Schistosomiasis is a chronic parasitic disease caused by trematodes of the genus Schistosoma [1]. They remain a Neglected Tropical Disease (NTD) responsible for infant morbidity and mortality in sub-Saharan Africa, particularly in tropical and subtropical regions [2,3]. Of the various forms of schistosomiasis, urinary schistosomiasis, caused by Schistosoma hӕmatobium (S. hӕmatobium), is the most common in sub-Saharan Africa [4,5]. It mainly affects school-age children, who are considered to be the most exposed group because of their risk-taking behaviors, such as bathing or playing in contaminated water [6]. S. hӕmatobium infestation can lead to urological complications, anemia, and stunted growth in young children [7]. Despite chemoprevention interventions and mass treatment campaigns targeting children, the disease remains a significant public health problem [8]. Although schistosomiasis is predominantly prevalent in disadvantaged rural communities, particularly in areas with high fishing and agricultural activity [9], urban populations should not be overlooked. Indeed, recreational activities such as bathing in untreated water combined with a lack of hygiene also expose children to the risk of schistosomiasis. In the Ivory Coast, urinary schistosomiasis is endemic in many regions, but the majority of epidemiological studies have been done in rural areas, thus leaving cases in urban areas under-documented. However, the rapid urbanization of some cities, such as Bouaké, along with inadequate hygienic conditions, favors the increase in urban foci of transmission. In fact, Bouaké is the country’s second-largest city, where precarious neighborhoods coexist with stagnant and undeveloped streams of water. In addition, the COVID-19 pandemic has contributed to a significant reduction in schistosomiasis prevention and treatment activities since 2021 [10]. This situation has led to an upsurge of urinary bilharziasis in Bouaké, as described by cases diagnosed at the Parasitology-Mycology Laboratory of the University Teaching Hospital of Bouaké. Therefore, the objective of the study was to determine the epidemiological knowledge of the prevalence of urinary schistosomiasis in urban areas and its associated risk factors in school-age children in the city of Bouaké.

The present study provides an epidemiological overview of urinary schistosomiasis in school-age children in an urban environment in the Ivory Coast. The study was conducted in the Belleville district of the city of Bouaké and highlighted the persistence of this disease in urban areas despite national strategies of prevention. While chemoprevention programs regularly target children in rural areas [9], our results underline the importance of not neglecting urban areas. In our study, the prevalence of urogenital schistosomiasis was 3.6%, corresponding to an area of low endemicity according to World Health Organization (WHO) criteria [11]. This result was lower than that of rural areas in the Ivory Coast, as described by Angora et al. (16.1%) [12] and Ahoué et al. (24.6%) [13]. Our results suggest that this disease should be carefully reconsidered in urban settings. In addition, the overall difference between our results and those of other local studies could be due to epidemiological factors (rural or urban study areas, climatic zones), children’s contact with freshwater, and larger or smaller study numbers, longer or shorter study periods, as well as the analysis techniques used, the age of the studies, and the administration of mass chemotherapy. Our study showed that the prevalence of S. haematobium infestation was higher in the 10–14-year-old group (4.26%) than in the 5–9-year-old group (2.17%). This difference could be explained by the fact that younger children more frequently engage in behaviors that increase their exposure, such as bathing, doing laundry, or fishing in stagnant water, due to their greater independence in daily and recreational water-related activities. However, this difference was not significant (p = 1.0). Our findings were similar to those reported in Burkina Faso and Nigeria [14,15]. The prevalence of urinary schistosomiasis was higher in boys (4.4%) compared to girls (2.8%), but this difference was not statistically significant (p = 0.7). As a result, gender could not be regarded as a risk factor in the occurrence of schistosomiasis in our study population. These results are in accordance with those of Western Africa studies [16,17]. In contrast, our results differ from those of Bleindou in the city of Agboville, Ivory Coast, where a significant female predominance (p = 0.0067) was found [18]. Such a difference may be explained by the fact that girls are more often exposed as a result of their household activities involving repeated contact with water in rural areas, while in urban areas in our study, boys are generally more inclined to play around water sources. Moreover, urinary schistosomiasis was more common in elementary school students (4%) than in other grades, but the difference was not significant. Regarding behavior and exposure to water, our study shows that 45.7% of children regularly went to freshwater sources, mainly during break time or recreational activities. All positive cases were identified among children exposed to these bodies of water. A statistically significant association (p = 0.02) was found between this frequentation and the presence of S. hӕmatobium eggs in urine, therefore confirming the classic hypothesis that transmission of S. hӕmatobium is strongly associated with the aquatic environment [12]. Our results corroborate those of studies conducted in endemic regions [16,19], where repeated contact with stagnant water is the main risk factor. Objectively, all children lacked knowledge about the transmission of schistosomiasis through contaminated water. They did not know how to identify or name this disease, nor were they aware of any preventive strategies. This ignorance was also reported in other African studies. Hereby, ignorance is a major obstacle to effective disease control and results from the absence of educational health programs and of community awareness. This situation reinforces the need for a combined approach of chemoprevention, health education, and environmental management.

Our results must be interpreted with caution due to certain methodological limitations. Firstly, the method used for parasitological analysis was based on urine centrifugation without using more sensitive filtration techniques. Secondly, the small sample size from only one school limited the generalization of our findings to the whole city of Bouaké. Further larger and multicenter studies could be done to validate this trend and identify high-risk areas by using filtration and molecular biology methods. Despite these limitations, our study highlighted the real and silent presence of urinary schistosomiasis in urban areas and recommends a reassessment of national prevention strategies.

This study presents the epidemiological profile of urinary schistosomiasis in school-aged children in an urban area of Bouaké, the Ivory Coast. The observed prevalence rate of 3.6% indicates low endemicity according to WHO criteria. There were slightly higher rates among boys and in the 10–14-year-old group, though these differences were not statistically significant. Infection was significantly associated with contact with freshwater sources, but not with sex, school grade, age, or knowledge about the disease. These results underscore the ongoing presence of urban transmission foci despite national mass drug administration programs primarily targeting rural areas. Therefore, schistosomiasis control strategies should also address urban settings by integrating prevention measures, health education, community awareness, environmental management, and chemoprevention to advance toward elimination goals.