Prevalence of STH and S. mansoni.

BackgroundSoil-transmitted helminthiasis (STH) and schistosomiasis (SCH) remain significant public health challenges in Rwanda, affecting individuals across all age groups. Despite ongoing mass drug administration (MDA) efforts, updated data on prevalence and risk factors are crucial for effective control and elimination strategies. This study reassessed the prevalence of STH and SCH in both children and adults in Rwanda, along with their associated risk factors, to guide control efforts.MethodologyA nationwide survey was conducted across 30 districts, testing 17,360 individuals for STH and 17,342 for Schistosoma mansoni using Kato-Katz (KK) and Point-Of-Care Circulating Cathodic Antigen (POC-CCA) tests. Mixed-effects logistic regression models were used to identify risk factors while accounting for district-level variability.FindingsThe overall prevalence of STH was 38.7% (95% CI: 37.9–39.4), highest among adults (46.1%, 95% CI: 44.8–47.3) and lowest among preschool-aged children (30.2%, 95% CI: 29.0–31.5). Species-specific prevalence was 27.0% for Ascaris lumbricoides (95% CI: 26.3–27.6), 11.6% for Trichuris trichiura (95% CI: 11.2–12.1), and 10.7% for hookworm (95% CI: 10.3–11.2). Moderate-to-heavy intensity (MHI) infections were detected in 8.1% of Ascaris lumbricoides (95% CI: 7.7–8.5), 0.8% of Trichuris trichiura (95% CI: 0.6–0.9), and 0.1% of hookworm (95% CI: 0–0.2). SCH prevalence was 1.7% (95% CI: 1.5–1.9) by KK and 27.2% (95% CI: 26.5–27.9) when trace results on POC-CCA were considered positive. Heavy Schistosoma mansoni infections were rare (0.1%, 95% CI: 0–0.1). Mixed-effects logistic regression (p ConclusionSTH and SCH remain significant public health challenges in Rwanda, with certain regions and population groups still exceeding the elimination threshold as public health problems. Expanding MDA programs to include adults, improving sanitation and hygiene, ensuring universal access to clean water, and promoting community education on safe practices are essential for achieving sustainable control and elimination of these infections.

### 背景
土壤传播的蠕虫病（soil-transmitted helminthiasis, STH）与血吸虫病（schistosomiasis, SCH）仍是卢旺达面临的重大公共卫生挑战，波及所有年龄段人群。尽管当地持续推进大规模药物给药（mass drug administration, MDA）工作，但患病率与危险因素的最新数据，对于制定高效的防控与消除策略至关重要。本研究针对卢旺达儿童与成人的STH、SCH患病率及其相关危险因素开展重新评估，以期为防控工作提供科学指引。

### 研究方法
本研究在卢旺达30个县区实施全国性调查，采用加藤-卡特法（Kato-Katz, KK）与现场循环阴极抗原检测（Point-Of-Care Circulating Cathodic Antigen, POC-CCA），分别对17360名受试者进行STH检测、对17342名受试者开展曼氏血吸虫（Schistosoma mansoni）检测。研究采用混合效应logistic回归模型，在分析中纳入县区水平的变异因素，以识别相关危险因素。

### 研究结果
STH总体患病率为38.7%（95%置信区间：37.9–39.4），其中成人患病率最高（46.1%，95%CI：44.8–47.3），学龄前儿童患病率最低（30.2%，95%CI：29.0–31.5）。虫种特异性患病率方面，蛔虫（Ascaris lumbricoides）为27.0%（95%CI：26.3–27.6）、鞭虫（Trichuris trichiura）为11.6%（95%CI：11.2–12.1）、钩虫为10.7%（95%CI：10.3–11.2）。中重度感染（moderate-to-heavy intensity, MHI）情况：蛔虫感染中8.1%为中重度感染（95%CI：7.7–8.5）、鞭虫为0.8%（95%CI：0.6–0.9）、钩虫为0.1%（95%CI：0–0.2）。采用KK法检测的SCH患病率为1.7%（95%CI：1.5–1.9）；若将POC-CCA检测的弱阳性结果判定为阳性，则SCH患病率为27.2%（95%CI：26.5–27.9）。重度曼氏血吸虫感染较为罕见，仅为0.1%（95%CI：0–0.1）。混合效应logistic回归分析结果显示：

### 结论
STH与SCH仍是卢旺达面临的重大公共卫生挑战，部分区域与人群的感染水平仍未达到公共卫生消除阈值。需扩大MDA覆盖范围至成人人群、改善环境卫生与个人卫生、保障全民获得清洁饮用水，并开展社区安全行为宣教，方可实现此类感染的可持续防控与消除。