Diagnostic Accuracy of Urine Test Strip and Morbidity Indicators of Urogenital Schistosomiasis in Kwara State, Nigeria
,
Abstract
Background: The efficient management of schistosomiasis depends on the rapid and accurate diagnosis of infection. Rapid diagnostic tests are essential for identifying morbidity markers of urogenital schistosomiasis.
Methods: A total of 1,341 urine samples collected from school-age pupils in Kwara State were screened for Schistosoma haematobium eggs using the syringe filtration method. Haematuria and proteinuria were assessed using commercial urine reagent strips (Medi-Test Combur-9).
Results: Overall, 277 paticipants were infected, of which children >15 yr accounted for 37.5% of the disease prevalence. Only light and moderate infection was observed. Microhaematuria varied significantly with egg intensity (P<0.05), but no association was found between hematuria severity and age. The overall prevalence of macrohaematuria was 1.3%, while microhaematuria and proteinuria were 53.9% and 19%, respectively. Macrohaematuria was found in 88.9% of S. haematobium-positive children while 13% of positive children tested negative for microhaematuria. Microhaematuria showed higher sensitivity (70.8%) compared to other biomarkers, while macrohaematuria had higher specificity (99.8%).
Conclusion: In the absence of other morbidity markers, microhaematuria appears to be a good proxy for urogenital schistosomiasis in our setting.
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2. Colley D, Bustinduy A, Secor W, King C. Human schistosomiasis. Lancet. 2014; 383(9936):2253–64.
3. Ishida K, Hsieh M. Understanding urogenital schistosomiasis-related bladder cancer: an update. Front Med. 2018; 5:223-41.
4. Kayuni S, Lampiao F, Makaula P, Juziwelo L, Lacourse E, Reinhard-Rupp J. A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa. Parasite Epidemiol Control. 2019; 4(e00077).
5. Ross A, Olveda R, Acosta L. Road to the elimination of schistosomiasis from Asia: the journey is far from over. Microbes Infect. 2013; 15:858–65.
6. Beltrame A, Guerriero M, Angheben A, et al. Accuracy of Parasitological and Immunological Tests for the Screening of Human Schistosomiasis in Immigrants and Refugees from African Countries: An Approach with Latent Class Analysis. PLOS Negl Trop Dis. 2017; 11:e0005593.
7. Chala B. Advances in Diagnosis of Schistosomiasis: Focus on Challenges and Future Approaches. Int J General Med. 2023; 16:983–95.
8. Wang C, Chen L, Yin X. Application of DNA-based diagnostics in detection of schistosomal DNA in early infection and after drug treatment. Parasit Vectors. 2011; 4:164.
9. Colley D, Andros T, Campbell C. Schistosomiasis Is More Prevalent than Previously Thought: What Does It Mean for Public Health Goals, Policies, Strategies, Guidelines and Intervention Programmes?. Infect Dis of Poverty. 2017; 6:63-72.
10. King C, Bertsch D. Meta-analysis of urine heme dipstick diagnosis of Schistosoma haematobium infection, including low-prevalence and previously-treated populations. PloS Negl Trop Dis. 2013; 7:e2431.
11. Tanser F, Azongo D, Vandormael A. Impact of the scale-up of piped water on urogenital schistosomiasis infection in rural South Africa. eLife 2018; 7(e33065):1–24
12. Peters P, Warren K, Mahmoud A. Rapid, accurate quantification of schistosome eggs via nuclepore filters. J Parasitol. 1976; 62:154–5.
13. Morenikeji O, Quazim J, Omoregie C, et al. A cross-sectional study on urogenital schistosomiasis in children; haematuria and proteinuria as diagnostic indicators in an endemic rural area of Nigeria. African Health Sciences 2014; 14(2):390-6.
14. Ugbomoiko U, Dalumo V, Ariza L, Bezerra F, Heukelbach J. A simple approach improving the performance of urine reagent strips for rapid diagnosis of urinary schistosomiasis in Nigerian schoolchildren. Memórias do Instituto Oswaldo Cruz. 2009; 104:456-61.
