Visual Diagnosis in Low-Resource Settings: Evaluating Urine Color and Macroscopic Haematuria as Rapid Indicators for Schistosoma haematobium Intensity
Abstract
Urinary schistosomiasis, caused by Schistosoma haematobium, remains a significant public health burden in Nigeria, particularly in rural communities with limited access to diagnostic infrastructure. While urine filtration and microscopy remain the gold standard for diagnosis, they are often impractical in low-resource field settings. This study evaluates the diagnostic performance of visual indicators—specifically, urine colour and macroscopic haematuria—as rapid, low-cost proxies for determining infection intensity. A cross-sectional study was conducted across three locations in Makurdi, Benue State: North Bank, Agwan Jukun, and Jibata. A total of 1,032 participants were recruited and screened. Urine samples were examined macroscopically for colour and haematuria, and microscopically for S. haematobium eggs. Infection intensity was categorised as light or heavy based on egg counts. Statistical associations were analysed using Chi-square tests. The overall prevalence of urogenital schistosomiasis in the study area was 56.69% (585/1,032). Visual inspection revealed a strong correlation between urine appearance and infection intensity. Participants with "Bloody Red" urine had a 99.15% infection rate, with 77.97% of these cases classified as heavy infections. Similarly, the presence of haematuria (micro and macro combined) was associated with a 97.25% infection rate, with 64.19% of these cases being heavy infections. Self-reported bloody urine also showed a high diagnostic value, with 88.76% of symptomatic individuals testing positive. Visual diagnosis, particularly the observation of bloody urine and urine colour changes, serves as a highly reliable, rapid assessment tool for identifying heavy S. haematobium infections. In resource-constrained settings where microscopy is unavailable, these visual indicators can be effectively used to prioritise treatment and map high-risk communities.
Downloads
References
Aminu, S., Obajuluwa, A. O., Odeyemi, S. C., Madara, A. A., & Okiki, P. A. (2025). Molecular epidemiological investigation of urinary schistosomiasis among individuals residing along selected riparian communities in Bauchi State, Nigeria. ABUAD International Journal of Natural and Applied Sciences, 5(1), 23-41.
Aniaguya, R. N., Olusi, T. A., Dada, E. O., & Olaniran O. (2024). Water Contact! One Risk Too Many: Risk Factors Associated with Schistosoma haematobium infection in Osun State, Nigeria. Epidemol Int J, 8(4), 000284.
Ally, O., Kanoi, B. N., Ochola, L., Nyanjom, S. G., Shiluli, C., Misinzo, G., & Gitaka, J. (2024). Schistosomiasis diagnosis: Challenges and opportunities for elimination. PLOS Neglected Tropical Diseases, 18(7), e0012282. https://doi.org/10.1371/journal.pntd.0012282
Chala, B. (2023). Advances in Diagnosis of Schistosomiasis: Focus on Challenges and Future Approaches. International Journal of General Medicine, 16, 983-995. https://doi.org/10.2147/IJGM.S391017
Desale, S., Alemu, G., & Hailu, T. (2025). Accuracy of AI-assisted diagnostic tools for Schistosoma haematobium: A systematic review and meta-analysis. medRxiv. https://doi.org/10.1101/2025.10.31.25339255
Gebrehana, D. A., & Mulu, G. B. (2024). Prevalence of schistosomiasis and its association with anemia in Ethiopia, 2024: A systematic review and meta-analysis. BMC Infectious Diseases, 24(1), 1040. https://doi.org/10.1186/s12879-024-09926-5
Mott, K. E., Dixon, H., Osei-Tutu, E., & England, E. C. (1983). Relation between intensity of Schistosoma haematobium infection and clinical haematuria and proteinuria. The Lancet, 1(8332), 1005– 1008. https://doi.org/10.1016/s0140-6736(83)92641-7
Murare, H. M., & Taylor, P. (1987). Haematuria and proteinuria during Schistosoma haematobium infection: relationship to intensity of infection and the value of chemical reagent strips for pre- and post-treatment diagnosis. Transactions of the Royal Society of Tropical Medicine and Hygiene, 81(3), 426–430. https://doi.org/10.1016/0035-9203(87)90158-1
National Population Commission (NPC). (2006). Population and housing census of the Federal Republic of Nigeria: Priority tables. National Population Commission.
