Prevalence and associated factors of schistosomiasis among children and adolescents visiting Chitokoloki Mission Hospital of Zambezi District

Prevalence and associated factors of schistosomiasis among children and adolescents visiting Chitokoloki Mission Hospital of Zambezi District | 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 Prevalence and associated factors of schistosomiasis among children and adolescents visiting Chitokoloki Mission Hospital of Zambezi District Martin Chakulya, David Chisompola, Nyondo Chawela, Hanzooma Hatwiko, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7428590/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 12 You are reading this latest preprint version Abstract Background Urogenital schistosomiasis remains a major public health challenge among children and adolescents in subSaharan Africa. Data on prevalence and associated factors in Zambia are scarce. This study assessed the burden of Schistosoma haematobium infection and its correlates among 271 children and adolescents attending the outpatient department of Chitokoloki Mission Hospital, Northwestern Province. Methods We conducted a retrospective crosssectional review of clinical records from January to March 2025. Systematic random sampling of files for participants aged 5–18 years captured sociodemographic data, watercontact behaviours, haematuria (RBCs in urine), haematological indices (haemoglobin, MCV, MCHC), deworming history, and prior schistosomiasis. Urine microscopy for S. haematobium eggs defined infection status. Categorical variables were compared by chisquared test and medians by Wilcoxon ranksum. Multivariable logistic regression identified independent predictors of infection (p < 0.05). Results The median age was 13 years (IQR: 12–15); 58.3% were male. Overall prevalence of schistosomiasis was 25.8% (n = 70). Haematuria was present in 80.2% of infected versus 0.5% of uninfected participants (p < 0.0001). Infected children had lower median haemoglobin (11.3 g/dL vs. 11.9 g/dL; p = 0.0067) and MCHC (30.9 g/dL vs. 32.1 g/dL; p = 0.0022). Only 3.6% of previously dewormed children were infected compared with 49.2% of nondewormed peers (p < 0.0001). In adjusted analyses, absence of deworming (aOR 37.8; 95% CI 5.78–247.4), absence of haematuria (aOR 0.0014; 95% CI 0.0001–0.011), and lower haemoglobin (aOR 0.69 per g/dL; 95% CI 0.48–0.99) remained independently associated with infection. Conclusions There is a significant burden of urogenital schistosomiasis among school-aged children and adolescents attending Chitokoloki Mission Hospital in Zambezi District, Zambia. Targeted praziquantel distribution, cost-effective urine screening, and the integration of nutritional and anaemia management strategies are critical components for effective disease control. Strengthening these interventions is essential to advance progress toward achieving the World Health Organization’s 2030 schistosomiasis elimination targets in Zambia. Children Prevalence Schistosomiasis Urogenital Infection Zambia Figures Figure 1 Introduction Schistosomiasis, a debilitating parasitic disease caused by blood flukes of the genus Schistosoma, remains a critical public health challenge in tropical and subtropical regions worldwide [ 1 ]. Transmission occurs primarily through skin contact with freshwater contaminated by cercariae released from infected intermediate snail hosts, such as Bulinus truncatus for Schistosoma haematobium [ 2 , 3 ]. Globally, over 240 million people are infected annually, resulting in approximately 280,000 deaths and accounting for more than 3.3 million disability-adjusted life years (DALYs), ranking it among the most devastating neglected tropical diseases (NTDs) [ 4 , 5 ]. The burden of Schistosoma haematobium is disproportionately concentrated in sub-Saharan Africa (SSA), where impoverished communities face cyclical reinfection due to inadequate water, sanitation, and hygiene (WASH) infrastructure [ 6 – 8 ]. Children and adolescents bear the highest burden of schistosomiasis morbidity. Their frequent exposure to contaminated water during daily activities like swimming, bathing, fetching water, and fishing significantly increases infection risk [ 7 , 9 , 10 ]. The prevalence of Schistosomiasis in this demographic can exceed 75% in high-transmission foci [ 11 , 12 ]. Chronic infection during critical developmental stages leads to severe health complications, including hepatic fibrosis, portal hypertension, kidney failure, bladder cancer, and urogenital damage [ 13 , 14 ]. Beyond physical pathology, schistosomiasis causes anaemia, malnutrition, stunted growth, and impaired cognitive development, profoundly impacting educational attainment and long-term quality of life [ 15 , 16 ]. Despite global control efforts, including preventative chemotherapy targeting millions, prevalence remains persistently high, with an estimated 251.4 million people requiring treatment in 2022. Current strategies often fail to adequately address the specific vulnerabilities and transmission dynamics affecting youth [ 17 , 18 ]. In Zambia, schistosomiasis is endemic yet critically understudied, particularly among children and adolescents. Reported prevalence of approximately 35.5% indicates substantial transmission [ 19 ]. The surge in praziquantel uptake at facilities like Chitokoloki Mission Hospital underscores a significant local burden. However, recent and comprehensive data on the prevalence, severity, geographic distribution, and key risk factors of schistosomiasis among children and adolescents in Zambia remain limited. Understanding these correlates including environmental, socioeconomic, behavioral, and WASH-related factors is essential for designing effective, targeted interventions. This study therefore aims to assess the burden and identify the correlates of schistosomiasis among children and adolescents in Zambia. By quantifying prevalence and analyzing determinants of infection, this research will generate critical evidence to inform local and national public health strategies. Methodology Study Design and Study setting This was a retrospective crosssectional study conducted at Chitokoloki Mission Hospital in North-western Province, Zambia, among children and adolescents attending the outpatient department between 1 January 2025 and 31 March 2025. Chitokoloki Mission Hospital is a 180–200 bed capacity healthcare facility located in Zambezi District, Zambia. It serves a catchment population of approximately 150,000 people. In addition to providing inpatient and outpatient services, the hospital supports three satellite clinics within a 40 km radius, two of which are situated on the west bank of the Zambezi River, ensuring access to healthcare for remote and underserved communities. The outpatient department serves as the primary referral point for surrounding health centres in the district. Eligibility and recruitment criteria We abstracted hospital records from participants aged 5 to 18 years who visited the outpatient department. Records missing clinical or laboratory data were excluded. Using a systematic random sampling approach, every third file from the eligible patient records was selected for screening. From 610 files available for abstraction, 410 medical records were reviewed, 271 records met the inclusion criteria and were included in the analysis. 339 records were excluded due to incomplete information, such as missing details on age, sex, and missing outcome, diagnosis or the outcome, Fig. 1 . Sample Size Calculations The sample size for this study was determined using the single population proportion formula, based on an estimated prevalence of 20.3% [ 20 ], a 95% confidence level, and a margin of error of 5%. The formula applied was: $$\:n=\frac{{Z}^{2}\times\:p\times\:(1-p)}{{d}^{2}}$$ where n is the required sample size, Z is the Z-score corresponding to a 95% confidence level (1.96), p is the estimated prevalence (0.203), and d is the desired margin of error (0.05). Substituting these values into the formula yielded a minimum sample size of approximately 248. To account for potential non-response or incomplete data, a 10% adjustment was made, resulting in a final sample size of 271 participants included in the study. Specimen Collection and Processing As this was a retrospective study, all biological specimens had been collected and processed as part of routine clinical procedures at Chitokoloki Mission Hospital. According to standard hospital protocol, patients were provided with sterile urine containers and instructed to collect midstream urine samples to minimize contamination. The initial urine stream was discarded, and only the midstream portion was retained for analysis. At the same clinical visit, approximately 4 mL of venous blood was aseptically drawn from the antecubital fossa using EDTA vacutainer tubes. All samples were labeled with unique patient identifiers at the point of collection and transported to the laboratory in cooler boxes for testing maintained at recommended temperatures. Haematological analysis was conducted using a Horiba Micros ES60 haematology analyzer (Horiba ABX, Montpellier, France) to assess complete blood count (CBC) parameters, including haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC). Urine samples were initially inspected for visible blood (macrohaematuria), followed by dipstick testing using Hemastix reagent strips (Siemens Healthcare Diagnostics) to detect microhaematuria. Microscopic examination for Schistosoma haematobium eggs was performed on centrifuged urine sediments using standard light microscopy techniques [ 21 ]. Data collection Clinical and demographic