15. Okechukwu A, Dike A. Evaluating the effectiveness of positive urinalysis in the diagnosis of Schistosoma haematobium infection in children in Abuja. East Afr Med Journal. 2021; 98(2):3462-73.
16. Mazigo H, Mwingira U, Zinga M, et al. Urogenital schistosomiasis among pre-school and school aged children in four districts of north western Tanzania after 15 years of mass drug administration: Geographical prevalence, risk factors and performance of haematuria reagent strips. PLoS Negl Trop Dis. 2022; 16(10): e0010834.
17. Anosike JC, Nwoke BE, Njoku AJ. The validity of haematuria in the community diagnosis of urinary schistosomiasis infections. J Helminthol. 2001; 75(3):223-225.
18. Musa NY, Dadah AJ. Comparing the Sensitivity of Microscopy to Diagnostic Strip in the Survey for Urinary Schistosomiasis. Bioprocess Engineering. 2018; 2(1):14-19.
19. Awosolu OB, Adesina FP, Eke OS, Akinnifesi OJ. Efficacy of Chemical Reagent Strip in the Diagnosis of Urinary Schistosomiasis in Ikota, Ifedore Local Government Area, Ondo State, Nigeria. J Bacteriol Parasitol. 2019; 10(2):1-10.
20. Fatiregun AA, Osungbade KO, Olumide EA. Diagnostic performance of screening methods for urinary schistosomiasis in a school-based control programme, in Ibadan, Nigeria. J Comm Med and Pri Health Care 2005; 17(1): 1-8.
21. Ugbomoiko US, Obiezue RNN, Ogunniyi TAB, Ofoezie IE. Diagnostic accuracy of different urine dipsticks to detect urinary schistosomiasis: a comparative study in five endemic communities in Osun and Ogun States, Nigeria. J Helminthol. 2009; 83(3):203-209.
22. Sunday J, Oso O, Babamale A, Ugbomoiko U. Urinary Schistosomiasis Prevalence and Diagnostic Performance of Reagent Strip at Point-of-Care. J Biosci Med 2023; 11:239-51.
23. WHO. Basic Laboratory Methods in Medical Parasitology. Geneva, Switzerland: Macmillian Press; 1991.
24. Opara K, Akomolafe R, Udoidung N, Afia U, Yaro C, Bassey B. Urogenital Schistosomiasis among Primary School Children in Rural Communities in Obudu, Southern Nigeria. Int J Mch Aids 2021; 10(1):70-80.
25. Akindele A, Adedeji O, Amoo B, et al. Epidemiology and burden of Schistosoma haematobium infection among school children in Osun State, Nigeria. Am J Biomed Sci. 2020; 12(3):173-82.
26. Wiegand R, Secor W, Fleming F, et al. Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni. PLoS Negl Trop Dis. 2021; 15(5): e0009444.
27. Bolaji O, Elkanah F, Ojo J, Ojurongbe O, Adeyeba O. Prevalence and Intensity of Schistosoma haematobium among school children in Ajase-Ipo, Kwara State, Nigeria. Asian J Biomed Pharm Sci. 2015; 5(43):6-11.
28. Sunday O, Babamale O, Ugbomoiko U. Distribution Pattern of Human Urinary Schistosomiasis in Kwara State, Nigeria. Am J Infect Dis. 2017; 13(4):38-44.
29. Houmsou R, Agere H, Wama B, Bingbeng J, Amuta E, Kela S. Urinary Schistosomiasis among Children in Murbai and Surbai Communities of Ardo-Kola Local Government Area, Taraba State, Nigeria. J Trop Med. 2016; 2016: 9831265.
30. Ojo J, Adedokun S, Akindele A, et al. Prevalence of urogenital and intestinal schistosomiasis among school children in Southwest Nigeria. PLoS Negl Trop Dis. 2021; 15(7): e0009628.
