Human schistosomiasis in Benin: Countrywide evidence of Schistosoma haematobium predominance

Background: A national mapping of human schistosomiasis was conducted in Benin to provide the baseline epidemiological data required to implement the national strategy for schistosomiasis control and elimination to achieve the WHO's goal of reaching at least 75% of school-age children in endemic areas by 2020. Methods: Parasitological surveys were conducted from 2013 to 2015, among 19,250 children aged 8-14 years randomly sampled in 385 units (schools/villages) across all districts. Urine and stool samples were examined using parasite-egg filtration for urine samples and the Kato-Katz technique for stool specimens. Results: Human schistosome eggs from two major species (S. haematobium and S. mansoni) were detected in the surveyed population with variable prevalence and parasite intensity. Urinary schistosomiasis due to S. haematobium was widely distributed and detected in 76/77 districts with a national average prevalence of 17.56% (95 degrees CI:16.80%-18.32%), compared to S. mansoni detected in 28/77 districts with a national prevalence of 2.45% (95 degrees CI:2.14%-2.76%). The combined national prevalence of schistosomiasis, defined by infections with either or both schistosome species was 19.78% (95% CI:18.90%-20.49%), and was detected in 76/77 districts. Based on our findings, 31 districts were classified as low-risk (> 0% and < 10%); 37 as moderate-risk (>= 10% and < 50%); and 8 as high-risk (>= 50%) of schistosome infection. No infection was detected in Kpomasse district in this study. In several districts where the two species were endemic with prevalence >= 10%, S. haematobium was the most prevalent schistosome species. Boys were relatively more infected than girls (18.29% v 16.82%, p = 0.007). Of note, heavy infections with S. haematobium (> 50 eggs/10 mL) were detected in several districts of Atacora, Donga, Borgou, Collines, Oueme and Atlantique departments. Conclusions: The schistosomiasis mapping reported here clearly present a nationwide view of the epidemiological pattern of Schistosoma infections and the baseline data for implementing an effective control strategy by preventive chemotherapy (PCT). Although PCT might not be required in 32/77 districts, a yearly and bi-annual deworming is needed in 2 and 43 districts, respectively. If no environmental change occurs, and no mass treatment is delivered, prevalence is likely to remain stable for many years owing to poor hygiene and sanitation.