awardees-2020/nihr-awardees-2020). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. Authors' contributions: Conceptualization: FNN, CSW, SW; Data curation: FNN, LWGR, AMN; Formal analysis: FNN, LWGR, AMN, DNN; Funding acquisition: FNN; Investigation: FNN, LWGR, DNN, AMN, AK, LMJM, MJW, RAS; Methodology: FNN, AMN, AK, DNN; Resources : FNN, CSW, FN, JPW, AK, RAS, YGF; Project administration: FNN, CSW, SW, FN, CN; Supervision: CSW, SW, JPW, FN, CN; Writing – original draft: FNN; Writing – review & editing: FNN, DNN, AMN, AK, LMJM, MJW, RAS, DN, YGF, JF, CN, FN, JPW, SW, CSW. Acknowledgments The authors express thankfulness to the school children who took part in this study and to their parents/guardians for consenting. Special thanks to the community leaders and district health workers of the various study localities for their assistance in data collection. The authors are also grateful to the field work and laboratory staff members particularly Mr. Agbor Jean Pierre, Mr. Simon Daga and Mr. Ahmadou Ahidjo for the specimen preparation and reading of slides. 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Nkeng","email":"","orcid":"","institution":"Forzi Higher Institute of Science, Agriculture, and Technology (FHISAT)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Asongha","middleName":"M.","lastName":"Nkeng","suffix":""},{"id":138708561,"identity":"959f8918-1284-45c5-9771-0d5510819387","order_by":4,"name":"Alvine Kengne","email":"","orcid":"","institution":"University of Yaoundé I","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alvine","middleName":"","lastName":"Kengne","suffix":""},{"id":138708562,"identity":"8336ef68-3e02-4e37-b2e7-bc081cd17035","order_by":5,"name":"Leon M. J. Mugenzi","email":"","orcid":"","institution":"Centre for Research in Infectious Diseases","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Leon","middleName":"M. J.","lastName":"Mugenzi","suffix":""},{"id":138708563,"identity":"a2880395-0540-4c53-bb5b-314ee4ff7701","order_by":6,"name":"Yvan G. Fotso-Toguem","email":"","orcid":"","institution":"Centre for Research in Infectious Diseases","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yvan","middleName":"G.","lastName":"Fotso-Toguem","suffix":""},{"id":138708564,"identity":"95c06307-c5a5-4a4d-86c8-0e303c3efd52","order_by":7,"name":"Murielle J. Wondji","email":"","orcid":"","institution":"Liverpool School of Tropical Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Murielle","middleName":"J.","lastName":"Wondji","suffix":""},{"id":138708565,"identity":"cb360e7d-d7d2-4d01-9f54-dca8370a6a7a","order_by":8,"name":"Robert A. Shey","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"A.","lastName":"Shey","suffix":""},{"id":138708566,"identity":"9bbe083e-16e2-484f-8750-3ff612caded3","order_by":9,"name":"Jerome Fru-Cho","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jerome","middleName":"","lastName":"Fru-Cho","suffix":""},{"id":138708567,"identity":"f5ff53c7-c4d3-451f-8338-8b3bb318367f","order_by":10,"name":"Cyrille Ndo","email":"","orcid":"","institution":"University of Douala","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cyrille","middleName":"","lastName":"Ndo","suffix":""},{"id":138708568,"identity":"2e23c61c-62a2-49ef-a46a-207cefe5484d","order_by":11,"name":"Flobert Njiokou","email":"","orcid":"","institution":"University of Yaoundé I","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Flobert","middleName":"","lastName":"Njiokou","suffix":""},{"id":138708569,"identity":"3f70a098-6f39-40d5-a293-51a9bdf5cb1d","order_by":12,"name":"Joanne P. Webstar","email":"","orcid":"","institution":"University of London","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Joanne","middleName":"P.","lastName":"Webstar","suffix":""},{"id":138708570,"identity":"87452537-6fbe-4f73-b27c-804c1321f77b","order_by":13,"name":"Samuel Wanji","email":"","orcid":"","institution":"University of Buea","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Wanji","suffix":""},{"id":138708571,"identity":"870332f5-23f3-457f-8927-3c001b31c714","order_by":14,"name":"Charles S. Wondji","email":"","orcid":"","institution":"Liverpool School of Tropical Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Charles","middleName":"S.","lastName":"Wondji","suffix":""},{"id":138708572,"identity":"68fadcba-0b18-48d7-bf61-70ddb0af78cd","order_by":15,"name":"Daniel Nguiffo-Nguete","email":"","orcid":"","institution":"Centre for Research in Infectious Diseases","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Nguiffo-Nguete","suffix":""}],"badges":[],"createdAt":"2022-07-18 20:59:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1871446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1871446/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27153530,"identity":"3664192e-7d68-40b1-9d54-c44a9eaf35d1","added_by":"auto","created_at":"2022-09-29 20:22:45","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":326110,"visible":true,"origin":"","legend":"\u003cp\u003eStudy sites\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1871446/v1/781876bd4c20b62320ecdfe6.jpg"},{"id":27153532,"identity":"c01b468e-dee0-4b2d-9882-bc70996b94f5","added_by":"auto","created_at":"2022-09-29 20:22:46","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":193964,"visible":true,"origin":"","legend":"\u003cp\u003eAge and Sex related prevalence and species composition of (a) \u003cem\u003ePlasmodium\u003c/em\u003e sppand (b) \u003cem\u003eSchistosoma\u003c/em\u003e spp\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1871446/v1/76247c73a2f0651b01d94d0e.jpg"},{"id":27153533,"identity":"2e1f47f8-7044-4b07-95b6-66f60c868984","added_by":"auto","created_at":"2022-09-29 20:22:46","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":198592,"visible":true,"origin":"","legend":"\u003cp\u003ePictorial illustration of \u003cem\u003ePlasmodium\u003c/em\u003eand schistosomeparasites\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1871446/v1/acfba873bdd509d3eca6538f.jpg"},{"id":27981099,"identity":"942be4b6-c0c1-4041-9c22-7cda24f68c21","added_by":"auto","created_at":"2022-10-19 10:29:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1145492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1871446/v1/42c1624f-e2a4-482c-9a34-563a0e947c05.pdf"},{"id":27153621,"identity":"d8593f80-8a67-4338-9cbf-f4324f6616d9","added_by":"auto","created_at":"2022-09-29 20:27:45","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":43318,"visible":true,"origin":"","legend":"","description":"","filename":"1SupplementaryFNN0622.docx","url":"https://assets-eu.researchsquare.com/files/rs-1871446/v1/cf130e9319d50cc1b1cf5296.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological burden of persistent co-transmission of malaria, schistosomiasis, and geohelminthiasis among 3-15 years old children during the dry season in Northern Cameroon","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite the implementation of control measures since the early 2000s, malaria and helminth infections rank as the most prevalent parasitic diseases in Cameroon where they impose a tremendous public health burden particularly on children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Malaria was responsible for 6,840,000 cases and more than 3,500 deaths in 2019 with \u003cem\u003eP. falciparum\u003c/em\u003e accounting for approximately 95% of the attributed deaths in the country [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].In addition, the circulation and expansion of non- \u003cem\u003eP. falciparum\u003c/em\u003e species particularly \u003cem\u003eP. malariae\u003c/em\u003e [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and \u003cem\u003eP. ovale\u003c/em\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], often co-existing with \u003cem\u003eP. falciparum\u003c/em\u003e has been reported to widen the force of transmission and increase the magnitude of disease severity with anemia being the most profound outcome [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The disease exerts a significant impact on morbidity and mortality on children under five (0-5years) due, at least in part to diminished naturally acquired protective immunity [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As such, interventions such as long-lasting insecticide treated nets (LLINs), artemisinin combination therapy (ACTs), intermittent preventive treatment for infants (IPTi), seasonal malaria chemoprevention (SMC) and vaccination programs are concentrated on this group in order to significantly reduce the risk of death [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, beyond the under-five age category, school-aged children (SAC) (5\u0026ndash;15 years) represent a relevant demographic group due to ease of accessibility in primary schools although epidemiological data on their malaria burden is lacking [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Due to repeated exposure to malaria and acquisition of partial immunity to disease in high transmission settings, SAC are frequently subjected to prolonged carriage of untreated asymptomatic parasitemia thereby serving as potential infectious reservoirs for sustaining transmission [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, with the changing pattern and dynamics of malaria transmission in Cameroon following the scale-up of control interventions from 2015, monitoring the course in morbidity in the SAC age group remains absolutely fundamental to evaluating the success of control programmes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In spite of these, evidence from epidemiological studies has demonstrated that in areas of co-endemicity, children exposed to malaria have a high likelihood to helminth infections [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Helminthic infections particularly schistosomiasis (\u003cem\u003eSchistosoma haematobium\u003c/em\u003e, \u003cem\u003eS. mansoni\u003c/em\u003e and \u003cem\u003eS. guineensis\u003c/em\u003e) and soil-transmitted worms (\u003cem\u003eAscaris lumbricoides\u003c/em\u003e, \u003cem\u003eAncylostoma duodenale, Necator americanus\u003c/em\u003e and \u003cem\u003eTrichuris trichiura\u003c/em\u003e) are chronic debilitating neglected tropical diseases prevalent in Cameroon, and affecting more than 200,000 people [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The diseases thrive mostly in poor and rural communities where the vulnerable groups suffer from anemia, reduced productivity and poor psychological development [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Transmission of the diseases is primarily governed by social-ecological factors where access to safe water, poor latrine system, inadequate hygiene and sanitation practices combined with domestic activities predisposes the high-risk groups particularly children to water contacts or infected soils harboring the infective larva forms of the parasites [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Pathology of these diseases is largely mediated by the eggs which are often excreted in urine or feces to ensure continuity of the parasite life cycle [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The spined-eggs can lodge or persist in internal body organs stimulating immune reactions that lead to complications, particularly the conditions of female and male genital schistosomiasis which are still less recognized pathologies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Preventive chemotherapy (PCT) through school based periodic administration of praziquantel (PZQ) and albendazole (ABZ) to school-age children remains the cornerstone of schistosomiasis and STH control respectively in endemic foci in Cameroon [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. While this strategy reduces the egg load and minimizes transmission, it does not prevent infection or re-infection thereby posing concerns on the potential long-term interruption of disease transmission [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Moreover, the exclusion of infected pre-school children and adults from treatment campaigns implies that these groups continually serve as transmission hotspots and may suffer from serious reproductive and mental health outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In Cameroon, helminth infections, particularly schistosomiasis, are endemic in the Northern Region due to a complex of human factors, including weak health system and conditions favoring the establishment of the snail intermediate hosts that drives disease transmission [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Moreover, there exist enormous evidence on the prevalence and seasonal transmission of malaria and helminthiasis during the rainy season in the Region with limited available data during the dry season. Despite frequent geographical co-existence of polyparasitism with malaria and helminthiasis, the majority of research efforts still focus on the epidemiology of single infections [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] without assessing the epidemiological impact of polyparasitism which often tends to be chronic. This is fundamental as helminth infections particularly schistosomiasis and ascariasis have been implicated to exacerbate and/or suppress \u003cem\u003eP. falciparum\u003c/em\u003e infection and impair vaccine efficacy, making it relevant to assess the impact of co-infection on malaria outcome [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Also, since SAC and pre-school (PSAC) children are often under-represented in infectious diseases community-based cluster surveys, the burden of malaria and helminthiasis respectively in these cohorts remains poorly ascertained. Indeed, information on the co-morbidity and interactions between malaria and helminthiasis would be crucial in disease intervention strategies. Thus, this study sought to provide an update on the prevalence of malaria and helminths infections and to comprehensively assess the risk factors associated with the disease transmission in the North Region of Cameroon. These findings will contribute in the design or improvement of policy decision strategies to concomitantly interrupt malaria and helminths transmission in Cameroon.