Prevalence of Schistosoma haematobium and Schistosoma mansoni co-infection in sub-saharan Africa: a systematic review and meta-analysis

Schistosomiasis remains a significant public health challenge, especially in Sub-Saharan Africa (SSA). While individual species prevalence is well documented, the global burden of concurrent co-infection remains poorly quantified, despite its significant clinical and therapeutic implications. This study determined the prevalence of Schistosoma haemtobium (Sh) and Schistosoma mansoni (Sm) co-infection in SSA and its variation with age and geographical location. Following PRISMA guidelines, a systematic search of PubMed, African Journal Online, EMBASE and Google Scholar for studies published between 1980 and 2025 reporting Sh and Sm co-infection was conducted. A random-effects model was used to estimate pooled prevalence, with subgroup analyses conducted by geographical region and age. The study protocol was registered with PROSPERO (CRD420251176915). Twenty-six studies involving 33,121 participants across 11 African countries were included. The overall pooled prevalence of Schistosoma co-infection was 19.1% [95% CI; 12.3%-27.0%, I 2 = 99.6%, n = 26 studies p < 0.001]. The Western Africa region had the highest pooled prevalence of 26.9% [CI; 14.6%-41.4%, I 2 = 99.6%, n = 19 studies, p < 0.001] while the Eastern Africa had the lowest prevalence of 4.8% [CI; 1.7%-9.2%, I 2 = 97.2%, n = 5 studies. p < 0.001]. There was a significant difference in the pooled prevalence of Schistosoma co-infection across the various African sub-regions ( p < 0.001). There was no significant difference in the pooled prevalence of co-infection across the various age groups ( p = 0.47). The prevalence of Schistosoma co-infection is substantial in SSA, particularly within the West African subregion. However, the high heterogeneity observed in this study necessitates a cautious interpretation of the data. Not applicable.