Fine-scale-mapping of Schistosoma haematobium infections at the school and community levels and intermediate host snail abundance in the north of Pemba Island: baseline cross-sectional survey findings before the onset of a 3-year intervention study

Background: Schistosomiasis elimination has gained renewed priority in guiding documents published by the World Health Organization in 2020 and 2022. The SchistoBreak project, implemented in Pemba, Tanzania, between 2020 and 2024 aims to assess new tools and strategies for moving from elimination as a public health problem towards interruption of transmission. Here we report our baseline findings and discuss implications for future interventions.

Methods: In 2020, human water contact sites (HWCSs) in the study area were geolocated and snail surveys were conducted. A parasitological and questionnaire cross-sectional baseline survey was implemented in 20 communities and their 16 primary schools between November 2020 and February 2021. Urine samples were collected at school- and household-level from individuals aged ≥4 years. Schistosoma haematobium infection was detected by urine filtration microscopy. Snail, parasitological, and questionnaire-derived data were analysed descriptively, spatially, and with generalized estimated equation models.

Results: Bulinus globosus was detected in 19.8% (33/167) of HWCSs. The overall S. haematobium prevalence was 1.2% (26/2196) in schoolchildren and 0.8% (31/3893) in community members, with 0.2% (4/2196) and 0.1% (3/3893) heavy-intensity infections, respectively. Children who studied <1 km away from HWCSs with B. globosus had significantly higher odds for a S. haematobium infection than those attending a school located >2 km away (odds ratio (OR): 5.0; 95% confidence interval (CI): 2.3-11.1). Individuals living in a house located <1 km away from HWCSs with B. globosus had higher odds than those residing in >2 km distance (OR: 18.0; 95% CI: 2.9-111.0). Selfreported praziquantel treatment coverage was 83.2% (2015/2423) in schoolchildren in the mass drug administration (MDA) conducted in August 2020. Coverage among adult community members was 59.9% (574/958), but only 34.8% (333/958) took praziquantel correctly.

Conclusions: While the S. haematobium prevalence is very low in Pemba, there are many HWCSs with B. globosus situated close to schools or houses that pose a considerable risk of recrudescence. To maintain and accelerate the progress towards interruption of transmission, targeted and cost-effective interventions that are accepted by the community are needed; for example, snail control plus focal MDA, or test-and-treat in schools and households near infested waterbodies.