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in March 2021 during the dry season in three community health districts (HD) of the sudano-guinean climatic zone of the North Region of Cameroon (Fig. 1). These communities mainly dominated by Muslims include Pitoa Centre (9\u003csup\u003e0\u003c/sup\u003e38\u0026rsquo;95\u0026rdquo; N, 13\u003csup\u003e0\u003c/sup\u003e50\u0026rsquo;15\u0026rdquo; E) and Wouro-kessoum (PWK) (9\u003csup\u003e0\u003c/sup\u003e38\u0026rsquo;93\u0026rdquo; N, 13\u003csup\u003e0\u003c/sup\u003e50\u0026rsquo;14\u0026rdquo; E) in the Pitoa health district (PHD), Bainga Assoura (9\u003csup\u003e0\u003c/sup\u003e85\u0026rsquo;35\u0026rdquo; N, 13\u003csup\u003e0\u003c/sup\u003e95\u0026rsquo;68\u0026rdquo; E) and Kola (BAK) (9\u003csup\u003e0\u003c/sup\u003e85\u0026rsquo;86\u0026rdquo; N, 13\u003csup\u003e0\u003c/sup\u003e95\u0026rsquo;94\u0026rdquo; E) harboring a major touristic feature - Georges de Kola- in the Guider health district (GHD) and Gounougou (GNG) (9\u0026deg;03\u0026prime;00\u0026Prime;N, 13\u0026deg;43\u0026prime;59\u0026Prime;E) in the Lagdo health district (LHD); with daily temperatures ranging from 28 \u003csup\u003e0\u003c/sup\u003eC to 35 \u003csup\u003e0\u003c/sup\u003eC. The choice of selected sites was guided by the geo-cardinal positions (Fig.1) combined with the existence of previously available malaria and helminths parasitological data during the rainy season\u0026nbsp;[32, 37].\u0026nbsp;The climate of these localities is characterized by a short rainy season from May to September (mean annual rainfall of 900 to 1000 mm) and a long dry season from October to April\u0026nbsp;[38].\u0026nbsp;Farming (cotton and rice cultivation), cattle rearing and fishing are the primary occupation of the inhabitants since these communities are proximal to natural and artificial water bodies including major rivers (e.g., River Benou\u0026eacute;), streams and a hydroelectric power plant (Lagdo dam)\u0026nbsp;[39, 40]. These water bodies constitute the principal breeding sites of the snail intermediate host\u0026nbsp;[40].\u0026nbsp;Poor infrastructure planning with most houses lacking toilets or water system and the common practice of open defecation is the norm in these villages\u0026nbsp;[41].\u0026nbsp;Moreover, the influx of displaced persons from the Boko-Harram conflict-hit areas in the Far-North Region\u0026nbsp;[42]\u0026nbsp;coupled with conditions of poor personal and environmental sanitation facilities, exacerbates the transmission of diseases like schistosomiasis.\u0026nbsp;Indeed, the general lack of latrines and inadequate potable water supply at the community level compels the population to utilize these water bodies for personal, household and livelihood activities; further risking exposure to Schistosoma cercariae\u0026nbsp;[37].\u0026nbsp;However, sustained annual preventive chemotherapy-based MDA of PZQ and ABZ to SAC has been ongoing for over 15 years\u0026nbsp;[19]. Furthermore, malaria transmission is seasonal\u0026nbsp;[2]\u0026nbsp;with the peak period ranging from September to October. \u003cem\u003eAnopheles coluzzii\u0026nbsp;\u003c/em\u003eand \u003cem\u003eAn. arabiensis\u0026nbsp;\u003c/em\u003eare the main vectors involved\u0026nbsp;[16, 38]\u0026nbsp;with majority of the households administered a LLIN by the Cameroon National Malaria Control Programme at a coverage of ~ 76% during the 2018 mass distribution campaign\u0026nbsp;[2]..\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and sample size determination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community-based cross sectional design was utilized to recruit both pre-school\u0026nbsp;(3-4 years) and school aged (5-15 years) children residing in the North Region of Cameroon. The sample size of the study population was calculated based on a previous schistosomiasis prevalence of 38.5% during the rainy season considering that malaria is endemic in this region.\u0026nbsp;The sample size was determined using the Lorenz formula. The total number of samples N is given by: \u0026nbsp;N = Z\u003csup\u003e2\u003c/sup\u003e x P (1-P)/d\u003csup\u003e2\u003c/sup\u003e [43]\u0026nbsp;where Z is the standard normal deviation, Z = 1.96 for the confidence level of 95%, P = 0.385; proportion of schistosomiasis prevalence, d is the error width of the confidence interval (0.05). The minimum estimated sample size calculated was 370. A\u0026nbsp;total of 555 participants were considered for recruitment to anticipate factors like effect size, voluntary withdrawal and for greater precision. Each participant provided the three specimens including blood spot, stool and urine samples. Parents and their respective children were invited by local community leaders to assemble at a major focal point in each of the selected communities for sample collection. Health\u0026nbsp;education\u0026nbsp;talks on preventive measures for these diseases were delivered before each screening exercise. Furthermore, a questionnaire was administered to each participant by a trained research assistant to obtain anthropometric and socio-demographic data. As inclusion criteria, only children who had lived for at least a year in the selected villages and whose parents/guardians consented to participate were enrolled in the study. Those who declined to participate in the study or failed to provide feces or urine samples after the interview were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdministration of questionnaire and clinical assessment:\u0026nbsp;\u003c/strong\u003eA simple structured questionnaire was used to collect information about each individual based on the following indicators: socio-demographic data (including name, address, age, gender, educational level), clinical data, malaria risk factors (including knowledge on malaria, history of fever, long lasting insecticide treated nets (LLINs) ownership and use, antimalarial intake), schistosomiasis risk factors (including knowledge on schistosomiasis, source of water supply, frequency of water contact, open-air defecation practice, hand\u0026nbsp;washing and hygienic practice, deworming history).\u0026nbsp;A digital thermometer was used to measure the axillary temperature and fever was defined as body temperature \u0026ge; 37.5 \u0026deg;C.\u0026nbsp;Participants\u0026rsquo; heights were\u0026nbsp;measured using a\u0026nbsp;stadiometer\u0026nbsp;while a weighing balance of 120 Kg was used to measure the body weight.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample collection and parasitological examination:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinger prick (capillary) blood sample was collected from each individual to measure hemoglobin (Hb) level using a hemoglobinometer and perform a malaria rapid diagnostic test using the CareStart\u003csup\u003eTM\u003c/sup\u003e Malaria Pf/Pan (HRP2/pLDH) antigen Combo kit following standard procedures\u0026nbsp;[44].\u0026nbsp;Blood aliquots were used to prepare thick and thin films on labeled slides to determine the malaria parasite density using the Giemsa staining technique.\u0026nbsp;Slides were observed under X100 objective lens (oil immersion) of light microscope\u0026nbsp;[45].\u0026nbsp;Each blood film was independently examined under the light microscope by two trained and experienced microscopists, based on established protocols for the detection and identification of \u003cem\u003ePlasmodium\u003c/em\u003e parasites. Slides were considered positive when asexual stages (trophozoites and schizonts) or gametocytes were identified. Parasite density was determined on thick blood films by systematic counting of parasite numbers against at least 200 white blood cells (WBCs), assuming a standard WBC count of 8000/\u0026micro;L. If gametocytes were detected, the count was extended to 500 leukocytes\u0026nbsp;[45].\u0026nbsp;Malaria parasitemia was categorized as low (\u0026le; 1,000 parasite/\u0026mu;L of blood), moderate (1,000 \u0026ndash; 5,000 parasites/\u0026mu;L of blood) and high (\u0026gt; 5,000 parasites/\u0026mu;L of blood). Slides were considered negative after\u0026nbsp;scanning through the entire stained smear\u0026nbsp;[46].\u003c/p\u003e\n\u003cp\u003eFollowing the same slide and RDT numerical codes, three drops of capillary blood aliquoted onto an ID labeled\u0026nbsp;Whatman 3 mm filter paper were air-dried, kept in a sealed plastic bag and stored at room temperature for subsequent laboratory analysis. The dried blood spots (DBS) samples were used to detect and identify the malaria parasite species and to determine sub-microscopic \u003cem\u003ePlasmodium\u0026nbsp;\u003c/em\u003einfection. Genomic DNA was extracted from the DBS using chelex beads\u0026nbsp;[47, 48]\u0026nbsp;while primary and nested polymerase chain reaction (PCR) assays were run to discriminate the \u003cem\u003ePlasmodium\u003c/em\u003e species. The primary PCR was done using a pair of \u003cem\u003ePlasmodium\u0026nbsp;\u003c/em\u003egenus-specific primers which amplifies a 1100-base pair (bp) PCR product from the 18S rRNA small subunit gene while the nested primers are specific to the 04 human \u003cem\u003ePlasmodium\u0026nbsp;\u003c/em\u003especies (\u003cem\u003eP. falciparum, P. malariae, P. ovale\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;P. vivax\u003c/em\u003e) as described by\u0026nbsp;[49-51].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrine and stool analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn the day of enrolment, all parents/guardians of children who participated in the questionnaire sampling received two separate 50 mL sterile, wide mouthed; screw capped plastic\u0026nbsp;containers\u0026nbsp;carrying their identification information for urine and stool collection. Considering the circadian pattern of schistosome egg excretion, participants were requested to collect urine samples between 10 am\u0026ndash; 2 pm\u0026nbsp;[52].\u0026nbsp;Upon receipt of urine, hematuria was immediately determined by visual inspection and urine reagent strips (Uric11V, ACCU-ANSWER\u003csup\u003e\u0026reg;\u003c/sup\u003e) following the manufacturers\u0026rsquo; instruction. All urine and stool samples were stored in cooling boxes containing air cooler ice packs at temperature of about 4˚C to prevent \u003cem\u003eS\u003c/em\u003e. \u003cem\u003ehaematobium\u003c/em\u003e eggs from hatching and hookworm eggs from degrading during transportation to the laboratory for processing within 12-18 hours of collection. The urine samples were processed using the Nucleopore syringe urine filtration technique and examined microscopically for the presence of \u003cem\u003eS\u003c/em\u003e.\u0026nbsp;\u003cem\u003ehaematobium\u0026nbsp;\u003c/em\u003einfection based on morphology of the ova\u0026nbsp;[30, 41].\u0026nbsp;Briefly, 10-mL homogenized urine collected using a syringe was forced through a polycarbonate membrane filter (STERLITECH Corporation, USA). The filter was removed from the filter holder, and placed on a glass slide using blunt-ended forceps. The slide template was stained with 1% Lugol\u0026rsquo;s Iodine Solution, covered with a cover slip and examined microscopically under X10 objective of the light microscope. Terminal-spined eggs characteristic of \u003cem\u003eS\u003c/em\u003e. \u003cem\u003ehaematobium\u0026nbsp;\u003c/em\u003ewere identified and counted manually. The infection intensity was defined by the number of eggs per 10 mL of urine, and categorized as light (\u003cem\u003e\u0026lt;\u003c/em\u003e50 eggs/10\u0026nbsp;mL\u0026nbsp;of urine) or heavy (\u0026ge;50 eggs/10ml of urine) infection as defined by the WHO\u0026nbsp;[30].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilarly, fresh stool samples were analyzed using the Kato Katz technique employing a 41.7 mg template. Briefly, the feces were pressed through a mesh screen to remove large particles. A portion of the sieved sample was then transferred into the template orifice on each slide. After filling the hole, the template was removed and the sample (~ 41.7 mg) was firmly covered with a piece of cellophane soaked overnight in glycerol-malachite green (MG) solution. The glycerol clears the fecal material from around the eggs. The prepared slides were mounted under a Leica\u0026reg; light microscope and observed under X40 objective to identify the presence of \u003cem\u003eS\u003c/em\u003e.\u003cem\u003e\u0026nbsp;mansoni\u003c/em\u003e, \u003cem\u003eS. guineensis\u003c/em\u003e and STH eggs based on identification charts\u0026nbsp;[27].\u0026nbsp;The fecal smears were examined within 1 hour of preparation to avoid missing hookworm ova. Duplicate smears were prepared for each individual sample and examined by trained and experienced\u0026nbsp;microscopist. The intensity of infection was expressed as eggs/gram of feces (epg)\u0026nbsp;[53].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collected was entered in MS Excel, imported into and analyzed using GraphPad Prism V8 (GraphPad Software, La Jolla, California USA). Children were categorized into 3-9 and 10-15 years age groups. Continuous variables were summarized into means and standard deviations (SD), and categorical variables reported as frequencies while percentages were used to document descriptive statistics. General and species prevalence of malaria and schistosomiasis were calculated as the proportion of individuals that were identified as positive for the presence of parasites (or species) considering the villages, age group and gender category. Univariate logistic regression was used to assess the association between the prevalence of urogenital schistosomiasis with socio-demographics, KAP and WASH factors.\u0026nbsp;Independent variables with a p-value \u003cem\u003e\u0026lt;\u0026nbsp;\u003c/em\u003e0.25 were subjected to multivariate logistic regression analysis to obtain adjusted odds ratios (aOR).\u0026nbsp;Pearson\u0026apos;s\u0026nbsp;chi-square test\u0026nbsp;(\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e) and their p-value were used for comparisons of proportions. Significant levels were measured at 95 % confidence interval (CI) with statistically acceptable differences set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions of endpoints\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSub-microscopic infection was defined as low-density blood-stage parasitemia that was not detected by the gold-standard microscopy but positive by nested PCR (nPCR). Asymptomatic malaria parasitemia was defined as the presence of \u003cem\u003ePlasmodium\u003c/em\u003e parasite by microscopy or nPCR with an axillary temperature of \u0026lt; 37.5 \u0026deg;C and the absence of fever within the past 14 days while clinical malaria parasitemia was considered as the presence of \u003cem\u003ePlasmodium\u003c/em\u003e, with an axillary temperature of \u0026ge; 37.5 \u0026deg;C, joint pains, vomiting, headache, diarrhea, chills\u0026nbsp;[54, 55]. Anemia was defined as Hb \u0026lt; 11.0 g/dL and further categorized as severe (Hb \u0026lt; 7.0 g/dL), moderate (Hb level: 7.0 - 10.0 g/dL), and mild (10.1 and \u0026lt; 11 g/dL)\u0026nbsp;[44].\u0026nbsp;Similarly, non-symptomatic urinary schistosomiasis was defined as the presence of schistosome eggs in urine or stool by microscopy without any visible sign and symptoms of fever, hematuria, abdominal pain, and difficult/painful urination\u0026nbsp;[56, 57]\u0026nbsp;whereas ectopic egg excretion is considered as the presence of\u0026nbsp;\u003cem\u003eS. mansoni\u003c/em\u003e eggs in urine or \u003cem\u003eS. haematobium\u0026nbsp;\u003c/em\u003eeggs in feces\u0026nbsp;[40, 58]\u0026nbsp;.