Prevalence mapping of Schistosomiasis among Pre-school aged children in Rwanda

Schistosomiasis is endemic in Rwanda and control programs have been implemented with a special focus on school-aged children (SAC) ignoring pre-school aged children (pre-SAC) for which the actual prevalence of the disease is not well established. This study consisted of a cross-sectional quantitative mapping of the distribution of schistosomiasis and identification of associated risk factors among pre-SAC throughout the country. The study covered all the 17 Districts of Rwanda endemic for schistosomiasis with a total sample of 4675 children enrolled from 80 purposively selected villages. The Parasitological assessment of children’s urine and stool samples was conducted using CCA and Kato Katz methods respectively for infection detection. A standard questionnaire was used to collect data on the risk factors and geospatial assessment was performed using tablets and GPS to record geographic coordinates for plotting locations on maps using ArcGIS software. The overall prevalence of S mansoni infection across the surveyed areas was 24% and 0.8 by CCA and Kato-Katz, respectively. Infection was significantly associated with bathing children in open water bodies. Furthermore, pre-SAC looked after by siblings (sisters) were twice as much likely to be infected compared to those looked after by mothers. Schistosomiasis control interventions are needed for pre-SAC to limit their exposure to open water bodies with expectations of adapted chemotherapy to be availed. Community based deworming campaigns may be the best way to ensure good treatment coverage of pre-SAC in Rwanda. Author summary Schistosomiasis is one of the Neglected Tropical Diseases (NTD) of public health concern in Rwanda like in many tropical countries. The recently published NTD roadmap by the World Health Organization indicates that schistosomiasis is targeted for elimination as a public health problem worldwide by 2030. For this target to be achieved, all at risk populations should be reached by control programs’ interventions such as preventive chemotherapy, health education as well as water, sanitation and hygiene (WASH) practices. However, pre-school children (pre-SAC) are among populations at risk for whom infection burden is not fully documented. Implementation of the recent WHO guideline on schistosomiasis control and elimination that recommend inclusion of pre-SAC in control programs will be informed by detailed assessment of the infection burden and distribution in endemic countries. This study is showing for the first time a high burden of schistosomiasis among pre-SAC in high-risk areas of Rwanda. With the imminent availability of the paediatric formulation of Praziquantel (the drug of choice against the disease), the findings should guide the country in implementation strategies that include these children in mass deworming. The findings also highlight a number of risk factors including the passive exposure of these young children by their siblings while bathing them in open waters and the lack of knowledge of parents/guardians on the disease. Additional integrated interventions such as health education, improvement of water supply and sanitation as well as snail surveillance will lead to more sustainable solutions in the march towards schistosomiasis elimination. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was commissioned by the National Institute of Health Research (NIHR) Global Health Research programme (16/136/33) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, the National Institute of Health Research or the Department of Health and Social Care ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The current study was approved by the Institutional Review Board (IRB) of the University of Rwanda College of Medicine and Health Sciences (Approval Notice No 148/CMHS/IRB/2019) and endorsed by the Ministry of Health. Local authorities, community health workers and parents/guardians were informed about the aims, voluntary nature of their participation, potential risks and benefits of the study. A signed consent was obtained from parents/guardians before enrolling their child(ren) in the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable The data underlying the results presented in the study are available from the corresponding author