31. WHO. Report of the WHO Informal Consultation on Schistosomiasis in Low Transmission Areas: Control Strategies and Criteria for Elimination. WHO/CDS/CPE/SIP/2001.1. World Health Organization, London, England. 2000.
32. Adewole S, Fafure T. Epidemiology and prevalence of urinary schistosomiasis in pre-school children in Lagos, Nigeria. Int J Med and Med Sci. 2013; 5(10):456-9.
33. Awosolu O. Epidemiology of urinary schistosomiasis and knowledge of health personnel in rural communities of South-Western Nigeria. J Parasitol Vector Biol 2016; 8(10):99-106.
34. Opeyemi O, Simon-Oke I, Olusi T. Distribution of urinary schistosomiasis and associated risk factors among school-age children in Kwara State, Nigeria. J Parasit Dis. 2025; 49(1):215-223.
35. Doehring E, Reider F, Schmidt-Ehry G, Ehrich J. Reduction of pathological findings in urine and bladder lesions in infection with Schistosoma haematobium after treatment with praziquantel. J Infect Dis. 1985; 152:807-10.
36. Babatunde T, Asaolu S, Sowemimo O. Urinary schistosomiasis among pre-school and school aged children in two peri-urban communities in Southwest Nigeria. J Parasitol Vector Biol. 2013; 5(7):96-101.
37. Bong G, Metiendjo V, Mimfoumou G, Ngounouh C, Nguwoh P. Urinary schistosomiasis prevalence and risk factors among school children at matta-barrage in the Tikar Plain of Magba, West Region, Cameroon: A situational analysis in rural area. World J Adv Res Rev. 2022; 14(3):532–40.
38. Krauth S, Greter H, Stete K, et al. All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings. Parasites & Vectors. 2015; 8:584-95.
39. Ochodo E, Gopalakrishna G, Spek B, et al. Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas. Cochrane Database Syst Rev. 2015; 3(CD009579):1-249.
40. Walz Y, Wegmann M, Dech S, Raso G, Utzinger J. Risk Profiling of Schistosomiasis using Remote Sensing: Approaches, Challenges and Outlook. Parasites & Vectors. 2015; 8:163.
41. Useh M. Schistosomiasis. InTech Open Sci. 2013; 4:63–93.
2. Colley D, Bustinduy A, Secor W, King C. Human schistosomiasis. Lancet. 2014; 383(9936):2253–64.
3. Ishida K, Hsieh M. Understanding urogenital schistosomiasis-related bladder cancer: an update. Front Med. 2018; 5:223-41.
4. Kayuni S, Lampiao F, Makaula P, Juziwelo L, Lacourse E, Reinhard-Rupp J. A systematic review with epidemiological update of male genital schistosomiasis (MGS): A call for integrated case management across the health system in sub-Saharan Africa. Parasite Epidemiol Control. 2019; 4(e00077).
5. Ross A, Olveda R, Acosta L. Road to the elimination of schistosomiasis from Asia: the journey is far from over. Microbes Infect. 2013; 15:858–65.
6. Beltrame A, Guerriero M, Angheben A, et al. Accuracy of Parasitological and Immunological Tests for the Screening of Human Schistosomiasis in Immigrants and Refugees from African Countries: An Approach with Latent Class Analysis. PLOS Negl Trop Dis. 2017; 11:e0005593.
7. Chala B. Advances in Diagnosis of Schistosomiasis: Focus on Challenges and Future Approaches. Int J General Med. 2023; 16:983–95.
8. Wang C, Chen L, Yin X. Application of DNA-based diagnostics in detection of schistosomal DNA in early infection and after drug treatment. Parasit Vectors. 2011; 4:164.
9. Colley D, Andros T, Campbell C. Schistosomiasis Is More Prevalent than Previously Thought: What Does It Mean for Public Health Goals, Policies, Strategies, Guidelines and Intervention Programmes?. Infect Dis of Poverty. 2017; 6:63-72.