\u003c/p\u003e\n\u003cp\u003eTrue positive (TP) \u0026ndash; individuals who have the disease and test positive; False positive (FP) \u0026ndash; individuals who do not have the disease but test positive; True negative (TN) \u0026ndash; individuals who do not have the disease and test negative; False negative (FN) - individuals who have the disease but test negative. Sensitivity (Se) of the test is the ability of the test to identify correctly those who have the disease (true positive rate), usually denoted by Se = TP/ (TP + FN) while Specificity (Sp) of the test is the ability of the test to identify correctly those who do not have the disease (true negative rate), designated by Sp = TN/ (TN + FP). Positive predictive value (PPV) is the probability that a disease is present when the test is positive [PPV = TP/ (TP + FP)]. Negative predictive value (NPV) is the probability that the disease is not present when the test is negative [NPV = TN/ (TN + FN)]. \u0026nbsp;Accuracy (Acc) is the overall probability that a patient will be correctly classified [Acc = (TP + TN)/ (TP + TN + FP + FN)] [59].\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total number of 495 children (3\u0026ndash;15 years) who completed questionnaires were enrolled and provided capillary blood, urine and stool samples for this study. The baseline characteristics of the study population are shown in Table 1. Stratification of the age group showed that 62.6 % (310) of the participants were between 3 to 9 years old while 37.4 % (185) were within the 10-15 years range. Among the 495 participants enrolled in this study, 45.5% (225) were females while 54.5% (270) were males. The respective mean age and weight for females of the 3-9 years age group was 6 years (\u0026plusmn;1.9) and 23.9 kg alongside 11.5 years (\u0026plusmn;1.6) and 41.6 kg for the 10 -15 years age group. Similarly, the mean age and weight for males of the 3-9 years group was 5.9 years (\u0026plusmn;1.8), 24.9 kg with the 10-15 group recording 11.7 years (\u0026plusmn;1.5), 37.4 kg (Table 1). Females\u0026nbsp;(87.6%) with\u0026nbsp;body temperature ˂ 37.5 \u0026deg;C were more than males (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 17.79, p = 0.021) however no statistical difference was observed across the age groups (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 1.64, p = 0.83). At the time of the survey, 26.2 % of females (59/225) and 25.6 % of males (69/270) were currently not enrolled in the local basic educational system, accounting for the literacy gap observed in this Region, compared to other regional localities in Cameroon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Characteristics of study participants by sex and age in the three communities\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.118062563067609%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" width=\"7.265388496468214%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"26.337033299697275%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePitoa \u0026amp; Wourokessoum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 227)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"26.942482341069628%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBainga Assoura \u0026amp; Kola\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 118)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" width=\"26.337033299697275%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGounougou\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"14.176663031624864%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.176663031624864%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[41.4 (94)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.176663031624864%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[58.6 (133)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.830970556161397%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[45.8 (54)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[54.2 (64)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.176663031624864%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[51.3 (77)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"14.176663031624864%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[48.7 (73)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"14.192139737991265%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (yr)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.751091703056769%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"14.192139737991265%\"\u003e\n \u003cp\u003e\u003cstrong\u003e% (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e56.4 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e43.6 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e59.4 (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e40.6 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.751091703056769%\"\u003e\n \u003cp\u003e74.1 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e25.9 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e62.5 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e37.5 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e67.5 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e32.5 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e63 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.096069868995633%\"\u003e\n \u003cp\u003e36.9 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(yr \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e5.9 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.9 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e6.4 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.8 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e6.4 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e10.5 \u0026plusmn; 0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e5.7 \u0026plusmn; 1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.6 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e5.9 \u0026plusmn; 2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.3 \u0026plusmn; 1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e5.3 \u0026plusmn; 1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.5 \u0026plusmn; 1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean height\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(m \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.5 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.4 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e1.2 \u0026plusmn; 0.2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.4 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.4 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.4 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.1 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e1.4 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean weight\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(kg \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e26.1 \u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e47.9 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e28.5 \u0026plusmn; 9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e39.7 \u0026plusmn; 10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e21 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e31.9 \u0026plusmn; 6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e19.7 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e34 \u0026plusmn; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e24 \u0026plusmn; 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7 \u0026plusmn; 7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e23.4 \u0026plusmn; 5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e35.9 \u0026plusmn; 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean body temp (\u003csup\u003e0\u003c/sup\u003eC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.186234817813765%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.578947368421052%\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Hb (g/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool enrollment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e71.7 (38)\u003c/p\u003e\n \u003cp\u003e28.3 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e100 (41)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e77.2 (61)\u003c/p\u003e\n \u003cp\u003e22.8 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e100 (54)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e37.5 (15)\u003c/p\u003e\n \u003cp\u003e62.5 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e71.4 (10)\u003c/p\u003e\n \u003cp\u003e28.6 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e42.5 (17)\u003c/p\u003e\n \u003cp\u003e57.5 (23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e22 (91.7)\u003c/p\u003e\n \u003cp\u003e8.3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e71.2 (37)\u003c/p\u003e\n \u003cp\u003e28.8 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e100 (25)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e45.7 (21)\u003c/p\u003e\n \u003cp\u003e54.3 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e96.3 (26)\u003c/p\u003e\n \u003cp\u003e3.7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFever\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e90.6 (48)\u003c/p\u003e\n \u003cp\u003e9.4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e97.6 (40)\u003c/p\u003e\n \u003cp\u003e2.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e91.1 (72)\u003c/p\u003e\n \u003cp\u003e9.9 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e96.3 (52)\u003c/p\u003e\n \u003cp\u003e3.7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e85 (34)\u003c/p\u003e\n \u003cp\u003e15 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e92.9 (13)\u003c/p\u003e\n \u003cp\u003e7.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e95 (38)\u003c/p\u003e\n \u003cp\u003e5 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e95.8 (23)\u003c/p\u003e\n \u003cp\u003e4.2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e92.3 (48)\u003c/p\u003e\n \u003cp\u003e7.7 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e88 (22)\u003c/p\u003e\n \u003cp\u003e12 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e93.5 (43)\u003c/p\u003e\n \u003cp\u003e6.5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e96.3 (26)\u003c/p\u003e\n \u003cp\u003e3.7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"13.157894736842104%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of fever in the past 3 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.287449392712551%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e4.9 (2)\u003c/p\u003e\n \u003cp\u003e95.1 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e2.5 (2)\u003c/p\u003e\n \u003cp\u003e97.5 (77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e7.4 (4)\u003c/p\u003e\n \u003cp\u003e92.6 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"7.186234817813765%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e2.5 (1)\u003c/p\u003e\n \u003cp\u003e97.5 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"6.578947368421052%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e100 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of malaria and associated risk factors among study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the 495\u0026nbsp;participants\u0026nbsp;examined by microscopy, 31.5% (156/495)\u0026nbsp;tested positive for malaria parasites (Table 2). Generally, males (34.8%, 94/270) recorded a higher parasite prevalence than females (27.6%, 62/225) (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 2.99,\u0026nbsp;p = 0.08). Considering the sample size, children of 3-9 years were more infected (30.6%, 95/310) than the 10-15 years (32.9%, 61/185) age group although no significant difference in malaria prevalence was observed\u0026nbsp;(\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.29, p = 0.59). Among females, the 3-9 years age group had the highest malaria prevalence of 28.9% (42/145). Likewise, for the male gender, 32.1% (53/165) prevalence was observed in the 3-9 years category and 39% (41/105) in the 10\u0026ndash;15 age cohort with no significant difference observed (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 1.36, p = 0.24). \u003cem\u003eP. falciparum\u003c/em\u003e was the most dominant malaria causative species accounting for 62.1% (59/95) and 72.1% (44/61) of cases in the 3-9 and 10-15 age groups respectively. Mix infection of \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. malariae\u003c/em\u003e (\u003cem\u003ePf+Pm\u003c/em\u003e) was pronounced in the 3-9 years age group (10.5%, 10/95) and male gender (6.4%, 6/94) (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 13.3, p = 0.04). Mean \u003cem\u003eP. falciparum\u003c/em\u003e trophozoite density was higher in males [1351 parasites/\u0026mu;L; (440-13040)] and the 3-9 years age group [1426 parasites/\u0026mu;L; (440-49840)]. Contrary to microscopy, RDT and nPCR reported a malaria prevalence of 37.8% (186) (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 4.02, p = 0.04) and 55.9% (277) (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 60.1, p \u0026lt; 0.0001) respectively as shown in Table 2. The proportion of infected population by gender varied between female [36.9% (83) RDT vs 58.2% (131) nPCR] (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 46.2, p \u0026lt; 0.0001) and male [38.1% (103) RDT vs 54.1% (146) nPCR] (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 29.4, p \u0026lt; 0.0001). Similarly, the 3-9 years age group documented higher prevalence [36.8% (114) RDT vs 56.1% (174) nPCR] (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 43.4, p \u0026lt; 0.0001) than the 10-15 years [38.9% (72) RDT vs 55.7% (103) nPCR] (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u0026thinsp;= 30.5, p \u0026lt; 0.0001) (Fig. 2). PCR assay revealed that majority of the asymptomatic malaria infections among children were due to \u003cem\u003eP. falciparum\u003c/em\u003e mono-infections accounting for a prevalence of 81.9% (227); with a substantial proportion [17.3% (48)] of \u003cem\u003eP. falciparum\u003c/em\u003e + \u003cem\u003eP. malariae\u0026nbsp;\u003c/em\u003emix infection. The 3-9 age structure [\u003cem\u003ePf\u003c/em\u003e: 83.9% (146); \u003cem\u003ePf+Pm\u003c/em\u003e:\u003cem\u003e\u0026nbsp;\u003c/em\u003e14.9% (26)] and the male sex\u0026nbsp;[\u003cem\u003ePf\u003c/em\u003e: 78.8% (115); \u003cem\u003ePf+Pm\u003c/em\u003e: 20.5% (30)] recorded the highest prevalence for both species (Fig. 2). While a single case of triple \u003cem\u003ePf+Pm+Po\u0026nbsp;\u003c/em\u003ewas observed, no infection with \u003cem\u003eP. vivax\u003c/em\u003e was detected (Fig. 