Co-infections of Schistosoma mansoni and Helicobacter pylori in school-aged populations and implication for management and control practices in Niger State, Nigeria

Helicobacter pylori and Schistosoma mansoni are two important pathogens that infect the gastrointestinal tract, could be acquired earlier in childhood, and can remain asymptomatic for a long period. While S. mansoni is been controlled within routine primary healthcare program, there are no control guidelines for H. pylori. Here, we investigate the co-infection pattern of both pathogens to support improvement of management strategies. Fresh stool samples were obtained from 299 school-aged children between ages 6-17 years and analyzed using real-time and conventional polymerase chain reaction (PCR) for the direct detection of S. mansoni and H. pylori respectively. An overall prevalence of 19.7% (4.5% - 24.1%) was recorded for H. pylori, and 34.4% (0% - 42.1%) for S. mansoni, while co-infection of both was 7.0% (0% - 8.1%). Infections were significantly different across the study communities for S. mansoni (p = 0.00) when compared to H. pylori (p = 0.38). There were, however, no significant association between infection and gender (p > 0.05), with the following odds of infection for S. mansoni (OR=0.69, 95% CI: 0.42, 1.12), H. pylori (OR=1.33, 95% CI: 0.75, 2.36), and combination of both infections (OR=1.31, 95% CI: 0.83, 2.09). By age category, children below 14years were twice likely to be exposed to the combination of both infections; age 12-14 years (OR=1.9, 95% CI: 1.06, 3.44), and age 9-11 years (OR=1.96, 95% CI: 1.11, 3.48). But they were also less likely to be exposed to S. mansoni; age 12-14 years (OR=0.52, 95% CI: 0.27, 0.97), and age 9-11 years (OR=0.43, 95% CI: 0.23, 0.79). Our study highlights an unexpectedly high prevalence of S. mansoni, moderate prevalence of H. pylori, and very low coinfection prevalence for both. Our findings on S. mansoni are particularly concerning, suggesting potential challenges in control programs. It is therefore important to consider integrated interventions, including chemotherapy and improved water, sanitation, and hygiene (WASH) services.