Prevalence and Risk Factors of Schistosomiasis and Soil-transmitted Helminthiases Among Preschool Aged Children (1-5 years) in Rural KwaZulu-Natal, South Africa: a Cross-sectional Study

Background: Despite efforts to control neglected tropical diseases (NTDs), schistosomiasis and soil-transmitted helminthiases remain widely prevalent in sub-Saharan Africa. Recent data suggest that these infections are prevalent among preschool aged children (PSAC) in poor communities. Evidence of schistosomiasis and soil-transmitted helminths (STH) infection patterns and prevalence among PSAC is essential for effective treatment and control programmes. The aim of the study was to determine the prevalence, intensity and risk factors of schistosomiasis and STH infection among PSAC in the Ingwavuma area of uMkhanyakude District, South Africa.

Methods: A cross-sectional study was conducted among 1143 PSAC aged 1-5 years in 34 preschools and early childhood development (ECD) centres. Data on risk factors was collected using a semi-structured questionnaire. A Kruskal-Wallis test was used to compare the differences in infection intensity with age. Pearson Chi-square test and multivariate logistic regression were performed to assess the association between PSAC infection status, sociodemographic, household, water and sanitation variables and hygiene practices of PSAC and their caregivers.

Results: We observed a low prevalence of Schistosoma haematobium (1.0%) and S. mansoni (0.9%). The prevalence of Ascaris lumbricoides (18.3%) was high compared to Trichuris trichiura (1.2%), hookworms (1.6%) and Taenia (6.4%). The odds of schistosome infection were lowest among PSAC under younger (15-24 years) caregivers (0.1, 95% CI: 0.02-0.54) and those who used tap water (0.3, 95% CI: 0.09-0.78) for domestic purposes. Schistosome infection was however higher among PSAC who bathed in river water (17.4, 95% CI: 5.96-51.04). STH infection on the other hand was lowest among PSAC who did not play in soil (0.1, 95% CI: 0.51-0.28), were from households that used tap water for domestic purposes (0.5, 95% CI: 0.27-0.80) and PSAC under the care of younger (25-35 years) caregivers (0.3, 95% CI: 0.10-0.75). The risk of STH infection was highest among PSAC who did not wash their hands with soap (3.5, 95% CI: 1.04-11.67) and PSAC whose nails were not trimmed (3.6, 95% CI: 1.75-7.26).

Conclusions: The findings show low prevalence and infection intensity of schistosomiasis and STH infection except A. lumbricoides among PSAC. Factors predicting schistosomiasis and STH infection among PSAC were related to caregivers' age, educational status, water and hygiene practices. STH infection was exclusively associated with PSAC playing and handwashing habits. These findings highlight the need to include PSAC caregivers in schistosomiasis and STH prevention and control programmes.