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Malaria prevalence, parasitemia indices and associated risk factors by study communities\u003c/p\u003e\n\u003ctable align=\"left\" border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.112403100775193%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" width=\"9.98062015503876%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"25.58139534883721%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePitoa \u0026amp; Wourokessoum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 227)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"26.162790697674417%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBainga Assoura \u0026amp; Kola\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 118)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"26.162790697674417%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGounougou\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.455328310010763%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.208826695371368%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[41.4 (94)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.208826695371368%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[58.6 (133)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.854682454251884%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[45.8 (54)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.208826695371368%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[54.2 (64)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.854682454251884%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[51.3 (77)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.208826695371368%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[48.7 (73)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.455328310010763%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (yr)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.750269106566201%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.750269106566201%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.455328310010763%\"\u003e\n \u003cp\u003e\u003cstrong\u003e% (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e56.4 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e43.6 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e59.4 (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e40.6 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e74.1 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.750269106566201%\"\u003e\n \u003cp\u003e25.9 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e62.5 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e37.5 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.750269106566201%\"\u003e\n \u003cp\u003e67.5 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e32.5 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e63.0 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.104413347685684%\"\u003e\n \u003cp\u003e36.9 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.112403100775193%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalaria prevalence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.98062015503876%\"\u003e\n \u003cp\u003eRDTs\u003c/p\u003e\n \u003cp\u003eMicroscopy\u003c/p\u003e\n \u003cp\u003ePCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e22.6 (12)\u003c/p\u003e\n \u003cp\u003e28.3 (15)\u003c/p\u003e\n \u003cp\u003e26.4 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e24.4 (10)\u003c/p\u003e\n \u003cp\u003e24.4 (10)\u003c/p\u003e\n \u003cp\u003e19.5 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e29.1 (23)\u003c/p\u003e\n \u003cp\u003e30.4 (24)\u003c/p\u003e\n \u003cp\u003e34.2 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e27.8 (15)\u003c/p\u003e\n \u003cp\u003e46.3 (25)\u003c/p\u003e\n \u003cp\u003e35.2 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e52.5 (21)\u003c/p\u003e\n \u003cp\u003e37.5 (15)\u003c/p\u003e\n \u003cp\u003e75 (30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e78.6 (11)\u003c/p\u003e\n \u003cp\u003e35.7 (5)\u003c/p\u003e\n \u003cp\u003e92.9 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e70 (28)\u003c/p\u003e\n \u003cp\u003e47.5 (19)\u003c/p\u003e\n \u003cp\u003e72.5(29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e66.7 (16)\u003c/p\u003e\n \u003cp\u003e29.2 (7)\u003c/p\u003e\n \u003cp\u003e87.5 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e34.6 (18)\u003c/p\u003e\n \u003cp\u003e23.1 (12)\u003c/p\u003e\n \u003cp\u003e80.8 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e44 (11)\u003c/p\u003e\n \u003cp\u003e20 (5)\u003c/p\u003e\n \u003cp\u003e96 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e26.1 (12)\u003c/p\u003e\n \u003cp\u003e21.7 (10)\u003c/p\u003e\n \u003cp\u003e69.6 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e33.3 (9)\u003c/p\u003e\n \u003cp\u003e33.3 (9)\u003c/p\u003e\n \u003cp\u003e66.7 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"12.112403100775193%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of \u003cem\u003ePlasmodium\u0026nbsp;\u003c/em\u003especies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.98062015503876%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eMicroscopy\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP.f/P.m\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86.7 (13)\u003c/p\u003e\n \u003cp\u003e13.3 (2)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.0 (9)\u003c/p\u003e\n \u003cp\u003e10.0 (1)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.3 (20)\u003c/p\u003e\n \u003cp\u003e12.5 (3)\u003c/p\u003e\n \u003cp\u003e4.2 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.0 (19)\u003c/p\u003e\n \u003cp\u003e20.0 (5)\u003c/p\u003e\n \u003cp\u003e4.0 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33.3 (5)\u003c/p\u003e\n \u003cp\u003e33.3 (5)\u003c/p\u003e\n \u003cp\u003e33.3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e60.0 (3)\u003c/p\u003e\n \u003cp\u003e40.0 (2)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42.1 (8)\u003c/p\u003e\n \u003cp\u003e42.1 (8)\u003c/p\u003e\n \u003cp\u003e15.8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57.1 (4)\u003c/p\u003e\n \u003cp\u003e28.6 (2)\u003c/p\u003e\n \u003cp\u003e14.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41.7 (5)\u003c/p\u003e\n \u003cp\u003e50 (6)\u003c/p\u003e\n \u003cp\u003e8.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40.0 (2)\u003c/p\u003e\n \u003cp\u003e60.0 (3)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e80.0 (8)\u003c/p\u003e\n \u003cp\u003e20.0 (2)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e77.8 (7)\u003c/p\u003e\n \u003cp\u003e22.2 (2)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.3561190738699%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePCR\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP.f/P.m\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP.f/P.m/P.o\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e100 (14)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87.5 (7)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e12.5 (1)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e88.9 (24)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e11.1 (3)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84.2 (16)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e15. (3)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.7 (23)\u003c/p\u003e\n \u003cp\u003e3.3 (1)\u003c/p\u003e\n \u003cp\u003e20.0 (6)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.938257993384785%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76.9 (10)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e23.1 (3)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e69 (20)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e31.0 (9)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61.9 (13)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e38.1 (8)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.938257993384785%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e90.5 (38)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e9.5 (4)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.3 (20)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e16.7 (4)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e84.4 (27)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e12.5 (4)\u003c/p\u003e\n \u003cp\u003e3.1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e83.3 (15)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003cp\u003e16.7 (3)\u003c/p\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"12.112403100775193%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGeometric mean trophozoite\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(trophozoite/\u003c/strong\u003e\u003cstrong\u003e\u0026micro;L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.98062015503876%\"\u003e\n \u003cp\u003e\u003cem\u003eP. falciparum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1154.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1350.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1389.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1124.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1596.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e1005.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1255.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e908.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e1275.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1213.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e2417.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e1605.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.3561190738699%\"\u003e\n \u003cp\u003e\u003cem\u003eP. malariae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e2380.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e375.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e424.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e537.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e451.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.938257993384785%\"\u003e\n \u003cp\u003e1156.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e666.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e762.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.938257993384785%\"\u003e\n \u003cp\u003e661.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e603.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e1534.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.276736493936053%\"\u003e\n \u003cp\u003e3115.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe prevalence of schistosomiasis, geohelminthiasis and intensity of infection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 13.3% (66/495) of participants were positive for schistosomiasis comprising of 9.5% (47/495) urogenital and 3.8% (19/495) intestinal forms. Generally, males [69.7% (46/66)] documented significantly higher infection prevalence than females [30.3% (20/66)]\u0026nbsp;(\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 11.5, p = 0.0007). Likewise, the 3-9 years category [75.8% (50/66)] was remarkably infected than the 10-15 years [24.2% (16/66)] (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 16.8, p \u0026lt; 0.0001) (Fig. 2). The age-related and sex-related prevalence of both urogenital and intestinal schistosomiasis are presented on Table 3. The 3-9 years age group recorded a high prevalence of 72.3% (34/47) \u003cem\u003eS. haematobium\u003c/em\u003e only infection compared to 19.1% (9/47) of the 10-15 group in the urogenital schistosomiasis cohort (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 29.1, p \u0026lt; 0.0001). Males (59.6%, 28/47) were more infected than females (31.9%, 15/47)\u0026nbsp;(\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 15.1, p = 0.0003). Similarly, for intestinal schistosomiasis, \u003cem\u003eS. mansoni\u003c/em\u003e egg infection rate was higher in the 3-9 years range [78.9% (15/19)] and the male gender [78.9% (15/19)]. Interestingly, mixed-species infection of \u003cem\u003eS. haematobium\u003c/em\u003e + \u003cem\u003eS. mansoni\u0026nbsp;\u003c/em\u003eand\u003cem\u003e\u0026nbsp;S. haematobium\u003c/em\u003e + \u003cem\u003eS. mansoni\u0026nbsp;\u003c/em\u003e+\u003cem\u003e\u0026nbsp;S. guineensis\u003c/em\u003e were observed in urine samples of infected individuals at a frequency of 6.4% (3/47) and 2.1% (1/47) respectively (Fig. 2). Gender disparity data showed that males [62.1% (41/66)] had higher schistosome egg infection rate than females [37.9% (25/66)] with the former scoring a prevalence of 57.4% (27/47) \u003cem\u003eS. haematobium\u003c/em\u003e mono-and 78.9% (15/19) \u003cem\u003eS. mansoni\u003c/em\u003e mono-infections than the later [\u003cem\u003eS. haematobium\u003c/em\u003e: 34.0% (16/47) and \u003cem\u003eS. mansoni\u003c/em\u003e: 21.1% (4/19)]. The disparity in excretion of \u003cem\u003eS. haematobium\u003c/em\u003e only eggs reveal that 27.9% (12/43) had heavy infection (HI: \u0026ge;50 eggs/10ml of urine) while 72.1% (31/43) had light infection (LI: \u003cem\u003e\u0026lt;\u003c/em\u003e50 eggs/10ml of urine). The geometric mean load was 211.1 (range: 76-1079) and 11.0 (range: 2-48) eggs per 10ml of urine for heavy and light infections respectively. Generally, high mean egg loads were observed in males and the 3-9 years group. Egg shedding varied between female [HI = 22.2% (4/18); LI = 77.8% (14/18); mean egg count = 25.5 (range: 3-384)] and male [HI = 31.0% (9/29); LI = 68.9% (20/29); mean egg count = 34.4 (range: 2-1079)] and among the different age groups including the 3 \u0026ndash; 9 years [HI = 32.4% (11/34); LI = 67.6% (23/34); mean egg count = 19.9 (range: 2-384)] and 10 \u0026ndash; 15 category [HI = 22.2% (2/9); LI = 77.8% (7/9); mean egg count = 69.1 (range: 3-1079)]. Similarly, \u003cem\u003eS. mansoni\u003c/em\u003e egg excretion was reported for 28.8% (19/66) infected children categorized as 10.5% (2/19) heavy; 42.1% (8/19) moderate and 47.4% (9/19) light infections. The geometric mean egg counts were 605.9 (range: 510 \u0026ndash; 720), 211.9 (range: 264 \u0026ndash; 384) and 55.1 (range: 24 \u0026ndash; 96) eggs per gram of stool for heavy (HI: \u0026ge;400), moderate (MI: 100-399) and light (LI: 1-99) infections respectively. Egg expulsion differed between male [HI = 13.3% (2/15); MI = 40% (6/15); LI = 46.7% (7/15); mean egg count = 128 (range: 24-1254)] and female [MI = 50% (2/4); LI = 50% (2/4); mean egg count = 80.7 (range: 24-192)] and among the 3 \u0026ndash; 9 age group [HI = 20% (3/15); MI = 40% (6/15); LI = 40% (6/15); mean egg count = 102.4 (range: 24-384)] and 10 \u0026ndash; 15 years cluster [MI = 25% (1/4); LI = 75% (3/4); mean egg count = 106.4 (range: 24-720)].Variation in \u003cem\u003eS. haematobium\u003c/em\u003e + \u003cem\u003eS. mansoni\u003c/em\u003e infection prevalence between gender and