Hyper-Endemicity of Urinary Schistosomiasis in Riverine Communities: A Comparative Study of Risk Factors and Water Contact Patterns in Makurdi

Abstract

Despite national control efforts, urinary schistosomiasis remains a recalcitrant public health challenge in Nigeria’s Benue Trough. Current surveillance often overlooks the extreme micro-epidemiology of riverine "hotspots" where transmission dynamics defy general trends. This study investigated the hyper-endemicity of Schistosoma haematobium in Makurdi, aiming to unmask localized transmission drivers and seasonal risk factors. A comparative cross-sectional study was conducted among 1,032 participants across three riverine communities: Katungu, Agwan Jukun, and Jibata. Terminal urine samples were analyzed via filtration for S. haematobium eggs, and infection intensity was correlated with data from structured questionnaires regarding water contact behavior, sanitation, and seasonality. The study revealed a startling spatial heterogeneity. While the overall prevalence was 56.69%, the Jibata community recorded a "saturation prevalence" of 100.00% (344/344), marking it as a critical hyper-endemic focus compared to Katungu (10.76%). Challenging classical epidemiological models, females exhibited a significantly higher infection rate (62.73%) than males (48.26%) (P < 0.001), suggesting a shift in risk from recreational to domestic water contact. Infection peaked at 91.67% in the 16–19 age group. Risk analysis identified reliance on river water as the primary driver (88.84% prevalence), exacerbated by perennial transmission; participants active in both rainy and dry seasons faced the highest risk (66.07%). The absolute infection rate in Jibata indicates a total breakdown of sanitation barriers, identifying the community as a priority zone for emergency intervention. The study confirms that transmission in this axis is driven by occupational exposure and failed water infrastructure rather than mere recreation. Effective control must move beyond school-based treatment to include community-wide WASH implementation and targeted support for women and older adolescents.