data for 271 children and adolescents (aged 5–18 years) attending the outpatient department at Chitokoloki Mission Hospital in North-western Province, Zambia, were abstracted from both paper and electronic records. Key variables including age, sex, access to clean water, primary source of drinking water, water‑contact activities (swimming, washing clothes, drawing water), haematuria (RBCs in urine), complete blood count indices including haemoglobin, MCV, MCH, MCHC, differential leukocyte counts, platelets and deworming history were captured into REDCap. Records lacking essential clinical or laboratory data were excluded. Each file was screened and selected via systematic random sampling, with every third eligible record abstracted for analysis. Study Variables The primary outcome was schistosomiasis infection, defined as the presence of Schistosoma haematobium eggs on urine microscopy. Independent variables included demographic factors (age, sex), water‑related exposures (access to clean water, primary drinking‑water source, proximity to and activities in streams), clinical markers (haematuria, haemoglobin concentration, MCV, MCH, MCHC), and prevention history (praziquantel deworming status, self‑reported prior schistosomiasis). Data analysis Data were exported from REDCap to Microsoft Excel for cleaning and subsequently analyzed in StatCrunch. Categorical variables were summarized using frequencies and percentages, while continuous variables were described as medians with interquartile ranges (IQRs). The Shapiro–Wilk test assessed normality, and the Wilcoxon rank-sum test compared medians between infected and uninfected groups. Associations between categorical variables and schistosomiasis status were evaluated using chi‑squared tests. Factors associated with schistosomiasis were then examined via multivariable logistic regression. Candidate predictors including age, sex, access to clean water, primary drinking‑water source, water‑contact activities such as swimming, drawing water, haematuria, haemoglobin concentration, and deworming history were chosen based on prior literature and field expert input. Variables with a univariate p < 0.05 or established biological relevance were retained in the adjusted model. Statistical significance was defined as p < 0.05. Results The study included 271 participants with a median age of 13 years (interquartile range [IQR]: 12–15), of whom 25.8% (n = 70) had schistosomiasis. Most participants were male (58.3%, n = 158), used river water as their primary drinking source (60.5%, n = 164), lived near streams (85.6%, n = 232), and swam in streams (96.3%, n = 261). Schistosomiasis prevalence showed no significant associations with sex (p = 0.370), access to clean water (p = 0.645), water source (p = 0.618), symptoms (p = 0.902), proximity to streams (p = 0.412), or water-contact activities (e.g., swimming: p = 0.722). Significant findings included: a strong association between haematuria (RBCs in urine) and infection (80.2% [69/86] vs. 0.5% [1/185]; p < 0.0001), lower haemoglobin levels in infected participants (median: 11.3 g/dL, IQR: 8.3–12.3 vs. 11.9 g/dL, IQR: 10.3–13.5; p = 0.0067), and reduced mean corpuscular haemoglobin concentration (MCHC) (30.9 g/dL vs. 32.1 g/dL; p = 0.0022). Deworming (3.6% [5/139] infected vs. 49.2% [65/132]; p < 0.0001) and prior schistosomiasis history (9.9% [7/71] vs. 31.5% [63/200]; p < 0.0001) were strongly protective. Table 1 General characteristics of study Participants Schistosomiasis Variable Median (IQR) /Frequency (%) Yes = 70 (25.8) No = 201 (74.2) P value Age years 13 (12, 15) 13 (12,15) 13 (12,15) 0.4272 Sex Male 158 (58.3) 44 (27.9) 114 (72.2) 0.370 Female 113 (41.7) 26 (23.0) 87 (77.0) Access to clean water Yes 106 (39.1) 29 (27.4) 77 (72.6) 0.645 No 165 (60.9) 41 (24.9) 124 (75.1) Source of drinking water Tap 105 (38.8) 29 (27.6) 76 (72.4) 0.618 River water 164 (60.5) 40 (41.8) 124 (75.6) Any signs and symptoms Yes 99 (36.5) 26 (26.3) 73 (73.7) 0.902 No 172 (63.5) 44 (25.6) 128 (74.4) Water treatment Yes 14 (5.2) 3 (21.4) 11 (78.6) 1.000 No 257 (94.8) 67 (26.1) 190 (73.9) Living near the stream Yes 232 (85.6) 62 (26.7) 170 (73.3) 0.412 No 39 (14.4) 8 (20.5) 31 (79.5) Draw water from the stream Yes 49 (18.1) 10 (20.4) 39 (79.6) 0.338 No 222 (81.9) 60 (27.0) 162 (73.0) Draw water from the tap Yes 119 (43.9) 28 (23.5) 91 (76.5) 0.444 No 152 (56.1) 42 (27.6) 110 (72.4) Disinfects drinking water Yes 19 (7.0) 3 (15.8) 16 (84.2) 0.418 No 252 (93.0) 67 (26.6) 185 (73.4) Washing clothes in streams Yes 29 (10.7) 7 (24.1) 22 (75.9) 0.826 No 242 (89.3) 63 (26.0) 179 (74.0) Swimming in streams Yes 261 (96.3) 67 (25.7) 194 (74.3) 0.722 No 10 (3.7) 3 (30.0) 7 (70.0) RBCs in Urine Yes 86 (31.7) 69 (80.2) 17 (19.8) < 0.0001 No 185 (68.3) 1 (0.5) 184 (99.5) RBCs 4.5 (3.8, 5.0) 4.2 (3.4, 5.0) 4.5 (3.9, 5.0) 0.1221 Haemoglobin g/dl 11.8 (10.2, 13) 11.3 (8.3, 12.3) 11.9 (10.3, 13.5) 0.0067 MCV 83 (77, 88) 82 (78, 88) 83 (77, 88) 0.8754 MCH 26.3 (23.8, 28.1) 26.1 (23.9, 27.8) 26.4 (23.8, 28.2) 0.4123 MCHC 31.8 (30.5, 32.8) 30.9 (29.6, 32.6) 32.1 (30.8, 32.8) 0.0022 Granulocytes 2.9 (2.0, 4.5) 3.1 (2.0, 4.6) 2.9 (2.0, 4.4) 0.4516 Lymphocytes 1.9 (1.4, 2.4) 1.9 (1.4, 2.9) 1.9 (1.4, 2.3) 0.3243 Monocytes 0.3 (0.2, 0.4) 0.3 (0.2, 0.5) 0.3 (0.2, 0.4) 0.0628 Platelets 254 (194, 326) 265.5 (194, 335) 240 (194, 320) 0.1100 Have you received deworming Yes 139 (51.3) 5 (3.6) 134 (96.4) < 0.0001 No 132 (48.7) 65 (49.2) 67 (50.7) History of Schistosomiasis Yes 71 (26.2) 7 (9.9) 64 (90.1) < 0.0001 No 200 (73.8) 63 (31.5) 137 (68.5) Abbreviations : IQR, interquartile range; RBC, red blood cell; g/dL, grams per deciliter; MCV, mean corpuscular volume; MCH, mean corpuscular haemoglobin; MCHC, mean corpuscular haemoglobin concentration Factors Associated with Schistosomiasis Infection Variables for logistic regression analysis were selected based on a significance level of p < 0.05 in the univariate analysis. Additionally, sex and age were included in the model as potential confounders due to their biological relevance. Multivariate logistic regression identified lack of deworming (OR: 37.8; 95% CI: 5.78–247.4; p < 0.0001), absence of RBCs in urine (OR: 0.0014; 95% CI: 0.0001–0.011; p < 0.0001), and lower haemoglobin levels (OR: 0.69; 95% CI: 0.48–0.99; p = 0.044) as significant predictors of Schistosomiasis (Table 2 ). Although mean corpuscular haemoglobin concentration (MCHC) was significant in the univariate model (OR: 0.84; 95% CI: 0.74–0.95; p = 0.008), it was not significant in the multivariate model ( p = 0.754). Likewise, a history of Schistosomiasis was significant in the univariate analysis (OR: 4.20; 95% CI: 1.82–9.69; p = 0.001), but this association did not persist in the multivariate model ( p = 0.905). Age and sex were not statistically significant in either model (Table 2 ). Table 2 Logistic regression of factors associated with Schistosomiasis Univariate analysis Multivariate analysis Variable OR (95% CI) P value OR (95% CI) P value Age, Years 0.94 (0.82, 1.07) 0.389 1.38 (0.84, 2.25) 0.199 Sex Male Ref Ref Ref Ref Female 0.77 (0.44, 1.35) 0.370 1.77 (0.40, 7.73) 0.442 RBCs In Urine Yes Ref Ref Ref Ref No 0.0013 (0.0001, 0.0102) < 0.0001 0.0014 (0.0001, 0.011) < 0.0001 HB 0.84 (0.75, 0.95) 0.005 0.69 (0.48, 0.99) 0.044 MCHC 0.84 (0.74, 0.95) 0.008 0.96 (0.76, 1.20) 0.754 Received deworming Yes Ref Ref Ref Ref No 26 (9.99, 67.6) < 0.0001 37.8 (5.78, 247.4) < 0.0001 History of Schistosomiasis Yes Ref Ref Ref Ref No 4.20 (1.82, 9.69) 0.001 1.12 (0.16, 7.72) 0.905 Abbreviations: OR, odds ratio; CI, confidence interval; RBC, red blood cell; HB, haemoglobin; MCHC, mean corpuscular haemoglobin concentration; Ref., reference category. Discussion This study aimed to determine the prevalence of schistosomiasis among school-aged children and assess its association with urinary red blood cells, haemoglobin levels, and deworming history. Our findings revealed a schistosomiasis prevalence of 25.8%, which aligns with rates reported in South-western Nigeria (26.8–29.5%) [ 22 ]. However, this was lower than the prevalence observed in other Nigerian studies (45.6%) [ 23 ] and in South Africa (75%) [ 24 ], yet higher than rates documented in Zambia which was conducted in Siavonga District of Southern Province and in Lusaka (9.7%) [ 25 ], and Mauritania (4.0–15.6%) [ 26 , 27 ]. These disparities may be attributed to differences in environmental conditions including high temperatures in North-western Province that creates a favourable condition for the spread of Schistosoma species, which helps explain the high rates of schistosomiasis in the area. Moreover, warm weather speeds up the parasite’s life cycle by helping snails such as Bulinus and Biomphalaria species grow and reproduce more quickly [ 28 ]. It also makes the parasite develop faster inside the snails, leading to a greater release of infectious larvae. Additionally, the heat helps these larvae survive and stay infectious in water, increasing the chances of people getting infected [ 29 ]. Furthermore, social and behavioural factors play a major role in the continued spread of schistosomiasis, often worsening the effects of environmental risks [ 30 ]. Poverty limits access to clean water and sanitation, forcing people to use contaminated rivers and lakes for daily activities like bathing, washing, and farming activities that increase contact with the parasite [ 8 ]. Activities such as fishing and farming also involve frequent exposure to infested water, further raising the risk [ 31 ]. Poor sanitation practices, including open defecation and urination in water bodies, release parasite eggs into the environment and help maintain