Nwaorgu, O. C., & Anigbo, E. U. (1992). The diagnostic value of haematuria and proteinuria in Schistosoma haematobium infection in southern Nigeria. Journal of Helminthology, 66(3), 177–185. https://doi.org/10.1017/s0022149x00014387
Odaibo, A. B., Komolafe, A. K., Olajumoke, T. O., Diyan, K. D., Aluko, D. A., Alagbe, O. A., Ajagbe, O. A., & Olarinloye, D. B. (2024). Endemic status of urogenital schistosomiasis and the efficacy of a single-dose praziquantel treatment in unmapped rural farming communities in Oyo East Local Government Area, Oyo State, Nigeria. PLOS Neglected Tropical Diseases, 18(4), e0012101. https://doi.org/10.1371/journal.pntd.0012101
Okita, F., Agber, B., Enenche, G., Aladi, O., Omeje, O., Ogwuche, O., Luper, T., Kwaghdoo, A., Best, T., Apuu, V., Amali, O., Amuta, E., & Ikpa, T. (2023). Risk Factors and Urogenital Schistomiasis Prevalence among Primary School Children in Makurdi, Nigeria. East African Journal of Health and Science, 6(1), 460-471. https://doi.org/10.37284/eajhs.6.1.1542
Opeyemi, O. A., Simon-Oke, I. A., & Olusi, T. A. (2025). Distribution of urinary schistosomiasis and associated risk factors among school-age children in Kwara State, Nigeria. Journal of Parasitic Diseases, 49(1), 215–223. https://doi.org/10.1007/s12639-024-01745-4
Pourhoseingholi, M. A., Vahedi, M., & Rahimzadeh, M. (2013). Sample size calculation in medical studies. Gastroenterology and Hepatology from Bed to Bench, 6(1), 14–17.
Sturt, A. S., Webb, E. L., Colley, D. G., Secor, W. E., & King, C. H. (2023). Defining schistosomiasis hotspots based on literature and shareholder interviews. Trends in Parasitology, 39(12), 1032–1049. https://doi.org/10.1016/j.pt.2023.09.006
Vere, M., ten Ham-Baloyi, W., Oyedele, O., Mduluza, T., & Melariri, P. E. (2025). Urinary biomarkers and haematuria as indicators of urogenital schistosomiasis: A systematic review and meta-analysis. Acta Tropica, 269, 107716. https://doi.org/10.1016/j.actatropica.2025.107716
Wami, W. M., Wiegand, R. E., Odiere, M. R., Chan, K. H., & Rawago, F. (2014). Schistosoma haematobium hotspots in south Nyanza, western Kenya: Prevalence, distribution and co-endemicity with Schistosoma mansoni and soil-transmitted helminths. Parasites & Vectors, 7(1), 1–10.
Yelwa, S. L., Dogara, M. M., Balogun, J. B., Kani, Y. A., Dawaki, S. S., Adeniyi, A. K., Ibrahim, A. A., Abdurrahaman, A. U., & Ahmed, D. (2025). Persistent transmission of Schistosomiasis in Northwest Nigeria: A community-based assessment of urogenital and female genital infections. medRxiv. https://doi.org/10.1101/2025.08.01.25332782
Zamdayu, N. M., Qadeer, M. A., Chessed, G., & Francis, M. I. (2023). Prevalence of urinary schistosomiasis among children from three selected local government areas in Adamawa State, Nigeria. Dutse Journal of Pure and Applied Sciences, 9(3a), 168–178. https://doi.org/10.4314/dujopas.v9i3a.17
World Health Organization. (2022). WHO guideline on control and elimination of human schistosomiasis. World Health Organization. https://www.who.int/publications/i/item/9789240044814.
Copyright (c) 2026 Elizabeth Hembadoon Jande, Elizabeth Une Amuta, Amana Onekutu, Emmanuel Terseer Azua, James Agada Okete
This work is licensed under a Creative Commons Attribution 4.0 International License.