10. King C, Bertsch D. Meta-analysis of urine heme dipstick diagnosis of Schistosoma haematobium infection, including low-prevalence and previously-treated populations. PloS Negl Trop Dis. 2013; 7:e2431.
11. Tanser F, Azongo D, Vandormael A. Impact of the scale-up of piped water on urogenital schistosomiasis infection in rural South Africa. eLife 2018; 7(e33065):1–24
12. Peters P, Warren K, Mahmoud A. Rapid, accurate quantification of schistosome eggs via nuclepore filters. J Parasitol. 1976; 62:154–5.
13. Morenikeji O, Quazim J, Omoregie C, et al. A cross-sectional study on urogenital schistosomiasis in children; haematuria and proteinuria as diagnostic indicators in an endemic rural area of Nigeria. African Health Sciences 2014; 14(2):390-6.
14. Ugbomoiko U, Dalumo V, Ariza L, Bezerra F, Heukelbach J. A simple approach improving the performance of urine reagent strips for rapid diagnosis of urinary schistosomiasis in Nigerian schoolchildren. Memórias do Instituto Oswaldo Cruz. 2009; 104:456-61.
15. Okechukwu A, Dike A. Evaluating the effectiveness of positive urinalysis in the diagnosis of Schistosoma haematobium infection in children in Abuja. East Afr Med Journal. 2021; 98(2):3462-73.
16. Mazigo H, Mwingira U, Zinga M, et al. Urogenital schistosomiasis among pre-school and school aged children in four districts of north western Tanzania after 15 years of mass drug administration: Geographical prevalence, risk factors and performance of haematuria reagent strips. PLoS Negl Trop Dis. 2022; 16(10): e0010834.
17. Anosike JC, Nwoke BE, Njoku AJ. The validity of haematuria in the community diagnosis of urinary schistosomiasis infections. J Helminthol. 2001; 75(3):223-225.
18. Musa NY, Dadah AJ. Comparing the Sensitivity of Microscopy to Diagnostic Strip in the Survey for Urinary Schistosomiasis. Bioprocess Engineering. 2018; 2(1):14-19.
19. Awosolu OB, Adesina FP, Eke OS, Akinnifesi OJ. Efficacy of Chemical Reagent Strip in the Diagnosis of Urinary Schistosomiasis in Ikota, Ifedore Local Government Area, Ondo State, Nigeria. J Bacteriol Parasitol. 2019; 10(2):1-10.
20. Fatiregun AA, Osungbade KO, Olumide EA. Diagnostic performance of screening methods for urinary schistosomiasis in a school-based control programme, in Ibadan, Nigeria. J Comm Med and Pri Health Care 2005; 17(1): 1-8.
21. Ugbomoiko US, Obiezue RNN, Ogunniyi TAB, Ofoezie IE. Diagnostic accuracy of different urine dipsticks to detect urinary schistosomiasis: a comparative study in five endemic communities in Osun and Ogun States, Nigeria. J Helminthol. 2009; 83(3):203-209.
22. Sunday J, Oso O, Babamale A, Ugbomoiko U. Urinary Schistosomiasis Prevalence and Diagnostic Performance of Reagent Strip at Point-of-Care. J Biosci Med 2023; 11:239-51.
23. WHO. Basic Laboratory Methods in Medical Parasitology. Geneva, Switzerland: Macmillian Press; 1991.
24. Opara K, Akomolafe R, Udoidung N, Afia U, Yaro C, Bassey B. Urogenital Schistosomiasis among Primary School Children in Rural Communities in Obudu, Southern Nigeria. Int J Mch Aids 2021; 10(1):70-80.
25. Akindele A, Adedeji O, Amoo B, et al. Epidemiology and burden of Schistosoma haematobium infection among school children in Osun State, Nigeria. Am J Biomed Sci. 2020; 12(3):173-82.