the transmission cycle [ 2 , 32 ]. Communities relying on freshwater for bathing, washing, or religious rites face higher exposure risks, while seasonal rainfall and poor water access worsen transmission [ 33 ]. These findings highlight the need for tailored interventions, including health education, sanitation improvements, and targeted deworming, in endemic areas. Our analysis identified lack of deworming with praziquantel as a significant predictor of schistosomiasis infection indicating that children who had not received prior anthelmintic treatment were nearly 38 times more likely to be infected compared to those who had been dewormed. This finding is consistent with Salam et al., who reported that deworming children significantly reduces the odds of infestation by helminths and other parasites [ 34 ]. However, while prophylactic administration of praziquantel may reduce the burden of adult Schistosoma worms in the human host, it does not prevent future infections [ 35 ]. The drug acts by disrupting calcium homeostasis in the parasite, leading to paralysis and damage to its outer surface (tegument), which exposes the worm to the host's immune response for elimination [ 36 ]. World Health Organization data further corroborate these findings large‑scale preventive chemotherapy campaigns typically annual or biannual administration of praziquantel to at‑risk school‑aged children and community members in hyperendemic regions have been shown to drive dramatic declines in both infection prevalence and intensity [ 37 ]. Additionally, the absence of RBCs in urine showed a strong protective effect of schistosomiasis infection. This finding contrasts with urogenital schistosomiasis, in which this marker is well established as a specific clinical indicator of active infection, aligning with WHO diagnostic guidelines and other studies [ 38 , 39 ]. In resource‑constrained environments lacking access to standard schistosomiasis assays, the detection of urinary RBCs constitutes a sensitive and prognostically informative biomarker for active infection. Haemoglobin was another variable that was worth noting. Lower haemoglobin levels were modestly but significantly associated with infection likely reflecting chronic blood loss or inflammation-induced anaemia. Similarly, a study by Degarege et al , showed that chronic S.haematobium infection is known to cause iron‑deficiency anaemia through ongoing blood loss and inflammatory processes, so reduced haemoglobin levels serve as markers of both parasite burden and nutritional compromise [ 40 ]. Leir et al. similarly observed that declines in haemoglobin concentrations were closely associated with schistosomiasis infection. The parasite’s eggs, deposited in the venous plexus around the bladder, penetrate the bladder wall, causing tissue damage and inflammation that leads to haematuria visible blood in the urine [ 41 ]. It is his continual loss of red blood cells that often results in iron-deficiency anaemia [ 42 ]. In addition to direct blood loss, the immune response to eggs trapped in tissues induces chronic inflammation, which disrupts iron metabolism and suppresses red blood cell production, a condition known as anaemia of chronic disease [ 43 , 44 ]. This inflammatory process can also shorten the lifespan of existing red blood cells [ 45 ]. Moreover, S. haematobium infection frequently occurs in areas with poor nutrition, and the parasite can exacerbate nutritional deficiencies by reducing appetite and impairing nutrient absorption [ 46 ]. Together, these factors play a major role in the development and persistence of anaemia among individuals affected by schistosomiasis. These findings call for an urgent expansion of targeted mass drug administration campaigns alongside low‑cost community urine screening. Integrating nutritional support and anaemia management into schistosomiasis control efforts will be crucial for achieving the WHO’s 2030 elimination goals. A key strength of this study lies in its integration of both parasitological and haematological measures, combining microscopy-confirmed haematuria with haemoglobin and mean corpuscular haemoglobin concentration (MCHC) assessments to enhance diagnostic accuracy for Schistosoma haematobium infection in a field setting. By measuring both direct indicators of infection (e.g., red blood cells in urine) and physiological consequences (anaemia markers), we reduced the risk of misclassification and improved the reliability of case identification. Additionally, the inclusion of demographic (age, sex), behavioural (water-contact practices, deworming history), and clinical variables in a single, sufficiently powered multivariable logistic regression model allowed for a comprehensive analysis of infection risk factors. Controlling for potential confounders, such as age and sex, strengthened the validity of our inferences. Despite its valuable insights, this study has several important limitations. First, its cross-sectional design restricts causal interpretation we cannot determine whether anaemia preceded the infection or resulted from it. Second, the use of a single urine sample for microscopy may have underestimated the true prevalence, as egg shedding can be intermittent. Multiple samples would likely enhance diagnostic sensitivity. Third, self-reported deworming history introduces potential recall bias and may account for the extremely wide confidence interval observed for the adjusted odds ratio (AOR 37.8; 95% CI: 5.78–247.4), indicating imprecision due to small numbers in the reference group. Likewise, the near-zero AOR for absence of haematuria, with a wide confidence interval (0.0001–0.011), reflects both a strong association and limited data from discordant cases. Conclusion This study confirms a substantial burden of urogenital schistosomiasis among school-aged children in Zambia. These findings necessitate integrated interventions: targeted praziquantel distribution to underserved communities, school-based haematuria screening for rapid case detection, and bundled iron supplementation within parasite control programs. Despite methodological limitations, this evidence provides a roadmap for accelerating Zambia’s progress toward WHO 2030 elimination targets through context-specific, child-centered strategies. Abbreviations DALYs Disability–Adjusted Life Years LMICs Low–and Middle–Income Countries NTDs Neglected Tropical Diseases SSA Sub–Saharan Africa WASH Water, Sanitation, and Hygiene WHO World Health Organization Declarations Ethics approval and consent to participate Ethical approval for this study was granted by the Mulungushi University School of Medicine and Health Sciences Research Ethics Committee (MUSOMHSREC), which is the ethics committee under the Mulungushi University School of Medicine and Health Sciences (IRB: 00012281, FWA: 0002888; Reference No. SMHS-MU2-2025-25). The need for written informed consent and assent from participants and their guardians was waived by the MUSOMHSREC due to the retrospective nature of the study and the minimal risk posed to participants. To ensure confidentiality, patient information was anonymized, and all data were encrypted using encryption within the data collection and analysis tool. Access to the data was strictly restricted to the study investigators through password-protected systems and minimizing the risk of unauthorized access or disclosure. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki (2013 revision). Clinical Trial number Not applicable (N/A). Consent for publication Not applicable. Competing interests The authors have no conflicts of interest to declare. Funding Not applicable. Author Contribution MC and SKM conceived the Study. SKM and MC oversaw Data acquisition. SKM, MC, and LS supervised data acquisition. SKM and MC conducted the formal analysis. MC, LM, MM, BCM, GM, DC, LS, JPP, AK, BMH and SKM wrote the original draft. All authors contributed to the article edits and approved the final manuscript. Acknowledgement The authors gratefully acknowledge the Hands Research Group for their kind permission to utilize BioRender software. We also thank the Chitokoloki Mission Management for granting us permission to conduct this study. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Verjee MA. Schistosomiasis: Still a Cause of Significant Morbidity and Mortality. Res Rep Trop Med. 2019;10:153–63. Grimes JE, Croll D, Harrison WE, Utzinger J, Freeman MC, Templeton MR. The roles of water, sanitation and hygiene in reducing schistosomiasis: a review. Parasit Vectors. 2015;8:156. Gaye PM, Doucouré S, Sow D, Sokhna C, Ranque S. Freshwater snail-borne parasitic diseases in Africa. Trop Med Health. 2024;52:61. WHO. Leading causes of DALYs [Internet]. 2021 [cited 2025 Jul 11]. 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PROTOCOL: Mass deworming for soil-transmitted helminths and schistosomiasis among pregnant women: a systematic review and individual participant data meta-analysis. Campbell Syst Rev. 2018;14:1–22. Lamberton PHL, Faust CL, Webster JP. Praziquantel decreases fecundity in Schistosoma mansoni adult worms that survive treatment: evidence from a laboratory life-history trade-offs selection study. Infect Dis Poverty. 2017;6:110. Xiao S-H, Sun J, Chen M-G. Pharmacological and immunological effects of praziquantel against Schistosoma japonicum: a scoping review of experimental studies. Infect Dis Poverty. 2018;7:9. WHO. Schistosomiasis [Internet]. 