Kato-Katz versus urine POC-CCA for the diagnosis of Schistosoma mansoni in preschool-aged children in Homa Bay County, Kenya

The diagnosis of schistosomiasis in preschool-aged children (PSAC) is challenging. The point-of-care circulating cathodic antigen (POC-CCA) assay offers potential improvements in diagnostic access in hard-to-reach areas over the conventional Kato-Katz (KK) test. This study compared the diagnostic accuracy of KK versus POC-CCA in stool and urine samples from PSAC in a PSAC population residing in a S. mansoni endemic hard-to-reach area in Kenya. Using combined positive results of both KK and POC-CCA tests as the "gold standard," the overall sensitivity of KK (57.6%; 95% CI, 49.1-65.8) was significantly lower than that of POC-CCA (73.2%; 95% CI, 65.0-80.4); <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:msubsup><mml:mi>χ</mml:mi> <mml:mrow><mml:mi>m</mml:mi></mml:mrow> <mml:mn>2</mml:mn></mml:msubsup> </mml:math> = 5.88, p = 0.015. There was moderate agreement between KK and the combined results (k = 0.599, p < 0.001, concordance 80.9%) and a substantial agreement between POC-CCA and the combined results (k = 0.753, p < 0.001, concordance 88.1%). POC-CCA is a more sensitive diagnostic tool for schistosomiasis surveillance in PSAC compared to KK, particularly in hard-to-reach endemic areas.