26. Wiegand R, Secor W, Fleming F, et al. Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni. PLoS Negl Trop Dis. 2021; 15(5): e0009444.
27. Bolaji O, Elkanah F, Ojo J, Ojurongbe O, Adeyeba O. Prevalence and Intensity of Schistosoma haematobium among school children in Ajase-Ipo, Kwara State, Nigeria. Asian J Biomed Pharm Sci. 2015; 5(43):6-11.
28. Sunday O, Babamale O, Ugbomoiko U. Distribution Pattern of Human Urinary Schistosomiasis in Kwara State, Nigeria. Am J Infect Dis. 2017; 13(4):38-44.
29. Houmsou R, Agere H, Wama B, Bingbeng J, Amuta E, Kela S. Urinary Schistosomiasis among Children in Murbai and Surbai Communities of Ardo-Kola Local Government Area, Taraba State, Nigeria. J Trop Med. 2016; 2016: 9831265.
30. Ojo J, Adedokun S, Akindele A, et al. Prevalence of urogenital and intestinal schistosomiasis among school children in Southwest Nigeria. PLoS Negl Trop Dis. 2021; 15(7): e0009628.
31. WHO. Report of the WHO Informal Consultation on Schistosomiasis in Low Transmission Areas: Control Strategies and Criteria for Elimination. WHO/CDS/CPE/SIP/2001.1. World Health Organization, London, England. 2000.
32. Adewole S, Fafure T. Epidemiology and prevalence of urinary schistosomiasis in pre-school children in Lagos, Nigeria. Int J Med and Med Sci. 2013; 5(10):456-9.
33. Awosolu O. Epidemiology of urinary schistosomiasis and knowledge of health personnel in rural communities of South-Western Nigeria. J Parasitol Vector Biol 2016; 8(10):99-106.
34. Opeyemi O, Simon-Oke I, Olusi T. Distribution of urinary schistosomiasis and associated risk factors among school-age children in Kwara State, Nigeria. J Parasit Dis. 2025; 49(1):215-223.
35. Doehring E, Reider F, Schmidt-Ehry G, Ehrich J. Reduction of pathological findings in urine and bladder lesions in infection with Schistosoma haematobium after treatment with praziquantel. J Infect Dis. 1985; 152:807-10.
36. Babatunde T, Asaolu S, Sowemimo O. Urinary schistosomiasis among pre-school and school aged children in two peri-urban communities in Southwest Nigeria. J Parasitol Vector Biol. 2013; 5(7):96-101.
37. Bong G, Metiendjo V, Mimfoumou G, Ngounouh C, Nguwoh P. Urinary schistosomiasis prevalence and risk factors among school children at matta-barrage in the Tikar Plain of Magba, West Region, Cameroon: A situational analysis in rural area. World J Adv Res Rev. 2022; 14(3):532–40.
38. Krauth S, Greter H, Stete K, et al. All that is blood is not schistosomiasis: experiences with reagent strip testing for urogenital schistosomiasis with special consideration to very-low prevalence settings. Parasites & Vectors. 2015; 8:584-95.
39. Ochodo E, Gopalakrishna G, Spek B, et al. Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas. Cochrane Database Syst Rev. 2015; 3(CD009579):1-249.
40. Walz Y, Wegmann M, Dech S, Raso G, Utzinger J. Risk Profiling of Schistosomiasis using Remote Sensing: Approaches, Challenges and Outlook. Parasites & Vectors. 2015; 8:163.
41. Useh M. Schistosomiasis. InTech Open Sci. 2013; 4:63–93.
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| Issue | Vol 21 No 2 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Urine reagent strips Proteinuria Haematuria S. haematobium Prevalence | ||
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How to Cite
1.
Opeyemi O, Simon-Oke I, Olusi T. Diagnostic Accuracy of Urine Test Strip and Morbidity Indicators of Urogenital Schistosomiasis in Kwara State, Nigeria. Iran J Parasitol. 2026;21(2):227-236.