2023 [cited 2025 Jul 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/schistosomiasis Ojo JA, Adedokun SA, Akindele AA, Olorunfemi AB, Otutu OA, Ojurongbe TA, et al. Prevalence of urogenital and intestinal schistosomiasis among school children in South-west Nigeria. PLoS Negl Trop Dis. 2021;15:e0009628. Bishop HG. Detection of Urinary Analytes due to Schistosoma haematobium Infection among School Children for Possible Application in Screening for Urinary Schistosomiasis. UMYU J Microbiol Res. 2024;9:350–8. Degarege A, Erko B, Brett-Major DM, Levecke B, Animut A, Negash Y, et al. Performance of Urine Reagent Test Strips in Detecting Schistosoma haematobium Infection in Individual and Pooled Urine Samples. Microorganisms. 2025;13:510. Santos LL, Santos J, Gouveia MJ, Bernardo C, Lopes C, Rinaldi G, et al. Urogenital Schistosomiasis—History, Pathogenesis, and Bladder Cancer. J Clin Med. 2021;10:205. Nairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? Wien Med Wochenschr 1946. 2016;166:411–23. Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133:40–50. Lanser L, Fuchs D, Kurz K, Weiss G. Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis—Mechanistic Insights into Anemia of Inflammation and Its Treatment. Nutrients. 2021;13:3732. Zhao H, Zhao Y, Wu B, Bai L, Lu L, Zuo L. Influence of Inflammation on Red Blood Cell Lifespan in Peritoneal Dialysis Patients. J Clin Med. 2024;13:7104. Maciel PS, Gonçalves R, Antonelli LR do, Fonseca V. CT. Schistosoma mansoni Infection Is Impacted by Malnutrition. Front Microbiol [Internet]. 2021 [cited 2025 Jul 17];12. Available from: https://www.frontiersin.org/journals/microbiology/articles/ 10.3389/fmicb.2021.635843/full Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Dec, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 10 Nov, 2025 Reviews received at journal 30 Oct, 2025 Reviews received at journal 24 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 21 Oct, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers agreed at journal 19 Sep, 2025 Reviewers invited by journal 19 Sep, 2025 Editor assigned by journal 10 Sep, 2025 Editor invited by journal 05 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 02 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Transmission occurs primarily through skin contact with freshwater contaminated by cercariae released from infected intermediate snail hosts, such as Bulinus truncatus for \u003cem\u003eSchistosoma haematobium\u003c/em\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Globally, over 240\u0026nbsp;million people are infected annually, resulting in approximately 280,000 deaths and accounting for more than 3.3\u0026nbsp;million disability-adjusted life years (DALYs), ranking it among the most devastating neglected tropical diseases (NTDs) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The burden of \u003cem\u003eSchistosoma haematobium\u003c/em\u003e is disproportionately concentrated in sub-Saharan Africa (SSA), where impoverished communities face cyclical reinfection due to inadequate water, sanitation, and hygiene (WASH) infrastructure [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eChildren and adolescents bear the highest burden of schistosomiasis morbidity. Their frequent exposure to contaminated water during daily activities like swimming, bathing, fetching water, and fishing significantly increases infection risk [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The prevalence of Schistosomiasis in this demographic can exceed 75% in high-transmission foci [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Chronic infection during critical developmental stages leads to severe health complications, including hepatic fibrosis, portal hypertension, kidney failure, bladder cancer, and urogenital damage [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Beyond physical pathology, schistosomiasis causes anaemia, malnutrition, stunted growth, and impaired cognitive development, profoundly impacting educational attainment and long-term quality of life [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite global control efforts, including preventative chemotherapy targeting millions, prevalence remains persistently high, with an estimated 251.4\u0026nbsp;million people requiring treatment in 2022. Current strategies often fail to adequately address the specific vulnerabilities and transmission dynamics affecting youth [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Zambia, schistosomiasis is endemic yet critically understudied, particularly among children and adolescents. Reported prevalence of approximately 35.5% indicates substantial transmission [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The surge in praziquantel uptake at facilities like Chitokoloki Mission Hospital underscores a significant local burden. However, recent and comprehensive data on the prevalence, severity, geographic distribution, and key risk factors of schistosomiasis among children and adolescents in Zambia remain limited. Understanding these correlates including environmental, socioeconomic, behavioral, and WASH-related factors is essential for designing effective, targeted interventions.\u003c/p\u003e\u003cp\u003eThis study therefore aims to assess the burden and identify the correlates of schistosomiasis among children and adolescents in Zambia. By quantifying prevalence and analyzing determinants of infection, this research will generate critical evidence to inform local and national public health strategies.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Study setting\u003c/h2\u003e\u003cp\u003eThis was a retrospective crosssectional study conducted at Chitokoloki Mission Hospital in North-western Province, Zambia, among children and adolescents attending the outpatient department between 1 January 2025 and 31 March 2025. Chitokoloki Mission Hospital is a 180\u0026ndash;200 bed capacity healthcare facility located in Zambezi District, Zambia. It serves a catchment population of approximately 150,000 people. In addition to providing inpatient and outpatient services, the hospital supports three satellite clinics within a 40 km radius, two of which are situated on the west bank of the Zambezi River, ensuring access to healthcare for remote and underserved communities. The outpatient department serves as the primary referral point for surrounding health centres in the district.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEligibility and recruitment criteria\u003c/h3\u003e\n\u003cp\u003eWe abstracted hospital records from participants aged 5 to 18 years who visited the outpatient department. Records missing clinical or laboratory data were excluded. Using a systematic random sampling approach, every third file from the eligible patient records was selected for screening. From 610 files available for abstraction, 410 medical records were reviewed, 271 records met the inclusion criteria and were included in the analysis. 339 records were excluded due to incomplete information, such as missing details on age, sex, and missing outcome, diagnosis or the outcome, \u003cb\u003eFig.\u0026nbsp;1\u003c/b\u003e.\u003c/p\u003e\n\u003ch3\u003eSample Size Calculations\u003c/h3\u003e\n\u003cp\u003eThe sample size for this study was determined using the single population proportion formula, based on an estimated prevalence of 20.3% [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], a 95% confidence level, and a margin of error of 5%. The formula applied was:\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{Z}^{2}\\times\\:p\\times\\:(1-p)}{{d}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ewhere n is the required sample size, Z is the Z-score corresponding to a 95% confidence level (1.96), p is the estimated prevalence (0.203), and d is the desired margin of error (0.05). Substituting these values into the formula yielded a minimum sample size of approximately 248. To account for potential non-response or incomplete data, a 10% adjustment was made, resulting in a final sample size of 271 participants included in the study.\u003c/p\u003e\n\u003ch3\u003eSpecimen Collection and Processing\u003c/h3\u003e\n\u003cp\u003eAs this was a retrospective study, all biological specimens had been collected and processed as part of routine clinical procedures at Chitokoloki Mission Hospital. According to standard hospital protocol, patients were provided with sterile urine containers and instructed to collect midstream urine samples to minimize contamination. The initial urine stream was discarded, and only the midstream portion was retained for analysis. At the same clinical visit, approximately 4 mL of venous blood was aseptically drawn from the antecubital fossa using EDTA vacutainer tubes. All samples were labeled with unique patient identifiers at the point of collection and transported to the laboratory in cooler boxes for testing maintained at recommended temperatures. Haematological analysis was conducted using a Horiba Micros ES60 haematology analyzer (Horiba ABX, Montpellier, France) to assess complete blood count (CBC) parameters, including haemoglobin concentration, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC). Urine samples were initially inspected for visible blood (macrohaematuria), followed by dipstick testing using Hemastix reagent strips (Siemens Healthcare Diagnostics) to detect microhaematuria. Microscopic examination for \u003cem\u003eSchistosoma haematobium\u003c/em\u003e eggs was performed on centrifuged urine sediments using standard light microscopy techniques [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eClinical and demographic data for 271 children and adolescents (aged 5\u0026ndash;18 years) attending the outpatient department at Chitokoloki Mission Hospital in North-western Province, Zambia, were abstracted from both paper and electronic records. Key variables including age, sex, access to clean water, primary source of drinking water, water‑contact activities (swimming, washing clothes, drawing water), haematuria (RBCs in urine), complete blood count indices including haemoglobin, MCV, MCH, MCHC, differential leukocyte counts, platelets and deworming history were captured into REDCap. Records lacking essential clinical or laboratory data were excluded. Each file was screened and selected via systematic random sampling, with every third eligible record abstracted for analysis.