Sex-specific correlates of Schistosoma haematobium infection in a rural Zambian setting: A pilot study focusing on immune and hematological factors

Abstract Background This study aimed to identify and compare the sex-specific immune, hematological, and environmental factors associated with Schistosoma haematobium infection in a rural Zambian setting. Methods This community-based cross-sectional study enrolled participants from rural Zambia. Schistosoma haematobium infection was diagnosed microscopically from urine. Blood samples were analyzed for complete blood counts and cytokines via ELISA. Data were analyzed using sex-stratified logistic regression models in StatCunch. Results The analysis included 51 male and 92 female participants. In the multivariate model, for males, only lack of clean water (aOR=0.04, 95% CI; 0.00-0.60, p=0.0194) and symptomatic disease (aOR=68.10, 95% CI; 4.64-1000.29, p=0.0021) remained independent correlates of schistosomiasis infection. For females, the final model identified symptomatic disease (aOR=2155.53, 95% CI; 2.11-2198049.30, p=0.0299), elevated IL-4 (aOR=1.02, 95% CI; 1.01-1.03, p=0.0035), lower hemoglobin (aOR=0.17, 95% CI; 0.03-0.87, p=0.0336), and a lower platelet-to-lymphocyte ratio (aOR=0.97, 95% CI; 0.93-1.00, p=0.0489) as significant independent correlates. Conclusion The correlates of schistosomiasis infection are highly sex specific. While environmental exposure is a key driver for males, the female profile is characterized by a pronounced immunological response, including a Th2-skewed cytokine profile and associated hematological manifestations like anemia. These findings underscore the necessity for sex-differentiated approaches in both the clinical assessment and public health control of schistosomiasis.