Growth and Endocrine Complications of Schistosomiasis in Children and Adolescents: A Critical Narrative Review

Abstract

Schistosomiasis affects more children than any other neglected tropical disease, yet its consequences for somatic growth and endocrine function during childhood and adolescence remain less thoroughly characterised than its recognised effects on anaemia and hepatosplenic disease. This review critically synthesises evidence on growth impairment, pubertal disruption and hormonal alteration associated with Schistosoma mansoni, Schistosoma haematobium and Schistosoma japonicum infection in children and adolescents. Literature published between 1990 and 20 May 2026 was identified through structured searching of biomedical and institutional sources and appraised for methodological quality, source credibility and direct relevance to the review question. Cross-sectional and longitudinal cohort studies, principally from the Philippines, Kenya, Brazil, Zimbabwe and Egypt, demonstrate reasonably consistent associations between infection intensity and both reduced height-for-age and lower circulating insulin-like growth factor 1 (IGF-1), although evidence for categorical stunting is more heterogeneous and is confounded by co-occurring undernutrition, polyparasitism and socioeconomic deprivation. Mechanistic data implicate chronic pro-inflammatory cytokine elaboration, hepatic suppression of the growth hormone (GH)-IGF-1 axis, iron-restricted erythropoiesis mediated through hepcidin induction, and, in a small number of studies of children with hepatic fibrosis, altered adrenal and thyroid hormone concentrations. Evidence on pubertal timing derives principally from associations between dehydroepiandrosterone sulfate and infection resistance rather than direct measurement of pubertal delay, and female genital schistosomiasis in adolescents remains substantially under-investigated with respect to reproductive endocrine consequences. Praziquantel treatment produces measurable, though often incomplete, improvement in linear growth and nutritional indices, and the recent licensing of a paediatric orodispersible formulation extends this evidence base toward preschool-aged children. The literature is constrained by heterogeneous outcome definitions, geographical concentration in a small number of cohorts, scarcity of longitudinal endocrine measurement, and a near-absence of direct thyroid and cortisol assessment outside historical case-control data. Future research should prioritise longitudinal, multi-species cohorts that incorporate standardised GH-IGF-1 axis, thyroid and adrenal measures alongside anthropometry, with particular attention to preschool-aged children and to girls at risk of female genital schistosomiasis.