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStudy Variables\u003c/h2\u003e\u003cp\u003eThe primary outcome was schistosomiasis infection, defined as the presence of Schistosoma \u003cem\u003ehaematobium\u003c/em\u003e eggs on urine microscopy. Independent variables included demographic factors (age, sex), water‑related exposures (access to clean water, primary drinking‑water source, proximity to and activities in streams), clinical markers (haematuria, haemoglobin concentration, MCV, MCH, MCHC), and prevention history (praziquantel deworming status, self‑reported prior schistosomiasis).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were exported from REDCap to Microsoft Excel for cleaning and subsequently analyzed in StatCrunch. Categorical variables were summarized using frequencies and percentages, while continuous variables were described as medians with interquartile ranges (IQRs). The Shapiro\u0026ndash;Wilk test assessed normality, and the Wilcoxon rank-sum test compared medians between infected and uninfected groups. Associations between categorical variables and schistosomiasis status were evaluated using chi‑squared tests. Factors associated with schistosomiasis were then examined via multivariable logistic regression. Candidate predictors including age, sex, access to clean water, primary drinking‑water source, water‑contact activities such as swimming, drawing water, haematuria, haemoglobin concentration, and deworming history were chosen based on prior literature and field expert input. Variables with a univariate p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 or established biological relevance were retained in the adjusted model. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 271 participants with a median age of 13 years (interquartile range [IQR]: 12\u0026ndash;15), of whom 25.8% (n\u0026thinsp;=\u0026thinsp;70) had schistosomiasis. Most participants were male (58.3%, n\u0026thinsp;=\u0026thinsp;158), used river water as their primary drinking source (60.5%, n\u0026thinsp;=\u0026thinsp;164), lived near streams (85.6%, n\u0026thinsp;=\u0026thinsp;232), and swam in streams (96.3%, n\u0026thinsp;=\u0026thinsp;261). Schistosomiasis prevalence showed no significant associations with sex (p\u0026thinsp;=\u0026thinsp;0.370), access to clean water (p\u0026thinsp;=\u0026thinsp;0.645), water source (p\u0026thinsp;=\u0026thinsp;0.618), symptoms (p\u0026thinsp;=\u0026thinsp;0.902), proximity to streams (p\u0026thinsp;=\u0026thinsp;0.412), or water-contact activities (e.g., swimming: p\u0026thinsp;=\u0026thinsp;0.722). Significant findings included: a strong association between haematuria (RBCs in urine) and infection (80.2% [69/86] vs. 0.5% [1/185]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), lower haemoglobin levels in infected participants (median: 11.3 g/dL, IQR: 8.3\u0026ndash;12.3 vs. 11.9 g/dL, IQR: 10.3\u0026ndash;13.5; p\u0026thinsp;=\u0026thinsp;0.0067), and reduced mean corpuscular haemoglobin concentration (MCHC) (30.9 g/dL vs. 32.1 g/dL; p\u0026thinsp;=\u0026thinsp;0.0022). Deworming (3.6% [5/139] infected vs. 49.2% [65/132]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and prior schistosomiasis history (9.9% [7/71] vs. 31.5% [63/200]; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) were strongly protective.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGeneral characteristics of study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eSchistosomiasis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian (IQR) /Frequency (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u0026thinsp;=\u0026thinsp;70 (25.8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u0026thinsp;=\u0026thinsp;201 (74.2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (12, 15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (12,15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (12,15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4272\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (27.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e114 (72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.370\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113 (41.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (77.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAccess to clean water\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (39.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (27.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77 (72.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.645\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165 (60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124 (75.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of drinking water\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eTap\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e105 (38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29 (27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76 (72.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.618\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eRiver water\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e164 (60.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40 (41.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e124 (75.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAny signs and symptoms\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99 (36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (26.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.902\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e172 (63.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e128 (74.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWater treatment\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (5.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (21.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (78.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e257 (94.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e190 (73.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving near the stream\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e232 (85.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170 (73.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.412\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (14.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (20.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (79.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDraw water from the stream\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (20.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (79.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.338\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e222 (81.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60 (27.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e162 (73.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDraw water from the tap\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119 (43.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91 (76.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e152 (56.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (27.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110 (72.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDisinfects drinking water\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (7.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (84.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.418\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e252 (93.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e185 (73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWashing clothes in streams\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (75.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.826\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e242 (89.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (26.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e179 (74.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSwimming in streams\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e261 (96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67 (25.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e194 (74.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.722\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (30.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (70.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRBCs in Urine\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69 (80.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17 (19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e185 (68.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e184 (99.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRBCs\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.5 (3.8, 5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.2 (3.4, 5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5 (3.9, 5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1221\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHaemoglobin g/dl\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.8 (10.2, 13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.3 (8.3, 12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.9 (10.3, 13.