Persistent Burden of Schistosomiasis in South Africa: A National Laboratory-Based Analysis, 2019-2024

Schistosomiasis remains the second leading cause of death among parasitic diseases globally, contributing substantially to chronic morbidity and disability. South Africa (SA) is endemic for schistosomiasis, with ongoing efforts to expand mass drug administration. In the absence of true prevalence data, this study retrospectively analysed public sector laboratory-confirmed schistosomiasis cases from 2019 to 2024. Over this period, 73,680 cases were microscopically diagnosed, with Schistosoma haematobium accounting for 99.9% of infections. The test positivity rate of 20 per 100,000 population is lower than previously reported, with the burden concentrated among boys aged 5-19 years, particularly in the KwaZulu-Natal, Limpopo, and Mpumalanga provinces. These findings highlight a persistent burden within defined demographic groups and geographic areas, while also suggesting possible early signs of improvement that are potentially linked to public health interventions. The results provide valuable evidence to inform the scale-up of national schistosomiasis control programmes and the prioritisation of interventions towards the most affected populations.