Prevalence, risk and spatial distribution of schistosomiasis among adults to promote Universal Health Coverage: a cross-sectional study in Madagascar

Abstract Background: The goal to eliminate the parasitic disease of poverty schistosomiasis as a public health problem is aligned with the 2030 United Nations agenda for Sustainable Development Goals, including Universal Health Coverage (UHC). Current control strategies focus on school-aged children, systematically neglecting adults. We aimed at providing evidence for the need of shifting the paradigm of schistosomiasis control programs from targeted to generalized approaches as key element for both the elimination of schistosomiasis as a public health problem and the promotion of UHC. Methods: In a cross-sectional study we determined prevalence and risk factors for schistosomiasis by a semi-quantitative PCR assay from specimens collected from 1,482 adult participants at three primary health-care centers in north-western and central areas of Madagascar. Results: The highest prevalence of S. mansoni, S. haematobium and co-infection of both species was 59.5%, 61.3% and 3.3%, respectively. Higher prevalence was observed among males and main contributors to the family income. Not working as a farmer and higher age were found to be protective factors for infection. Conclusions: Our findings provide evidence that adults are a high-risk group for schistosomiasis. The general focus on children and the exclusion of adults from control strategies for schistosomiasis in high endemic countries may hamper the achievement of both the schistosomiasis elimination goal and UHC. Our data suggests that, for ensuring basic health as a human right, current public health strategies for schistosomiasis prevention and control need to be re-addressed towards more context specific, holistic and integrated approaches.