Prevalence and factors associated with urinary schistosomiasis in women attending cervical cancer screening in Sithobela, Eswatini: A facility-based cross-sectional study.

Abstract

Urinary schistosomiasis remains endemic in sub-Saharan Africa, yet data on women of reproductive age are limited. This study aimed to determine the prevalence of Schistosoma haematobium infection and to identify associated sociodemographic and exposure-related factors - including employment status - among women attending cervical cancer screening in Eswatini. A facility-based cross-sectional study was conducted at Sithobela Health Centre (Lowveld region) between September and October 2023. Using convenience sampling, 360 women aged 20 - 49 years attending routine screening were enrolled. Sociodemographic characteristics (including education and employment/occupation) and water-related exposures were collected using a semi-structured questionnaire. A single mid-morning 10-mL urine sample was examined by sedimentation microscopy, and infection was defined as ≥1 S. haematobium egg per 10 mL of urine. Data were analyzed using descriptive statistics and multivariable logistic regression. The prevalence of urinary schistosomiasis was 10.83% (39/360). Women older than the median age (26 years) had higher odds of infection (AOR 2.29, 95% CI 1.04 - 5.05; p = 0.04), while secondary education or higher was associated with lower odds (AOR 0.38, 95% CI 0.16 - 0.89; p = 0.03). Employment status (employed vs unemployed) was not associated with infection (AOR 0.89, 95% CI 0.39 - 2.02; p = 0.79). Use of open or protected wells was associated with lower odds compared with tap water (AOR 0.14, 95% CI 0.05 - 0.35; p < 0.01). Urinary schistosomiasis persists among women attending cervical cancer screening, supporting inclusion of women of reproductive age in control strategies.