Assessing the prevalence of Schistosoma mansoni infections among school-going children aged 5-14 years old in Nelson Mandela Bay: A comprehensive diagnostic approach.
1
Environmental health, Nelson Mandela University, Summerstrand, Port Elizabeth, South Africa
2
Nursing science, Nelson Mandela University, Summerstrand, Port Elizabeth, South Africa
3
Institute of Primate Research, Institute of Primate Research, Nairobi, Kenya
4
Computing, Mathematical and Statistical Sciences, University of Namibia, Nairobi, Namibia
5
Medical Laboratory Services, Nelson Mandela University, Summerstrand, Port Elizabeth, South Africa
6
Biochemistry and Biotechnology, University of Zimbabwe, Harare, Zimbabwe
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Intestinal schistosomiasis caused by Schistosoma mansoni is frequently underestimated in low-transmission settings due to the low sensitivity of stool microscopy. Low-intensity infections often occur without detectable eggs, necessitating the use of more sensitive diagnostic tools such as point-of-care circulating cathodic antigen (POC-CCA) tests and molecular methods. This study determined the prevalence of S. mansoni infection among school-going children in Nelson Mandela Bay (NMB), South Africa, using complementary diagnostic approaches.
METHODS:
A cross-sectional study was conducted among 759 children aged 5–14 years from 15 primary schools in NMB. Stool samples were analysed using the Kato-Katz technique. Urine samples were tested using POC-CCA assays, and stool samples corresponding to POC-CCA–positive cases were analysed using conventional polymerase chain reaction (cPCR).
RESULTS:
Among the 759 school participants, 438 (57.7%) were males and 321 (42.3%) females, mean age 11.00 ± 1.50 years, in grades 0 to 7. No cases of S. mansoni were found by the Kato-Katz. Most participants were in grades four to seven (61.5%), and no S. mansoni infections were detected by Kato-Katz microscopy. Additionally, further testing for S. mansoni was performed using POC-CCA tests, revealing a prevalence rate of 3.2%. Given the impracticality of testing all samples with molecular methods, a more focused and cost-effective strategy was adopted by targeting the 28 POC-CCA–positive samples, representing 3.2% of the total. Because POC-CCA indicated probable S. mansoni infection, cPCR was used to confirm low-intensity cases likely missed by Kato-Katz, targeting the S. mansoni cox-1 repeat sequence for definitive identification. Remarkably, 32.1% (9/28) of the CCA-positive samples tested positive for S. mansoni DNA, demonstrating the method’s effectiveness in identifying infections that were missed by traditional microscopy.
CONCLUSIONS:
The findings indicate low-level but ongoing transmission of S. mansoni in NMB. Sensitive diagnostic tools are essential for accurate surveillance in low-endemic settings.
Intestinal schistosomiasis caused by Schistosoma mansoni is frequently underestimated in low-transmission settings due to the low sensitivity of stool microscopy. Low-intensity infections often occur without detectable eggs, necessitating the use of more sensitive diagnostic tools such as point-of-care circulating cathodic antigen (POC-CCA) tests and molecular methods. This study determined the prevalence of S. mansoni infection among school-going children in Nelson Mandela Bay (NMB), South Africa, using complementary diagnostic approaches.
METHODS:
A cross-sectional study was conducted among 759 children aged 5–14 years from 15 primary schools in NMB. Stool samples were analysed using the Kato-Katz technique. Urine samples were tested using POC-CCA assays, and stool samples corresponding to POC-CCA–positive cases were analysed using conventional polymerase chain reaction (cPCR).
RESULTS:
Among the 759 school participants, 438 (57.7%) were males and 321 (42.3%) females, mean age 11.00 ± 1.50 years, in grades 0 to 7. No cases of S. mansoni were found by the Kato-Katz. Most participants were in grades four to seven (61.5%), and no S. mansoni infections were detected by Kato-Katz microscopy. Additionally, further testing for S. mansoni was performed using POC-CCA tests, revealing a prevalence rate of 3.2%. Given the impracticality of testing all samples with molecular methods, a more focused and cost-effective strategy was adopted by targeting the 28 POC-CCA–positive samples, representing 3.2% of the total. Because POC-CCA indicated probable S. mansoni infection, cPCR was used to confirm low-intensity cases likely missed by Kato-Katz, targeting the S. mansoni cox-1 repeat sequence for definitive identification. Remarkably, 32.1% (9/28) of the CCA-positive samples tested positive for S. mansoni DNA, demonstrating the method’s effectiveness in identifying infections that were missed by traditional microscopy.
CONCLUSIONS:
The findings indicate low-level but ongoing transmission of S. mansoni in NMB. Sensitive diagnostic tools are essential for accurate surveillance in low-endemic settings.
| eISSN: | 2654-1459 |
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