Prevalence of urinary schistosomiasis in school-aged children, knowledge, attitude and practice of household heads regarding hematuria, Haho Health District, Togo

Introduction: In March 2020, Wahala Health area in Haho Health District notified 47 confirmed urinary schistosomiasis in school-age children, despite Praziquantel Mass Distribution (MDA), one of the WHO recommended strategies to end schistosomiasis by 2030, was being implemented for ten years. The district coordination team investigated to determine schistosomiasis’ prevalence in school aged children and describe the heads of household’s knowledge, attitudes and practices regarding hematuria. Methods: This was a cross-sectional study conducted in Wahala Health area in March 2020. It included heads of households and their school-age children. Schwartz’s formula adjusted for a 10% non-response rate determined the sample size. We interviewed heads of households and collected data on knowledge, attitudes, and practices on hematuria. Urine samples from all school-age children found in the households were collected after a moderate exercise of 5 to 10 minutes for parasitological examinations at Wahala Health Center laboratory and the National Reference Laboratory to determine the prevalence. The laboratory performed direct microscopy of urine sediment after centrifugation to identify bilharzia eggs. Epi Info 7 was used for descriptive analysis using median with its interquartile range (IQR) and proportion at 95% confidence interval (95%CI). Results: A total of 427 heads of households were interviewed, of whom 33.6% were women, and 969 urine samples were collected. The overall prevalence of schistosomiasis was 31.8%(95%CI:28.9-34.8). Prevalence by gender and residence zone was 29.3%(95%CI:25.3-33.8) in girls, 33.8%(95% CI:29.9-37.9) in boys, 30.9%(95%CI:27.7 – 34.3) in rural and 34.7%(95%CI:28.4 – 41.3) in semi urban zones. Hematuria was reported as a disease by 80.6%(95%CI:76.6-84.1) of heads of households and 81.5%(95%CI:77.8-84.90) considered swimming in rivers as a risk. They thought MDA: 40.1%(95%CI:35.5-44.8) and medical consultation: 41.7%(95%CI:37.1-46.4) contribute to preventing hematuria. Regarding what they would do in case a child of their household got hematuria, 83.1%(95%CI:79.3-86.4) and 11.7%(95%CI:9.0 – 11.2) declared they would take their child to the hospital or a Community Health Worker (CHW), respectively. Out of the 23.2%(95%CI:19.4–27.4) heads of household whose children experienced hematuria, 36.4%(95%CI:26.4 – 47.3) took the child to hospital, 18.2%(95%CI:10.8–27.8) took the child to a CHW, 1.4%(95%CI:0.04–7.6) consulted a traditional healer, 18.2%(95%CI:10.8–27.8) self-medicated and 20.5%(95%CI:12.6–30.4) did nothing. During the last MDA, 2.1%(95%CI:0.9-5.1) expressed resistance, and 1.4%(95% CI:0.7–3.0) refused to welcome CHWs into their households. Conclusion: Schistosomiasis magnitude remains high despite 10 years of MDA, compromising the target to end schistosomiasis by 2030. Most heads of households knew what hematuria represents and how to prevent it, but there still exist practices favouring its persistence. MDA and communication strategies should be redefined and combined with improved water and sanitation conditions and permanent free administration of Praziquantel in routine medical consultations.