age groups reveals that males [66.7% (2/3); MEC = 17.9% were more infected than females [33.3% (1/3); MEC = 6]. Similarly, only the 3-9 years [88.9% (8/9); MEC = 23.7%] documented infection. Triple mixed \u003cem\u003eS. haematobium\u003c/em\u003e + \u003cem\u003eS. mansoni\u0026nbsp;\u003c/em\u003e+ \u003cem\u003eS. guineensis\u003c/em\u003e eggs were observed only in males [25% (1/4); MEC = 53.2] with no apparent difference between age groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003ePrevalence and intensity of \u003cem\u003eSchistosoma\u003c/em\u003e spp and STHs infections\u003c/p\u003e\n\u003ctable align=\"left\" border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.143410852713178%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" width=\"10.949612403100776%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"25.58139534883721%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePitoa \u0026amp; Wourokessoum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 227)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"26.162790697674417%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBainga Assoura \u0026amp; Kola\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 118)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" width=\"26.162790697674417%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGounougou\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N = 150)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.513601741022851%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.363438520130577%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[41.4 (94)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.363438520130577%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[58.6 (133)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.01632208922742%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[45.8 (54)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.363438520130577%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[54.2 (64)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"15.01632208922742%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[51.3 (77)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"14.363438520130577%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e[48.7 (73)]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.513601741022851%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (yr)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.834602829162133%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.834602829162133%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10-15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"12.513601741022851%\"\u003e\n \u003cp\u003e\u003cstrong\u003e% (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e56.4 (53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e43.6 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e59.4 (79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e40.6 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e74.1 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.834602829162133%\"\u003e\n \u003cp\u003e25.9 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e62.5 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e37.5 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.834602829162133%\"\u003e\n \u003cp\u003e67.5 (52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e32.5 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e63 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.181719260065289%\"\u003e\n \u003cp\u003e36.9 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.143410852713178%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchistosomiasis prevalence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.949612403100776%\"\u003e\n \u003cp\u003ePositive; % (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e9.4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e4.9 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e15.2 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e7.4 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e15.0 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e14.3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e37.5 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e12.5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e5.8 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e8.0 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e19.6 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e11.1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" width=\"11.143410852713178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of \u003cem\u003eSchistosoma\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003especies; % (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.949612403100776%\"\u003e\n \u003cp\u003e\u003cem\u003eS. haematobium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e60.0 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e50 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e58.3 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e25 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e83.3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e50.0\u0026nbsp;(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e46.7 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e33.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e100 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e100 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e100 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e100 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eS. mansoni\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e20.0\u0026nbsp;(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e50 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e33.3 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e75 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e16.7 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e50.0\u0026nbsp;(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e40.0\u0026nbsp;(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e66.7 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eS.h/S.m\u003c/em\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e20.0 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e13.3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eS.h/S.m/S.g\u003c/em\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e8.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"11.143410852713178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence of STHs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.949612403100776%\"\u003e\n \u003cp\u003e\u003cem\u003eA. lumbricoides\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e5.7 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e2.4 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e5.1 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e5.6 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e2.5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e7.5 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e8.3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e1.9 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e4.4 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003eHookworms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e1.9 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e2.5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e1.9 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eT. trichuris\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e1.3 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" width=\"11.143410852713178%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Intensity of helminths eggs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.949612403100776%\"\u003e\n \u003cp\u003e\u003cem\u003eS. haematobium\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e113.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e71.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e163.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e87.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.976744186046512%\"\u003e\n \u003cp\u003e99.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e326.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.395348837209302%\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eS. mansoni\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e141.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e118.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e71.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e176.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e160.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e96.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003e\u003cem\u003eS. guineensis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003eAscaris\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e206.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e424.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e538.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e408.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e345.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e504.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e251.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e166.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e528.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003eHookworm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.322791712104689%\"\u003e\n \u003cp\u003eTrichuris\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.851690294438386%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.1973827699018535%\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eKey: Sh = \u003cem\u003eS. haematobium\u003c/em\u003e; Sm = \u003cem\u003eS. mansoni\u003c/em\u003e; Sg = \u003cem\u003eS. guineensis\u003c/em\u003e; \u003csup\u003e1\u003c/sup\u003ePresence of mixed \u003cem\u003eSchistosoma\u003c/em\u003e species in urine\u003c/p\u003e\n\u003cp\u003eThere was significant correlation (r = 0.8) between microhematuria (prevalence: 10.3%) and nucleopore urine filtration in the diagnosis of urogenital schistosomiasis with a marked difference (\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 279.7, p \u0026lt; 0.0001) between infected (MH\u003csup\u003e+\u003c/sup\u003eNUF\u003csup\u003e+\u003c/sup\u003e = 38) and un-infected (MH\u003csup\u003e-\u003c/sup\u003eNUF\u003csup\u003e-\u003c/sup\u003e = 435) individuals as highlighted in Table 4. Microhematuria exhibited a sensitivity and specificity of 80.9% and 97.1%. Among the STHs, \u003cem\u003eA. lumbricoides\u003c/em\u003e was the most common [4.0% (20/495); 3 - 9 years: 70% (14); male: 65% (13)]; Hookworms [0.6% (3/495)] and Trichuiris [0.2% (1/495)].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003ePairwise comparison between microhematuria and nucleopore urine filtration in urogenital schistosomiasis diagnosis\u003c/p\u003e\n\u003ctable align=\"left\" border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory: Age/Sex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"50%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMicrohematuria (MH)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.294117647058826%\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"32.35294117647059%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNucleopore Urine filtration (NUF)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.647058823529413%\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.647058823529413%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.647058823529413%\"\u003e\n \u003cp\u003e\u0026nbsp; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73913043478261%\"\u003e\n \u003cp\u003e448\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.08695652173913%\"\u003e\n \u003cp\u003e444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.73913043478261%\"\u003e\n \u003cp\u003e495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between KAP, WaSH, Praziquantel (PZQ) intake and schistosomiasis outcome among the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was a significant match between the determinants of risk factors of schistosomiasis and disease outcome. The most important factors associated with infection in the study areas were age and gender. Association factors such as poor knowledge, insufficient WaSH practices and frequent absence of consuming PZQ during school-based treatment campaigns were relatively higher in children between 3 \u0026ndash; 9 years and strongly correlate with high schistosomiasis prevalence. Similarly, higher schistosomiasis prevalence was recorded in males exhibiting high risk factor scores including KAP, WaSH and PZQ intake as shown in Table S1.\u003c/p\u003e\n\u003cp\u003eIn Table 5, the univariate logistic data presents key determinants associated with the risk of schistosomiasis. Higher prevalence values correlated with lower class levels [unregistered to class (I-III): 86.4%]; poor knowledge on the cause of bilharzia (82.2%); absence of community water source (36.4%); bathing in streams (100%); use of streams as daily water source (77.1%); absence of communal toilets (73.7%); absence of individual house toilets (7.6%); open-air defecation and use of stream as excretion site (69.5%); lack of functional health club in school (88.1%); unawareness about periodic school deworming program (67.8%) and tendency of missing PZQ administration in school by teacher (55.9%). