Pooling poo for Strongyloides PCR screening in communities in South-eastern Ghana

Abstract Background Strongyloidiasis, caused by Strongyloides spp., is a neglected tropical disease with significant but underreported public health impact. In Ghana, particularly in the Volta and Oti regions, data on prevalence is limited due to inadequate surveillance and low sensitivity diagnostics. Methods This cross-sectional study analyzed 1,392 archived human stool samples from seven communities across three districts (Adaklu, Hohoe, Nkwanta North). Samples were pooled (up to 10 samples per pool) for DNA extraction and PCR targeting the 18 S rRNA gene. Samples from positive pools were tested individually. Results Overall pooled prevalence was 7.2% (95% CI: 5.5–9.3), while individual prevalence was 18.5% (95% CI: 16.5–20.6), with notable variation across communities. Lancha (27.9%) and Dawanu (27.4%) showed the highest rates. Logistic regression found no significant associations with sex, age, or district. Conclusion The pooling strategy proved sensitive and resource efficient, supporting its use in Strongyloidiasis surveillance, despite underestimating the prevalence of infection. This study highlights the need for sensitive diagnostics and integrated surveillance to guide targeted public health interventions.