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0067\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMCV\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (77, 88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82 (78, 88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83 (77, 88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.8754\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMCH\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.3 (23.8, 28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.1 (23.9, 27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.4 (23.8, 28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMCHC\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.8 (30.5, 32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.9 (29.6, 32.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.1 (30.8, 32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.0022\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGranulocytes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.9 (2.0, 4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1 (2.0, 4.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.9 (2.0, 4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.4516\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLymphocytes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.9 (1.4, 2.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9 (1.4, 2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9 (1.4, 2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.3243\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonocytes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.3 (0.2, 0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3 (0.2, 0.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3 (0.2, 0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.0628\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlatelets\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e254 (194, 326)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e265.5 (194, 335)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e240 (194, 320)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.1100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHave you received deworming\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139 (51.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (3.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134 (96.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e132 (48.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of Schistosomiasis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (9.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (90.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e200 (73.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (31.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e137 (68.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAbbreviations\u003c/b\u003e: IQR, interquartile range; RBC, red blood cell; g/dL, grams per deciliter; MCV, mean corpuscular volume; MCH, mean corpuscular haemoglobin; MCHC, mean corpuscular haemoglobin concentration\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFactors Associated with Schistosomiasis Infection\u003c/h2\u003e\u003cp\u003eVariables for logistic regression analysis were selected based on a significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis. Additionally, sex and age were included in the model as potential confounders due to their biological relevance. Multivariate logistic regression identified lack of deworming (OR: 37.8; 95% CI: 5.78\u0026ndash;247.4; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), absence of RBCs in urine (OR: 0.0014; 95% CI: 0.0001\u0026ndash;0.011; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and lower haemoglobin levels (OR: 0.69; 95% CI: 0.48\u0026ndash;0.99; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) as significant predictors of Schistosomiasis (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Although mean corpuscular haemoglobin concentration (MCHC) was significant in the univariate model (OR: 0.84; 95% CI: 0.74\u0026ndash;0.95; p\u0026thinsp;=\u0026thinsp;0.008), it was not significant in the multivariate model (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.754). Likewise, a history of Schistosomiasis was significant in the univariate analysis (OR: 4.20; 95% CI: 1.82\u0026ndash;9.69; p\u0026thinsp;=\u0026thinsp;0.001), but this association did not persist in the multivariate model (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.905). Age and sex were not statistically significant in either model (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression of factors associated with Schistosomiasis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eOR (95% CI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.94 (0.82, 1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.38 (0.84, 2.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.199\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77 (0.44, 1.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.370\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.77 (0.40, 7.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.442\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRBCs In Urine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0013 (0.0001, 0.0102)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0014 (0.0001, 0.011)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84 (0.75, 0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.69 (0.48, 0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMCHC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.84 (0.74, 0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.96 (0.76, 1.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.754\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReceived deworming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (9.99, 67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.8 (5.78, 247.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHistory of Schistosomiasis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eYes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRef\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNo\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.20 (1.82, 9.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12 (0.16, 7.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eAbbreviations: OR, odds ratio; CI, confidence interval; RBC, red blood cell; HB, haemoglobin; MCHC, mean corpuscular haemoglobin concentration; Ref., reference category.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to determine the prevalence of schistosomiasis among school-aged children and assess its association with urinary red blood cells, haemoglobin levels, and deworming history. Our findings revealed a schistosomiasis prevalence of 25.8%, which aligns with rates reported in South-western Nigeria (26.8\u0026ndash;29.5%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, this was lower than the prevalence observed in other Nigerian studies (45.6%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and in South Africa (75%) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], yet higher than rates documented in Zambia which was conducted in Siavonga District of Southern Province and in Lusaka (9.7%) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and Mauritania (4.0\u0026ndash;15.6%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These disparities may be attributed to differences in environmental conditions including high temperatures in North-western Province that creates a favourable condition for the spread of Schistosoma species, which helps explain the high rates of schistosomiasis in the area. Moreover, warm weather speeds up the parasite\u0026rsquo;s life cycle by helping snails such as Bulinus and Biomphalaria species grow and reproduce more quickly [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It also makes the parasite develop faster inside the snails, leading to a greater release of infectious larvae. Additionally, the heat helps these larvae survive and stay infectious in water, increasing the chances of people getting infected [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Furthermore, social and behavioural factors play a major role in the continued spread of schistosomiasis, often worsening the effects of environmental risks [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Poverty limits access to clean water and sanitation, forcing people to use contaminated rivers and lakes for daily activities like bathing, washing, and farming activities that increase contact with the parasite [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Activities such as fishing and farming also involve frequent exposure to infested water, further raising the risk [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Poor sanitation practices, including open defecation and urination in water bodies, release parasite eggs into the environment and help maintain the transmission cycle [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Communities relying on freshwater for bathing, washing, or religious rites face higher exposure risks, while seasonal rainfall and poor water access worsen transmission [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These findings highlight the need for tailored interventions, including health education, sanitation improvements, and targeted deworming, in endemic areas.