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Schistosomiasis risk factors analysis with age and sex\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" width=\"32.48407643312102%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" width=\"67.51592356687898%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchistosomiasis risk factor score: % (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" width=\"33.333333333333336%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"26.10062893081761%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.39622641509434%\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.169811320754718%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e [p-value]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.09433962264151%\"\u003e\n \u003cp\u003e3 \u0026ndash; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.238993710691823%\"\u003e\n \u003cp\u003e10 \u0026ndash; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.264150943396226%\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.836477987421384%\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.39622641509434%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.169811320754718%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eClass level: unregistered to class (I-III)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e84.8 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e55 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e64 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e82.9 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e75.8 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e12.9 [\u0026lt; 0.0001]**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003ePoor knowledge on schistosomiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e93.5 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e70 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e84 (21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e87.8 (36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e86.4 (57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e7.9 [0.005]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eAbsence of communal pipe-borne water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e23.9 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e15 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e20 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e21.9 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e21.2 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e2.3 [0.13]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eBathing in streams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e89.1 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e100 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e88 (22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e95.1 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e92.4 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e9.5 [0.002]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eUse of stream as daily water source\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e86.9 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e100 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e76 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e100 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e90.9 (60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e16.1 [\u0026lt; 0.0001]***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eAbsence of communal toilets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e91.3 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e80 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e80 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e92.7 (38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e87.9 (58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e11.2 [0.0008]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eAbsence of household toilets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e36.9 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e(35) 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e36 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e36.6 (15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e36.4 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e3 [0.08]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eOpen air defecation and excrete in streams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e86.9 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e15 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e44 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e78.1 (32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e65.2 (43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e20.5 [\u0026lt; 0.0001]***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eLack of functional health club in school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e76.1 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e45 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e68 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e65.9 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e66.7 (44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e4.5 [0.03]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eUnaware of periodic school deworming\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e58.7 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e35 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e40 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e58.5 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e51.5 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e11.5 [0.007]**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.48407643312102%\"\u003e\n \u003cp\u003eMissed taking PZQ regularly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.19108280254777%\"\u003e\n \u003cp\u003e67.4 (31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.314225053078557%\"\u003e\n \u003cp\u003e80 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.280254777070065%\"\u003e\n \u003cp\u003e52 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.341825902335456%\"\u003e\n \u003cp\u003e82.9 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.420382165605096%\"\u003e\n \u003cp\u003e71.2 (47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.968152866242038%\"\u003e\n \u003cp\u003e18.8 [\u0026lt; 0.0001]***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSignificant: * = p \u0026lt; 0.05, ** = p \u0026lt; 0.001, *** = p \u0026lt; 0.0001)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of malaria and schistosome co-infection (polyparasitism) and impact on anemia level \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of malaria/schistosomiasis and malaria/STHs polyparasitism was 11.9% (59/495) and 1.2% (6/495) respectively with the predominance of \u003cem\u003eP. falciparum\u003c/em\u003e/\u003cem\u003eS. haematobium\u003c/em\u003e co-infection followed by \u003cem\u003eP. falciparum/S. mansoni\u003c/em\u003e. The overall anemia prevalence was 32.9% (163/495) with a greater proportion categorized as moderate. A positive association (r = 0.9; p \u0026lt; 0.01) between \u003cem\u003eP. falciparum\u003c/em\u003e prevalence and schistosome infection was observed. Notably, children infected with \u003cem\u003eS. mansoni\u003c/em\u003e had significantly higher \u003cem\u003eP. falciparum\u003c/em\u003e parasite density compared to \u003cem\u003eS. haematobium/Plasmodium spp\u0026nbsp;\u003c/em\u003eco-infection or \u003cem\u003eP. falciparum\u003c/em\u003e mono-infection implying that \u003cem\u003eS. mansoni\u003c/em\u003e may influence the severity of malaria and the malaria parasite density. \u003cem\u003eP. falciparum\u003c/em\u003e/\u003cem\u003eS. haematobium-\u003c/em\u003e\u003cem\u003einfected\u003c/em\u003e children had lower mean parasite density than their \u003cem\u003eP. falciparum\u003c/em\u003e only counterpart with a reduction in hemoglobin concentration. Similarly, mixed \u003cem\u003eP. falciparum + P. malariae\u003c/em\u003e infection with \u003cem\u003eS. mansoni\u0026nbsp;\u003c/em\u003ewas associated with a two-fold higher malaria parasite load than the \u003cem\u003eS. haematobium\u0026nbsp;\u003c/em\u003eequivalent. Contrarily, \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eAscaris\u003c/em\u003e infection was negatively correlated although a significantly higher mean trophozoite density compared to \u003cem\u003eP. falciparum\u003c/em\u003e mono-infection was observed for the few co-infected cases as shown in Table 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. \u0026nbsp;\u003c/strong\u003eAssociation between \u003cem\u003ePlasmodium\u003c/em\u003e species and helminths worms and impact on mean parasite density and Hb level\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"9.090909090909092%\"\u003e\n \u003cp\u003ePrevalence:\u003c/p\u003e\n \u003cp\u003e% (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" width=\"11.8488253319714%\"\u003e\n \u003cp\u003e\u003csup\u003e+\u003c/sup\u003eGeometric mean parasite density\u003c/p\u003e\n \u003cp\u003e(parasites/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"10.929519918283964%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" width=\"46.27170582226762%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia status: Hb level [% (n)]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"9.805924412665986%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" width=\"35.97560975609756%\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.548780487804878%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e [p-value]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"33.84146341463415%\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.634146341463415%\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e [p-value]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" width=\"18.597560975609756%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 \u0026ndash; 9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.378048780487806%\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 \u0026ndash; 15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"15.548780487804878%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"17.378048780487806%\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"16.463414634146343%\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"14.634146341463415%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/em\u003e\u003cem\u003ePf\u0026nbsp;\u003c/em\u003eonly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e62.8 (174)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e1263.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e10.2 [46.6 (81)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.4 [13.2 (23)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e64.7 [0.0000]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.4 [36.2 (63)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.2 [23.6 (41)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e9.3 [0.002]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/em\u003e\u003cem\u003ePf + Pm\u0026nbsp;\u003c/em\u003eonly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e13.4 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e806.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e9.6 [51.4 (19)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.4 [ 27.0 (10)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e5.6 [0.02]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e9.9 [45.9 (17)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e9.6 [32.4 (12)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e1.7 [0.18]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf/Sh\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e55.9 (33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e1072.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e9.9 [63.6 (21)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.1 [ 15.2 (5)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e19.6 [0.0009]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.2 [30.3 (10)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.5 [48.5 (16)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e2.8 [0.09]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf/Sm\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e18.6 (11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e2249.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e10.3 [72.7 (8)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.8 [9.1 (1)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e10.9 [0.001]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.6 [27.3 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.4 [54.5 (6)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e2 [0.16]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf/Sh + Sm\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e5.1 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e10.5 [ 100 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e6 [0.01]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.4 [100 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e6 [0.01]*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf + Pm/Sh\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e11.9 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e415.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e9.6 [71.4 (5)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e10 [0.002]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.3 [42.9 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10. 4[28.6 (2)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e0.4 [0.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf + Pm/Sm\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e6.8 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e784.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e10.3 [75 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e6 [0.01]*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.5 [25 (1)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.2 [50 (2)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e0.67 [0.41]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.053115423901941%\"\u003e\n \u003cp\u003e\u003cem\u003ePf/Ascaris\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e30 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.8488253319714%\"\u003e\n \u003cp\u003e2287.