Comparative Detection of Schistosoma haematobium Using Microscopy, Circulating Cathodic Antigen Test, and qPCR in Northern Nigeria

Urogenital schistosomiasis caused by Schistosoma haematobium remains a major neglected tropical disease in sub-Saharan Africa, particularly in Nigeria, where transmission is sustained by poor sanitation, inadequate water infrastructure, and frequent human contact with infested freshwater bodies.  Accurate diagnosis is critical for surveillance, treatment monitoring, and control programs; however, conventional microscopy often underestimates infection prevalence due to low sensitivity in light-intensity infections.  A hospital-based cross-sectional study involving 100 participants was conducted between December 2024 and April 2025 at Federal Medical Centre Birnin Kudu, Jigawa State, Nigeria.  Urine samples were analyzed using microscopy, point-of-care circulating cathodic antigen (POC-CCA) assay, and quantitative polymerase chain reaction (qPCR).  Diagnostic indices, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, and 95% confidence intervals, were determined using microscopy as the conventional reference method.  The prevalence of S. haematobium infection detected by microscopy, POC-CCA, and qPCR was 18%, 23%, and 32%, respectively.  qPCR demonstrated the highest sensitivity (77.7%) and NPV (94.1%), while POC-CCA showed sensitivity and specificity values of 72.2% and 87.8%, respectively.  Positive likelihood ratios were 5.92 for POC-CCA and 3.55 for qPCR, whereas negative likelihood ratios were 0.32 and 0.29, respectively.  Male participants showed higher prevalence rates across all diagnostic methods, with microscopy prevalence of 27.5% among males compared to 8.2% among females.  Participants aged 11–20 years had the highest infection prevalence (41.7%).  qPCR consistently detected more low-intensity infections than microscopy and antigen-based methods.  In conclusion, Molecular and antigen detection methods demonstrated superior diagnostic performance compared to conventional microscopy for detecting S. haematobium infection.  The higher sensitivity of qPCR highlights its usefulness in identifying low-intensity and subclinical infections that may be missed by microscopy.  Integration of qPCR and POC-CCA into schistosomiasis surveillance and control programs could substantially improve early detection, epidemiological monitoring, and post-treatment evaluation in endemic communities.