\u003c/p\u003e\u003cp\u003eOur analysis identified lack of deworming with praziquantel as a significant predictor of schistosomiasis infection indicating that children who had not received prior anthelmintic treatment were nearly 38 times more likely to be infected compared to those who had been dewormed. This finding is consistent with Salam et al., who reported that deworming children significantly reduces the odds of infestation by helminths and other parasites [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, while prophylactic administration of praziquantel may reduce the burden of adult \u003cem\u003eSchistosoma\u003c/em\u003e worms in the human host, it does not prevent future infections [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The drug acts by disrupting calcium homeostasis in the parasite, leading to paralysis and damage to its outer surface (tegument), which exposes the worm to the host's immune response for elimination [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. World Health Organization data further corroborate these findings large‑scale preventive chemotherapy campaigns typically annual or biannual administration of praziquantel to at‑risk school‑aged children and community members in hyperendemic regions have been shown to drive dramatic declines in both infection prevalence and intensity [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, the absence of RBCs in urine showed a strong protective effect of schistosomiasis infection. This finding contrasts with urogenital schistosomiasis, in which this marker is well established as a specific clinical indicator of active infection, aligning with WHO diagnostic guidelines and other studies [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In resource‑constrained environments lacking access to standard schistosomiasis assays, the detection of urinary RBCs constitutes a sensitive and prognostically informative biomarker for active infection.\u003c/p\u003e\u003cp\u003eHaemoglobin was another variable that was worth noting. Lower haemoglobin levels were modestly but significantly associated with infection likely reflecting chronic blood loss or inflammation-induced anaemia. Similarly, a study by Degarege \u003cem\u003eet al\u003c/em\u003e, showed that chronic \u003cem\u003eS.haematobium\u003c/em\u003e infection is known to cause iron‑deficiency anaemia through ongoing blood loss and inflammatory processes, so reduced haemoglobin levels serve as markers of both parasite burden and nutritional compromise [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Leir \u003cem\u003eet al.\u003c/em\u003e similarly observed that declines in haemoglobin concentrations were closely associated with schistosomiasis infection. The parasite\u0026rsquo;s eggs, deposited in the venous plexus around the bladder, penetrate the bladder wall, causing tissue damage and inflammation that leads to haematuria visible blood in the urine [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. It is his continual loss of red blood cells that often results in iron-deficiency anaemia [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. In addition to direct blood loss, the immune response to eggs trapped in tissues induces chronic inflammation, which disrupts iron metabolism and suppresses red blood cell production, a condition known as anaemia of chronic disease [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. This inflammatory process can also shorten the lifespan of existing red blood cells [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Moreover, \u003cem\u003eS. haematobium\u003c/em\u003e infection frequently occurs in areas with poor nutrition, and the parasite can exacerbate nutritional deficiencies by reducing appetite and impairing nutrient absorption [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Together, these factors play a major role in the development and persistence of anaemia among individuals affected by schistosomiasis. These findings call for an urgent expansion of targeted mass drug administration campaigns alongside low‑cost community urine screening. Integrating nutritional support and anaemia management into schistosomiasis control efforts will be crucial for achieving the WHO\u0026rsquo;s 2030 elimination goals.\u003c/p\u003e\u003cp\u003eA key strength of this study lies in its integration of both parasitological and haematological measures, combining microscopy-confirmed haematuria with haemoglobin and mean corpuscular haemoglobin concentration (MCHC) assessments to enhance diagnostic accuracy for \u003cem\u003eSchistosoma haematobium\u003c/em\u003e infection in a field setting. By measuring both direct indicators of infection (e.g., red blood cells in urine) and physiological consequences (anaemia markers), we reduced the risk of misclassification and improved the reliability of case identification. Additionally, the inclusion of demographic (age, sex), behavioural (water-contact practices, deworming history), and clinical variables in a single, sufficiently powered multivariable logistic regression model allowed for a comprehensive analysis of infection risk factors. Controlling for potential confounders, such as age and sex, strengthened the validity of our inferences.\u003c/p\u003e\u003cp\u003eDespite its valuable insights, this study has several important limitations. First, its cross-sectional design restricts causal interpretation we cannot determine whether anaemia preceded the infection or resulted from it. Second, the use of a single urine sample for microscopy may have underestimated the true prevalence, as egg shedding can be intermittent. Multiple samples would likely enhance diagnostic sensitivity. Third, self-reported deworming history introduces potential recall bias and may account for the extremely wide confidence interval observed for the adjusted odds ratio (AOR 37.8; 95% CI: 5.78\u0026ndash;247.4), indicating imprecision due to small numbers in the reference group. Likewise, the near-zero AOR for absence of haematuria, with a wide confidence interval (0.0001\u0026ndash;0.011), reflects both a strong association and limited data from discordant cases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study confirms a substantial burden of urogenital schistosomiasis among school-aged children in Zambia. These findings necessitate integrated interventions: targeted praziquantel distribution to underserved communities, school-based haematuria screening for rapid case detection, and bundled iron supplementation within parasite control programs. Despite methodological limitations, this evidence provides a roadmap for accelerating Zambia\u0026rsquo;s progress toward WHO 2030 elimination targets through context-specific, child-centered strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDALYs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDisability\u0026ndash;Adjusted Life Years\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow\u0026ndash;and Middle\u0026ndash;Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNTDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeglected Tropical Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSub\u0026ndash;Saharan Africa\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWASH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWater, Sanitation, and Hygiene\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e Ethical approval for this study was granted by the Mulungushi University School of Medicine and Health Sciences Research Ethics Committee (MUSOMHSREC), which is the ethics committee under the Mulungushi University School of Medicine and Health Sciences (IRB: 00012281, FWA: 0002888; Reference No. SMHS-MU2-2025-25). The need for written informed consent and assent from participants and their guardians was waived by the MUSOMHSREC due to the retrospective nature of the study and the minimal risk posed to participants. To ensure confidentiality, patient information was anonymized, and all data were encrypted using encryption within the data collection and analysis tool. Access to the data was strictly restricted to the study investigators through password-protected systems and minimizing the risk of unauthorized access or disclosure. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki (2013 revision).\u003c/p\u003e\u003ch2\u003eClinical Trial number\u003c/h2\u003e\u003cp\u003eNot applicable (N/A).\u003c/p\u003e\u003ch2\u003eConsent for publication\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eMC and SKM conceived the Study. SKM and MC oversaw Data acquisition. SKM, MC, and LS supervised data acquisition. SKM and MC conducted the formal analysis. MC, LM, MM, BCM, GM, DC, LS, JPP, AK, BMH and SKM wrote the original draft. All authors contributed to the article edits and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge the Hands Research Group for their kind permission to utilize BioRender software. We also thank the Chitokoloki Mission Management for granting us permission to conduct this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVerjee MA. Schistosomiasis: Still a Cause of Significant Morbidity and Mortality. Res Rep Trop Med. 2019;10:153\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrimes JE, Croll D, Harrison WE, Utzinger J, Freeman MC, Templeton MR. The roles of water, sanitation and hygiene in reducing schistosomiasis: a review. Parasit Vectors. 2015;8:156.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGaye PM, Doucour\u0026eacute; S, Sow D, Sokhna C, Ranque S. Freshwater snail-borne parasitic diseases in Africa. Trop Med Health. 