Prevalence of schistosome infection among children under two years of age: a brief report from medium-to-high endemic regions of Schistosoma mansoni in Madagascar.

INTRODUCTION

Schistosome infections in early childhood can affect a child's growth and development, leading to lifelong consequences. Historically, monitoring and control of schistosomiasis have focused primarily on school-aged children leading to a knowledge gap on the magnitude of the prevalence of infections in younger age groups in many endemic countries. This study aimed to estimate the prevalence of schistosome infections among children under 2 years of age and describe its distribution in three regions of Madagascar endemic for Schistosoma mansoni, thereby informing public health strategies in the country.

METHODS

A cross-sectional study was conducted on a sample of 2018 children under 2 years of age recruited from 42 primary health care centres in the regions of Itasy, Bongolava and Amoron'i Mania, Madagascar, from March 2020 to June 2021. Urine samples were collected to perform an up-converting reporter particle lateral flow circulating anodic antigen assay (UCP-LF-CAA) for the detection of schistosome infections. To identify factors associated with the prevalence of schistosome infection, prevalence ratios with 95% CIs were estimated using mixed-effects Poisson regression.

RESULTS

Among 2018 sampled children with an average age of 9.6 months (SD = 1.2), the prevalence of schistosome infection was 6.2% [CI95%: 5.0, 7.8]. The prevalence estimates were similar across all population subgroups. We observed no statistically significant associations of schistosome infections in children with maternal age (p-value = 0.4110), education (p-value = 0.1281), occupation (p-value = 0.3333), child sex (p-value = 0.3692), urbanisation (p-value = 0.8272) or region of residence (p-value = 0.7425).

CONCLUSION

Our results show that the prevalence of schistosome infection in children under 2 years of age in Madagascar is significant. Given the high burden and long-term consequences of early schistosome infection, integrated and inclusive public health interventions that combine treatment, caregiver health education, with improvements in sanitation and access to clean water, are needed for children under 2 years of age in endemic settings.