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Despite growing evidence that infants and very young children can be infected with schistosomes, the epidemiological features and risk factors are not well described in this age group. We aimed to assess the prevalence of  S .  mansoni  infection in children under two years of age from a population with a known high burden of infection in school-aged children and adults and thus inform the need for interventions in this potentially vulnerable age group. In a cross-sectional study in Mbita Sub-county, along the east coast of Lake Victoria, Western Kenya, we enrolled 361 children aged 6–23 months. The prevalence of  S .  mansoni  infection was detected using the Kato-Katz stool examination and a point-of-care test for urinary circulating cathodic antigen (POC-CCA) (Rapid Medical Diagnostics, Pretoria, South Africa). Three-hundred and five (305) children had complete data of whom 276 (90.5%, 95%CI: 86.6–93.5) children were positive for  S .  mansoni  by the POC-CCA test, while 11 (3.6%, 95%CI: 1.8–6.4) were positive by the Kato-Katz method. All Kato-Katz positive cases were also positive by the POC-CCA test. In multivariable analysis, only geographical area, Rusinga West (AOR = 7.1, 95%CI: 1.4–35.2, P = 0.02), was associated with  S .  mansoni  infection using Kato-Katz test. Independent associations for POC-CCA positivity included age, (12–17 months vs 6–11 months; AOR = 7.8, 95%CI: 1.8–32.6, P = 0.002) and breastfeeding in the previous 24 hours (AOR = 3.4, 95%CI: 1.3–9.0, P = 0.009).  We found a potentially very high prevalence of  S .  mansoni  infection among children under two years of age based on POC-CCA test results in Mbita Sub-county, Kenya, which if confirmed strongly supports the need to include infants in public health strategies providing universal prophylactic treatment in high burden settings. Further research is required to determine the accuracy of diagnostic tools to detect light infection among very young children and possible long-term health impacts.

Prevalence and risk factors of Schistosoma mansoni infection among children under two years of age in Mbita, Western Kenya