Schistosomiasis status and health impact in preschool-aged children in hard-to-reach areas and populations of Homa Bay County, Kenya.

Pediatric schistosomiasis in hard-to-reach communities is poorly understood, hampering tailored interventions. This study investigated the prevalence, intensity, health impact, and risk factors for schistosomiasis in preschool-aged children (PSAC) residing in hard-to-reach areas and populations of Homa Bay County, Kenya. A cross-sectional study was conducted among 476 PSAC aged 2-5 years across 6 islands in Lake Victoria, Homa Bay County, Kenya. Kato-Katz and urine filtration techniques diagnosed Schistosoma mansoni and S. haematobium infections respectively. Fecal occult blood (FOB) was tested to assess morbidity, and questionnaires captured sociodemographic and household water, sanitation, and hygiene data. Logistic regression models explored risk factors. The overall prevalence of S. mansoni was 26.0 %, varying considerably between islands; Ringiti had the highest prevalence (62.1 %), while Sukru had the lowest (7.7 %). No S. haematobium infections were diagnosed. Light infections were most common (15.4 %), followed by moderate (8.5 %) and heavy infections (2.2 %). Significantly increased odds for infection were observed in children aged four (aOR = 4.4, 95 % CI: 1.7-11.2) and five years (aOR = 5.6, 95 % CI: 2.2-14.5), in girls (aOR = 2.5, 95 % CI: 1.3-4.8), and in children living in Ringiti (aOR = 6.1, 95 % CI: 1.8-15.0). We noted a strong association between S. mansoni infection and FOB (aOR= 3.3, 95 % CI: 1.6-7.0). We found a high burden of schistosomiasis among PSAC in hard-to-reach communities of Homa Bay County, emphasizing the urgent need to include them in control programs. FOB could be a promising indicator for assessing schistosomiasis-related morbidity in this age group.