Bacterial urinary tract infections and urogenital schistosomiasis co-infection among primary school children in a Meatu district, Tanzania: A call for an integrated preventive approach

BACKGROUND: Urogenital schistosomiasis (UGS) remains a significant public health issue in Tanzania, co-infection with urinary tract infections (UTIs) can complicate diagnosis due to overlapping symptoms. Additionally, gastrointestinal carriage of multidrug-resistant bacteria (MDRB) increases risks of self-infection and transmission to others. Primary school-aged children in rural settings are particularly at risk for both diseases due to poor water sanitation and risky behaviors. This study reports the prevalence and patterns of UGS and UTI co-infection, and MDRB gut carriage among primary school-aged children. METHODOLOGY: A school-based cross-sectional study was conducted in Meatu district, Tanzania (Oct-Dec 2024). UGS was diagnosed using urine filtration, UTIs through urine culture while stool samples were screened for Extended spectrum beta lactamase (ESBL) producing bacteria. Descriptive analysis was done using STATA 15.0. RESULTS: Among 405 children enrolled, the prevalence of UGS, UTIs, and UGS-UTI co-infection was 44.1%, 12.8%, and 5.2%, respectively. Heavy UGS infection was associated with a greater likelihood of UTI than light infection. Haematuria was associated with UGS, whereas frequent and painful urination were common among children with UTIs and co-infection. Escherichia coli was the predominant UTI pathogen, with substantial resistance to third-generation cephalosporins. ESBL-producing bacteria and multidrug-resistant bacteria were also identified among UTI isolates. CONCLUSIONS: Co-infection of UGS & UTI among primary school children is a noticeable problem in the study settings; fever, frequent urination and painful urination are good predictors for co-infection. Similarities in clinical symptoms among co-infected individuals may complicate diagnosis and management on the initial assessment. High proportion of MDRB carriage in rural settings indicates the extensive burden of antimicrobial resistance in developing countries.