Water-Contact Behaviour, Community Knowledge and Freshwater Snail Ecology as Drivers of Urinary Schistosomiasis Transmission in Ekori, Cross River State, Nigeria

Abstract

Aims: Persistent urinary schistosomiasis transmission depends on human exposure to freshwater, contamination of water bodies, and the presence of suitable snail intermediate hosts. This article focuses on four freshwater sites in Ekori, examining behavioural exposure, community knowledge, and malacological findings. Study Design: A cross-sectional and malacological community survey. Place and Duration of Study: Four freshwater sites in Ekori, Yakurr Local Government Area, Cross River State, Nigeria, from June 2025 to January 2026. Methodology: A cross-sectional survey was conducted among 637 adults, who provided urine samples and completed a predesigned questionnaire on water-contact activities and knowledge of schistosomiasis. Freshwater snails were collected with scoop nets from 23 sampling points at the Ekori, Afrekpe, Epenti, and Ajere beaches, identified morphologically, and exposed to light to induce cercarial shedding. Results: Infection prevalence was highest among participants who reported swimming (23.41%), followed by fetching water (13.40%), bathing (7.41%), and washing (5.04%), with water-contact activity being significantly associated with infection (χ² = 24.184, p = 0.000023). Infection prevalence was 15.16% among participants without prior knowledge of schistosomiasis and 10.54% among those with prior knowledge. Fewer than one-third (27.9%) associated infection with contact with contaminated water, and none mentioned snails as part of transmission. Of 371 freshwater snails, 57.41% were Biomphalaria spp., 25.88% were Bulinus spp., and 16.71% were Lymnaea spp. Fifty-six snails (15.09%) shed cercariae. Conclusion: The findings indicate that transmission in Ekori is maintained through an interconnected human–snail–water system. The observed pattern supports integrated chemotherapy, WASH, behaviour change, snail surveillance, and environmental management because of repeated water contact, gaps in transmission knowledge, and the presence of cercaria-shedding freshwater snails.