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"12.461695607763023%\"\u003e\n \u003cp\u003e10.2 [ 50 (3)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.5 [ 16.7 (1)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.41879468845761%\"\u003e\n \u003cp\u003e2 [0.15]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.644535240040858%\"\u003e\n \u003cp\u003e10.3 [33.3 (2)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.031664964249234%\"\u003e\n \u003cp\u003e10.6 [33.3 (2)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.805924412665986%\"\u003e\n \u003cp\u003e0.19 [0.66]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Prevalence of \u003cem\u003ePf\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e was inferred from PCR; \u003csup\u003e+\u003c/sup\u003eMean Parasite density was computed from microscopy/PCR true positives. Significant p\u0026lt;0.05; Key: Pf = \u003cem\u003eP. falciparum\u003c/em\u003e; Pm = \u003cem\u003eP. malariae\u003c/em\u003e; Sh = \u003cem\u003eS. haematobium\u003c/em\u003e; Sm = \u003cem\u003eS. mansoni\u003c/em\u003e; Hb = Hemoglobin\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMalaria and helminths infection are responsible for a significant burden of morbidity and mortality in children across many parts of the world. Dependent on \u003cem\u003eAnopheles\u003c/em\u003e mosquito and snail intermediate host (notably for schistosomiasis) for complete life-cycle propagation, \u003cem\u003ePlasmodium\u003c/em\u003e and schistosome parasites respectively encounter a remarkable challenge during the dry season in regions where the absence of rain limits the vector or intermediate host abundance and survival for several months [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Moreover, the social, ecological and environmental drivers facilitating transmission of these diseases are significantly lessened during the dry season. While the majority of malaria and helminthiasis cases are predominant during the wet season, clinically silent asymptomatic \u003cem\u003eP. falciparum\u003c/em\u003e and helminths infections can persist through the dry season and constitute an important reservoir for transmission during the advent of the next rainy season. This study therefore investigated the prevalence and factors driving sustained malaria and helminths transmission despite regular delivery of long-lasting insecticide treated nets and systematic PZQ/ALB preventive chemotherapy campaigns by control programs. Whilst there has been a sizeable reduction in malaria burden among children ˂ 5 years in the North Region of Cameroon from 2000 to 2020; [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] the current study reports a high \u003cem\u003ePlasmodium\u003c/em\u003e prevalence in children notably between 5 and 10 years. This epidemiological shift in malaria prevalence from younger preschool children (˂ 5 years) who constitute the primary at-risk group to school-age children (5\u0026ndash;15 years) is attributed to the massive implementation of various control strategies that have largely contributed in protecting the under-five vulnerable populations [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. Compared with younger children, SAC often experience mild clinical disease, usually harboring infections that go untreated. Also, their reduced likelihood of utilizing malaria prevention methods such as insecticide treated bed nets further predisposes them to infectious mosquito bites that facilitate transmission. This is contrary to the preschool where the scale-up of LLINs and ACTs has led to a decline of malaria prevalence in this age group although mean parasite density is often high owing to low-level acquired immunity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA high prevalence of \u003cem\u003eP. falciparum\u003c/em\u003e asymptomatic malaria in the SAC group was observed at a prevalence of 46.9%, lower than 91.6% recorded during the rainy season in this Region by a previous study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These asymptomatic infections may affect the performance of epidemiological diagnostic tools such that detection of these parasites becomes difficult and are missed by traditional microscopy and RDTs [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Males recorded a higher \u003cem\u003ePlasmodium\u003c/em\u003e infection prevalence and mean parasite density than their female counterpart probably because of the tendency to participate in outdoor activities for longer periods without protection and the non-adherent to sleeping under LLINs. Co-infection of \u003cem\u003eP. falciparum\u003c/em\u003e and \u003cem\u003eP. malariae\u003c/em\u003e in children was responsible for anemia (10.5%, 29/277) probably as a result of the double impact on RBC lysis, further contributing to the substantial morbidity burden.\u003c/p\u003e \u003cp\u003eOn the other hand, the epidemiology and transmission of schistosomiasis in the North Region is governed by a nexus of human behavior, cultural factors, socio-economic status, and ecology which cooperate to spur the biological interaction between the human and snail host life cycle stages of the parasite and establishes the relevance for community monitoring and evaluation of prevalence and intensity of infection in order to document the impact of treatment success and to optimize control programme outputs [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Schistosomiasis presents a public health challenge in this Region where a majority of the inhabitant population relies on water networks of the Geoges de Kola and Lagdo dam for daily activities that constitutes the source of schistosome infection particularly in the BAK and Gounougou communities [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This may also be influenced by the population influx from the Boko Haram conflict-hit zones which further imposes a huge reliance on water bodies for daily activities and facilitates the contamination of these waters with urine or stool-infected schistosome eggs that enhances infection of the snail intermediate host [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This study therefore highlights the sympatric transmission of persistent urogenital and intestinal schistosomiasis in three communities characterized by a high prevalence, risk and severity of infection in the 3\u0026ndash;9 years age cohort and males than their respective counterparts despite fifteen years of regular PZQ and ABZ school-based mass deworming campaigns. However, due to the constrained 2020 COVID pandemic wave, PZQ and ABZ MDA campaigns were not implemented in this Region. Age and gender were two key predictive determinants of infection. Children in the age groups 3\u0026ndash;9 years were twice more likely to be at risk of schistosomiasis infection than the 10\u0026ndash;15 years. This younger age group exhibits high frequency of contact with water sources for domestic purposes such as bathing, laundry, fishing and drinking. Also, since PZQ does not prevent reinfection of the immature worm stages, parasite transmission could not be interrupted [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, besides PZQ administration, the contribution of age-acquired immunity to (re)infection accounts for a decrease in infection prevalence for the older 10\u0026ndash;15 years children regardless of their enormous water contact habits [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. The intensity of both \u003cem\u003eS. haematobium\u003c/em\u003e and \u003cem\u003eS. mansoni\u003c/em\u003e egg excretion was significantly lower in the older aged children compared to their counterpart. Although an important element, behavioral differences in exposure alone are insufficient to account for the significant reduction in intensity of infection with age, especially post-PZQ treatment. Indeed, the intensity of egg excretion is largely influenced by age mediated immunity to a reduction in worm fecundity and egg load [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. This well documented inverse relationship between prevalence, infection intensity and increasing age could be explained by the direct effect of parasite metabolic regulation and host mediated innate resistance to infection that drives a strong protective immunity associated with increased hormonal levels during puberty [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Additionally, the wide access and use of ACTs may have also contributed in the observed reduction in egg intensity [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs predicted, sex variation in prevalence and intensity of egg excretion was significantly higher in the male gender due to prolonged exposure to cercariaeted-snail infested streams during swimming and fishing activities which are more common amongst males than females as highlighted by several studies [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. However, this differs with other studies reporting females as the predominantly infected gender probably owing to the frequent water contact tendencies involved during laundry activities. The observed intensity of egg infection in both males and females poses a high risk of male genital (MGS) and female genital schistosomiasis (FGS) respectively; amplified by the high frequency of unawareness (58.5% males; 64% females) about schistosomiasis risk factors and transmission routes in primary school children of these villages as also observed with similar studies across Africa [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The presence of \u003cem\u003eS. haematobium\u003c/em\u003e eggs in urine with the verbal reports of females experiencing hematuria, dysuria and itchy urination may suggest the occurrence of genital schistosomiasis infection that poses a serious yet neglected disease burden in women. Caused by the deposition of eggs in the female reproductive tract, this condition often leads to chronic fibrosis and scarring with irreversible long term consequence on sexual dysfunction aggravated by genital ulcers and infertility problems [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Moreover, a low frequency of mixed schistosome infections (\u003cem\u003eS. haematobium\u003c/em\u003e, \u003cem\u003eS. mansoni\u003c/em\u003e and \u003cem\u003eS. guineensis)\u003c/em\u003e were identified in infected children owing to the focal distribution of the snail intermediate hosts and substantial human mobility between transmission sites [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. Also, Leger \u0026amp; Webstar (2016) [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e] previously revealed evidence of mating between distantly related schistosome species notably \u003cem\u003eS. haematobium\u003c/em\u003e males and \u003cem\u003eS. mansoni\u003c/em\u003e female adult worms in Central Africa leading to the deposition and excretion of hybrid eggs through the urogenital tract thereby aggravating the outcome of urogenital schistosomiasis and associated pathologies [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. This consequently has an impact both on the nature of disease morbidity and the success of MDA control programmes. Infection load, defined by egg count was generally low with 9.5% shedding eggs in urine characterized by a majority (72.3%) of light infection intensity status (\u0026lt;\u0026thinsp;50 eggs/10 ml urine). This could be attributed to a shrink in the network of factors favoring schistosomiasis transmission and infection intensity among the study population including age, minimal water contact, drying-up of temporal water bodies, marked reduction in snail population density during the dry season and concomitant immunity as a consequence of past infections or poly-parasitism [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. In particular, the geographical distribution and abundance of the snail intermediate host (\u003cem\u003eBulinus spp\u003c/em\u003e or \u003cem\u003eBiomphalaria spp\u003c/em\u003e) is a principal determinant, accounting to a large extent for variation in seasonal transmission of the disease. Indeed, during the dry season, the adult snails die while the younger snail population aestivates under the soil to ensure adaptation and survival during the next rainy season [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e, \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. This may explain the reason for the decreased prevalence compared to previous studies conducted during the rainy season in this Region.\u003c/p\u003e \u003cp\u003eThis study also assessed the association between schistosomiasis infection, school attendance, KAP and water, sanitation and hygiene (WaSH) practice among children. The observed schistosomiasis prevalence aligns with the high prevalence of children who are unenrolled and do not attend school regularly; further leading to poor therapeutic compliance outcome. Previous studies have indicated that intensity of \u003cem\u003eS. haematobium\u003c/em\u003e infection which is often associated with hematuria negatively impacts school attendance with high cognitive and psychological mental health consequences on the infected children [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. The generally observed low primary school attendance in the study localities hinders the non-school enrolled SAC and PSAC from treatment campaign benefits, further reiterating the necessity to effectively include this neglected group. In line with the current WHO guidelines on schistosomiasis control and elimination [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], this study therefore emphasizes the opinion of a treatment scale-up from the school-centered approach to an intensified community-based preventive chemotherapy strategy inclusively targeting all at risk groups (SAC, PSAC, occupation-related, pregnant women) to reduce disease morbidity [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. Furthermore, the lack of comprehension about the factors associated with schistosomiasis transmission even after several years of school system based PZQ campaigns reflects the limited public health knowledge about the disease combined with the high level of illiteracy. Indeed, many of the older children (9\u0026ndash;15 years) usually accompany their parents for cattle breeding activities during school periods; further contributing to the poor knowledge gap and reduced treatment uptake [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Also, the co-utilization of streams for cattle rearing may increase the risk of bovine schistosomiasis transmission [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. Moreover, the absence of functional health education clubs in primary schools of these communities is also contributing to the disease knowledge gap. Emphasis must be directed towards strengthening health education through the promotion and implementation of local language-based comic cartoons in schools of endemic areas as a complementary intervention for reducing morbidity and transmission. This will boost the local social and behavioral change communication practices in communities. However, in spite of the fundamental role of health education in disease prevention, improvement of community water supply is imperative to limit frequent contact with streams and reduce the incidence of diarrhea possibly caused by cryptosporidiosis or Rotavirus infection [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, in this study, the reliability of urine reagent strips as an indicator for detecting infection was 80.9% agreeing with a previous meta-analysis that reported a sensitivity and specificity of 81% and 89% respectively [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e]. However, the observed \u0026ldquo;non-symptomatic\u0026rdquo; urinary schistosomiasis in the older age group may be attributed to the combined effect of immune response and low egg infection intensity leading to possibly undetected microhematuria by urine strips which was otherwise identified by the more sensitive urine filtration technique. Importantly, the biologically significant minority hotspot of high egg shedding individuals in these localities poses concern in sustaining disease transmission necessitating further investigation on the genetic determinants predisposing such reservoir super-spreaders.