Hidden Burden: Schistosomiasis Prevalence and Risk Factors among Enrolled and Out-of-School Children in Kebbi State, Nigeria

Abstract

Background: Schistosomiasis, a parasitic infection classified as a major neglected tropical disease, remains stubbornly endemic within the riverine communities of Kebbi State, Nigeria. Existing control efforts, centered on school-based mass drug administration (MDA), unintentionally bypass a potentially large hidden reservoir of infection: children not enrolled in formal education (out-of-school children, or OOSC). This study set out to quantify the difference in schistosomiasis burden and exposure risks between enrolled and out-of-school children aged 0 to 14 years. Methods: We conducted a comparative cross-sectional survey across six high-endemicity riverine communities in Kebbi State. Utilizing stratified cluster sampling, we enrolled a cohort of 1,155 children (881 enrolled; 274 OOSC). Infection status was determined by analyzing midstream urine samples via sedimentation microscopy. Caregivers completed detailed questionnaires capturing demographic data and behavioral risk factors. To isolate the most influential predictors, we used survey-weighted multivariable logistic regression. Results: The overall prevalence of schistosomiasis across the cohort was 11.4% (132/1,155). Crucially, OOSC carried a significantly higher infection rate (31.4%) compared to enrolled children (5.2%). This disparity resulted in an Adjusted Odds Ratio (AOR) of 8.23 (95% CI: 5.29–12.78). Independent risk factors strongly associated with infection included: relying on stream water (22.1% prevalence), practicing open defecation (15.2% prevalence), using water only for anal cleansing (15.3%), and having parents engaged in fishing and pastoral occupations. Conclusion: Our findings confirm that schistosomiasis persists as a significant public health issue in Kebbi State, with OOSC bearing a disproportionately heavy, hidden burden. This elevated risk appears driven by unsafe water practices and deficient sanitation. Moving forward, integrated Water, Sanitation, and Hygiene (WASH) interventions combined with inclusive, community-based MDA strategies are essential steps for effectively reaching these high-risk children and ensuring Nigeria can meet the WHO’s ambitious 2030 elimination targets.