Epidemiological burden of schistosomiasis among schoolchildren in conflict-stricken mesoendemic districts of Yemen: A decade after national mapping.

BACKGROUND

Despite multiple rounds of mass drug administration (MDA), schistosomiasis remains a major public health problem in Yemen. This study assessed the burden of schistosomiasis among schoolchildren in mesoendemic districts over a decade after the 2014 national mapping in the context of the ongoing humanitarian crisis, conflict, and disrupted control efforts.

METHODS

A cross-sectional study was conducted among 348 schoolchildren aged 5-15 years in three randomly selected mesoendemic districts: Al Husha, Bura, and Habur Zulaymah districts. Data on sociodemographics and potential risk factors were collected using a pilot-tested, structured questionnaire. Parasitological examinations for Schistosoma haematobium and S. mansoni were performed using urine filtration and Kato-Katz techniques, respectively. Independent predictors of infection were identified using multivariable binary logistic regression.

RESULTS

The overall schistosomiasis prevalence among schoolchildren was 21% (95% CI: 17, 25), with 13.5% infected with S. haematobium, 6% with S. mansoni, and 1.4% co-infected. Compared to 2014, prevalence increased across all study districts, particularly for S. haematobium. Most infections were of light intensity. Infection with S. haematobium was significantly associated with dysuria, macrohematuria, microhematuria, and proteinuria. Independent predictors of schistosomiasis included male gender (AOR = 2.6; 95% CI: 1.34, 4.82; P = 0.003), age ≥ 10 years (AOR = 2.4; 95% CI: 1.20, 4.92; P = 0.013), household size larger than eight members (AOR = 2.4; 95% CI: 1.28, 4.63; P = 0.007), and contact with open water sources (AOR = 2.5; 95% CI: 1.20, 5.19; P = 0.014).

CONCLUSION

Despite multiple MDA campaigns, schistosomiasis remains moderately endemic in the districts of Yemen classified as mesoendemic in 2014, with an increased S. haematobium prevalence. While MDA has reduced the prevalence of heavy infections, transmission persists. These findings underscore the need for an integrated strategy combining biannual MDA, health education, improved sanitation, and environmental management to interrupt transmission.