\u003c/p\u003e \u003cp\u003eAs expected, STHs were not common in these localities, similar to the previous study by [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Although replicate slides of a single individual fecal sample may be adequate at baseline in moderate to high endemic zones, the Kato-Katz technique may have a low sensitivity for \u003cem\u003eS. mansoni\u003c/em\u003e and STHs diagnosis. In addition to mono-parasite infections, this study demonstrated the common occurrence of polyparasitism whereby 13.1% of children were simultaneously co-infected with mixed \u003cem\u003ePlasmodium\u003c/em\u003e species and helminths worms. Bivariate analysis revealed a positive association between schistosomiasis and malaria attributed to schistosome-mediated polarized Th2/Treg immunomodulation that leads to increase susceptibility to \u003cem\u003ePlasmodium\u003c/em\u003e infection and may increase the risk of malaria transmission in areas of co-endemicity, in line with numerous published findings [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e] but contrary to [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e].Notably, while \u003cem\u003eS. mansoni\u003c/em\u003e infection was an important predictor of malaria parasite density, \u003cem\u003eS. haematobium\u003c/em\u003e infection was a significant predictor of anemia and malaria prevalence. However, this correlation was negatively skewed for \u003cem\u003eAscaris\u003c/em\u003e infections probably due to the arid eco-epidemiological limitations of factors that favor the seasonal transmission of the parasite in these settings. Previous studies have shown the protective effect of \u003cem\u003eAscaris\u003c/em\u003e worms on \u003cem\u003eP. falciparum\u003c/em\u003e infection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e]. This observation should be interpreted with caution since only six cases of \u003cem\u003eAscaris/P. falciparum\u003c/em\u003e prevalence were documented. On the other hand, concomitant \u003cem\u003eAscaris/P. falciparum\u003c/em\u003e infection was associated with a high geometric mean asexual \u003cem\u003eP. falciparum\u003c/em\u003e trophozoite carriage than \u003cem\u003eP. falciparum\u003c/em\u003e mono-infection. This shows that the association between malaria and helminthic infections may depend on the host age and specific type of worm infection and therefore underscores for further investigation [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Both \u003cem\u003ePlasmodium\u003c/em\u003e parasite and \u003cem\u003ePlasmodium\u003c/em\u003e-helminth infection types were associated with moderate anemia as indicated by the mean hemoglobin score. This may probably be explained by the \u0026ldquo;light\u0026rdquo; majority of helminth infections observed supported by the fact that anemia caused by helminths is dependent on the intensity of infection [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In agreement with other studies, lower Hb levels and anemia correlated with single and multi-parasitic infections [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. In rural settings, malnutrition and parasitic infections are the major causes of anemia. The anemia level of children in this study sources from destruction of infected red blood cells and alteration of hematopoiesis by \u003cem\u003ePlasmodium\u003c/em\u003e parasites in addition to the pathology of chronic blood loss by the spined-eggs of schistosome infections [\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]. This observation reveals that synergistic interaction between multiple parasite infections increases the risk and clinical outcome of anemia particularly in children.\u003c/p\u003e \u003cp\u003eThe cross-sectional design of this study being a limitation implies that a longitudinal characterization involving a higher sample size of children in these localities will provide fine insights on the biology, interaction and transmission dynamics of malaria, schistosomiasis and STHs. Similarly, this study focused on quantifying schistosomiasis prevalence only in mostly school-age children without including other high risk groups including pre-school, pregnant women and occupation-related inhabitants. Also, schistosomiasis diagnosis was based on parasitological capture that employed only a single collection of urine and stool samples instead of the standard three consecutive samples and this may have underestimated the prevalence by missing patent infection. Likewise, malacological and ecological surveys including snail population bionomics and cercariae infection in mollusks which constitute key targets in schistosomiasis control were not done. However, the current findings provide a situational prevalence of these diseases during the dry season.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese findings demonstrate that despite regular LLINs distribution and over fifteen years of preventive chemotherapy campaigns, multiple parasite infections are frequent in children who constitute hidden reservoirs of asymptomatic malaria infections and epidemiological carriers of schistosome worms. This suggests that malaria control must prioritize targeting asymptomatic cases through sensitive diagnostic testing strategies and expanded treatment interventions. Likewise, interruption of schistosomiasis transmission in these villages requires multisectoral health system strengthening efforts involving high-level PZQ/ALB geographic coverage and therapeutic compliance of all at-risk groups, unlimited access to WASH facilities and community-driven health education programs structured towards improving behavioral change. This study also highlights that schistosomiasis enhances the susceptibility to \u003cem\u003ePlasmodium\u003c/em\u003e infection and increases the risk of malaria and anemia in school children. Moreover, the study provides further evidence that optimizing helminth control interventions in children dually contribute to reducing the malaria and anemia burden in endemic areas where both diseases geographically overlap.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received institutional approvals (2021/1250-10/UB/SG/IRB/FHS) and (N0 2020/05/1234/CE/CNERSH/SP)\u0026nbsp;from the Ethics Review Board of the Faculty of Health Sciences, University of Buea and the Cameroon National Committee on Ethics for Human Health Research respectively.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAdministrative authorization was sought from the North Regional Delegations of Public Health and Basic Education, Garoua, Cameroon. The study was conducted in conformity with the World Medical Association (WMA) guidelines as highlighted in the Declaration of Helsinki. Sensitization of the population was done in the various communities prior to the study. The purpose, risk and benefits of the study was explained to the parents and guardians of children both in French and the local dialect (Fulfulde) and written informed consent was obtained from all the parents/guardians whose children were enrolled in the study. By signing the form, the participants agreed to answer a questionnaire and to provide finger-prick blood, urine and stool samples for parasitological analysis. Confidentiality was respected as participants responded to the questionnaire and even during data processing and analyses, as well as during data sharing. Participation was voluntary, and individuals could freely terminate involvement in the study at any time, even without prior notice. Children positive for malaria were administered first line treatment as recommended by the national treatment guideline policy. However, children positive for schistosomiasis and worm infections were referred to the local district hospital where free Praziquantel (40 mg/kg body weight) and Albendazole (400 mg) treatments were respectively given in accordance with the Cameroon Schistosomiasis Control Program (PNLSHI)\u0026nbsp;[28, 30].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll relevant data are within the paper\u0026nbsp;and its supplementary files.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have declared that no competing interests exist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eFNN received a Joint Royal Society of Tropical Medicine \u0026amp; Hygiene (RSTMH) and National Institute of Health Research (NIHR) early career research grant (https://rstmh.org/grants/grant-awardees-2020/nihr-awardees-2020). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions: Conceptualization:\u0026nbsp;\u003c/strong\u003eFNN, CSW, SW;\u0026nbsp;\u003cstrong\u003eData curation:\u0026nbsp;\u003c/strong\u003eFNN, LWGR, AMN; \u003cstrong\u003eFormal analysis:\u0026nbsp;\u003c/strong\u003eFNN, LWGR, AMN, DNN; \u003cstrong\u003eFunding acquisition:\u0026nbsp;\u003c/strong\u003eFNN; \u003cstrong\u003eInvestigation:\u0026nbsp;\u003c/strong\u003eFNN, LWGR, DNN, AMN, AK, LMJM, MJW, RAS; \u003cstrong\u003eMethodology:\u0026nbsp;\u003c/strong\u003eFNN, AMN, AK, DNN;\u0026nbsp;\u003cstrong\u003eResources\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e FNN, CSW, FN, JPW, AK, RAS, YGF; \u003cstrong\u003eProject administration:\u0026nbsp;\u003c/strong\u003eFNN, CSW, SW, FN, CN; \u003cstrong\u003eSupervision:\u0026nbsp;\u003c/strong\u003eCSW, SW, JPW, FN, CN; \u003cstrong\u003eWriting \u0026ndash; original draft:\u0026nbsp;\u003c/strong\u003eFNN;\u0026nbsp;\u003cstrong\u003eWriting \u0026ndash; review \u0026amp; editing:\u0026nbsp;\u003c/strong\u003eFNN,\u0026nbsp;DNN, AMN, AK, LMJM, MJW, RAS, DN, YGF, JF, CN, FN, JPW,\u0026nbsp;SW,\u0026nbsp;CSW.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/strong\u003eThe authors express thankfulness to the school children who took part in this study and to their parents/guardians for consenting. Special thanks to the community leaders and district health workers of the various study localities for their assistance in data collection. The authors are also grateful to the field work and laboratory staff members particularly Mr. Agbor Jean Pierre, Mr. Simon Daga and Mr. Ahmadou Ahidjo for the specimen preparation and reading of slides.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTchuem Tchuent\u0026eacute;, L.-A., et al., \u003cem\u003ePrecision mapping: An innovative tool and way forward to shrink the map, better target interventions, and accelerate toward the elimination of schistosomiasis\u003c/em\u003e. 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Sokhna, \u003cem\u003eWorms can worsen malaria: towards a new means to roll back malaria?\u003c/em\u003e Trends in parasitology, 2005. \u003cb\u003e21\u003c/b\u003e(8): p.\u0026nbsp;359\u0026ndash;362.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Malaria, schistosomiasis, geohelminthiasis, school-age children, North Region-Cameroon","lastPublishedDoi":"10.21203/rs.3.rs-1871446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1871446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe double burden of malaria and helminthiasis in children poses an obvious public health challenge particularly in terms of anemia morbidity. While both diseases geographically overlap, most studies focus on mono-infection and general prevalence surveys without molecular analysis. The current study investigated the epidemiological determinants of malaria, schistosomiasis and geohelminthiasis transmission among children in the North Region of Cameroon\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eSchool and pre-school children aged between 3\u0026ndash;15 years were enrolled from three communities in March 2021 using a community cross sectional design. Capillary-blood samples were obtained, and each was examined for malaria parasites using RDT, microscopy and PCR while hemoglobin level was measured using a hemoglobinometer. Stool samples were analyzed for \u003cem\u003eSchistosoma mansoni\u003c/em\u003e, \u003cem\u003eS. guineensis\u003c/em\u003e and STH infections using Kato Katz method and urine samples were assessed for the presence of \u003cem\u003eS. haematobium\u003c/em\u003e eggs using the standard urine filtration technique.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eA malaria prevalence of 56% (277/495) was recorded by PCR as opposed to 31.5% (156/495) by microscopy and 37.8% (186/495) by RDT. Similarly, schistosomiasis was observed at prevalence levels of up to 13.3% (66/495) overall [\u003cem\u003eS. haematobium\u003c/em\u003e (8.7%); \u003cem\u003eS. mansoni\u003c/em\u003e (3.8%); mixed \u003cem\u003eSh/Sm\u003c/em\u003e (0.6%); mixed \u003cem\u003eSh/Sm/Sg\u003c/em\u003e (0.2%). Both infections were higher in males and the 3\u0026ndash;9 years age group. A high frequency of PCR reported \u003cem\u003eP. falciparum\u003c/em\u003e mono-infection of 81.9% (227/277) and mixed \u003cem\u003eP. falciparum/P. malariae\u003c/em\u003e infection of 17.3% (48/277) was observed. Malaria-helminths co-infections were observed at 13.1% (65/495) with marked variation between \u003cem\u003eP. falciparum\u003c/em\u003e/\u003cem\u003eS. haematobium\u003c/em\u003e (50.8%, 33/65); \u003cem\u003eP. falciparum\u003c/em\u003e/S. \u003cem\u003emansoni\u003c/em\u003e (16.9%, 11/65) and \u003cem\u003eP. falciparum\u003c/em\u003e/\u003cem\u003eAscaris\u003c/em\u003e (9.2%, 6/65) (\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;17.5, p\u0026thinsp;=\u0026thinsp;0.00003). Anemia prevalence was 32.9% (163/495), categorically associated with \u003cem\u003eP. falciparum\u003c/em\u003e (45.8%, 104/227), and Pf/Sh (11.5%, 26/227) and Pf/Sm (3.9%, 9/227) polyparasitism.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePolyparasitism with malaria and helminth infections are common in school children despite periodic long lasting insecticide treated nets (LLINs) distribution and regular school-based Praziquantel and Albendazole campaigns. Co-existence of \u003cem\u003ePlasmodium\u003c/em\u003e parasites and helminths infections notably \u003cem\u003eSchistosoma\u003c/em\u003e species among children may concurrently lead to an increase in the force of \u003cem\u003ePlasmodium\u003c/em\u003e infection and an enhanced the risk of anemia, highlighting the necessity of an integrated approach for disease control interventions.\u003c/p\u003e","manuscriptTitle":"Epidemiological burden of persistent co-transmission of malaria, schistosomiasis, and geohelminthiasis among 3-15 years old children during the dry season in Northern Cameroon","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-29 20:22:43","doi":"10.21203/rs.3.rs-1871446/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7b0cbf3d-ea7f-46e8-a9c4-cfe9d09f3678","owner":[],"postedDate":"September 29th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-10-19T10:29:27+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-29 20:22:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1871446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1871446","identity":"rs-1871446","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}