2024;52:61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Leading causes of DALYs [Internet]. 2021 [cited 2025 Jul 11]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys\u003c/span\u003e\u003cspan address=\"https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitra AK, Mawson AR. Neglected Tropical Diseases: Epidemiology and Global Burden. 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PLoS Negl Trop Dis. 2021;15:e0009380.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdewale B, Mafe MA, Mogaji HO, Balogun JB, Sulyman MA, Ajayi MB, et al. Urinary schistosomiasis and anemia among school-aged children from southwestern Nigeria. Pathog Glob Health. 2024;118:325\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdulkareem BO, Habeeb KO, Kazeem A, Adam AO, Samuel UU. Urogenital Schistosomiasis among Schoolchildren and the Associated Risk Factors in Selected Rural Communities of Kwara State, Nigeria. J Trop Med. 2018;2018:6913918.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNjikho SL, Quan VC, Mbonane TP, Van Wyk RH. Evaluating the Prevalence and Risk Factors of Schistosomiasis Amongst School-Aged Children in Low- and Middle-Income Communities: Ehlanzeni District Municipality, South Africa, 2015\u0026ndash;2021. Trop Med Infect Dis. 2023;8:522.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTembo R, Muleya W, Yabe J, Kainga H, Nalubamba KS, Zulu M, et al. Prevalence and Molecular Identification of Schistosoma haematobium among Children in Lusaka and Siavonga Districts, Zambia. Trop Med Infect Dis. 2022;7:239.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOuld Ahmed Salem CB, Boussery A, Hafid J. Study of prevalence and parasite load of Schistosoma haematobium in schoolchildren in the Rosso region, Mauritania. Med Sante Trop. 2019;29:268\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGbal\u0026eacute;gba NGC, Silu\u0026eacute; KD, Ba O, Ba H, Tian-Bi NTY, Yapi GY, et al. Prevalence and seasonal transmission of Schistosoma haematobium infection among school-aged children in Kaedi town, southern Mauritania. 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PROTOCOL: Mass deworming for soil-transmitted helminths and schistosomiasis among pregnant women: a systematic review and individual participant data meta-analysis. Campbell Syst Rev. 2018;14:1\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLamberton PHL, Faust CL, Webster JP. Praziquantel decreases fecundity in Schistosoma mansoni adult worms that survive treatment: evidence from a laboratory life-history trade-offs selection study. Infect Dis Poverty. 2017;6:110.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao S-H, Sun J, Chen M-G. Pharmacological and immunological effects of praziquantel against Schistosoma japonicum: a scoping review of experimental studies. Infect Dis Poverty. 2018;7:9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO. Schistosomiasis [Internet]. 2023 [cited 2025 Jul 12]. 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UMYU J Microbiol Res. 2024;9:350\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDegarege A, Erko B, Brett-Major DM, Levecke B, Animut A, Negash Y, et al. Performance of Urine Reagent Test Strips in Detecting Schistosoma haematobium Infection in Individual and Pooled Urine Samples. Microorganisms. 2025;13:510.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSantos LL, Santos J, Gouveia MJ, Bernardo C, Lopes C, Rinaldi G, et al. Urogenital Schistosomiasis\u0026mdash;History, Pathogenesis, and Bladder Cancer. J Clin Med. 2021;10:205.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNairz M, Theurl I, Wolf D, Weiss G. Iron deficiency or anemia of inflammation? Wien Med Wochenschr 1946. 2016;166:411\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWeiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133:40\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLanser L, Fuchs D, Kurz K, Weiss G. Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis\u0026mdash;Mechanistic Insights into Anemia of Inflammation and Its Treatment. Nutrients. 2021;13:3732.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao H, Zhao Y, Wu B, Bai L, Lu L, Zuo L. Influence of Inflammation on Red Blood Cell Lifespan in Peritoneal Dialysis Patients. J Clin Med. 2024;13:7104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMaciel PS, Gon\u0026ccedil;alves R, Antonelli LR do, Fonseca V. CT. Schistosoma mansoni Infection Is Impacted by Malnutrition. Front Microbiol [Internet]. 2021 [cited 2025 Jul 17];12. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/journals/microbiology/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/journals/microbiology/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmicb.2021.635843/full\u003c/span\u003e\u003cspan address=\"10.3389/fmicb.2021.635843/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Children, Prevalence, Schistosomiasis, Urogenital Infection, Zambia","lastPublishedDoi":"10.21203/rs.3.rs-7428590/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7428590/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eUrogenital schistosomiasis remains a major public health challenge among children and adolescents in subSaharan Africa. Data on prevalence and associated factors in Zambia are scarce. This study assessed the burden of \u003cem\u003eSchistosoma haematobium\u003c/em\u003e infection and its correlates among 271 children and adolescents attending the outpatient department of Chitokoloki Mission Hospital, Northwestern Province.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e We conducted a retrospective crosssectional review of clinical records from January to March 2025. Systematic random sampling of files for participants aged 5\u0026ndash;18 years captured sociodemographic data, watercontact behaviours, haematuria (RBCs in urine), haematological indices (haemoglobin, MCV, MCHC), deworming history, and prior schistosomiasis. Urine microscopy for \u003cem\u003eS. haematobium\u003c/em\u003e eggs defined infection status. Categorical variables were compared by chisquared test and medians by Wilcoxon ranksum. Multivariable logistic regression identified independent predictors of infection (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe median age was 13 years (IQR: 12\u0026ndash;15); 58.3% were male. Overall prevalence of schistosomiasis was 25.8% (n\u0026thinsp;=\u0026thinsp;70). Haematuria was present in 80.2% of infected versus 0.5% of uninfected participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Infected children had lower median haemoglobin (11.3 g/dL vs. 11.9 g/dL; p\u0026thinsp;=\u0026thinsp;0.0067) and MCHC (30.9 g/dL vs. 32.1 g/dL; p\u0026thinsp;=\u0026thinsp;0.0022). Only 3.6% of previously dewormed children were infected compared with 49.2% of nondewormed peers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In adjusted analyses, absence of deworming (aOR 37.8; 95% CI 5.78\u0026ndash;247.4), absence of haematuria (aOR 0.0014; 95% CI 0.0001\u0026ndash;0.011), and lower haemoglobin (aOR 0.69 per g/dL; 95% CI 0.48\u0026ndash;0.99) remained independently associated with infection.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThere is a significant burden of urogenital schistosomiasis among school-aged children and adolescents attending Chitokoloki Mission Hospital in Zambezi District, Zambia. Targeted praziquantel distribution, cost-effective urine screening, and the integration of nutritional and anaemia management strategies are critical components for effective disease control. Strengthening these interventions is essential to advance progress toward achieving the World Health Organization\u0026rsquo;s 2030 schistosomiasis elimination targets in Zambia.\u003c/p\u003e","manuscriptTitle":"Prevalence and associated factors of schistosomiasis among children and adolescents visiting Chitokoloki Mission Hospital of Zambezi District","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 09:40:19","doi":"10.21203/rs.3.rs-7428590/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-10T08:40:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-30T11:45:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-24T06:56:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180049714584365117329025807091107735647","date":"2025-10-24T06:25:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"49953566607906366927842129901606369604","date":"2025-10-21T13:35:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63500865893827993104346473456435028100","date":"2025-09-24T12:50:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236724045634304411326177656863447609371","date":"2025-09-19T09:08:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-19T04:19:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T22:24:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T14:36:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T10:13:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-09-02T10:09:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5ad4c46d-fe14-4f95-9cc6-bede0684ebea","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:04:38+00:00","versionOfRecord":{"articleIdentity":"rs-7428590","link":"https://doi.org/10.1186/s12879-025-12267-6","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-12-01 15:58:24","publishedOnDateReadable":"December 1st, 2025"},"versionCreatedAt":"2025-09-30 09:40:19","video":"","vorDoi":"10.1186/s12879-025-12267-6","vorDoiUrl":"https://doi.org/10.1186/s12879-025-12267-6","workflowStages":[]},"version":"v1","identity":"rs-7428590","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7428590","identity":"rs-7428590","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}