Identifying shared and parasite-specific determinants of Plasmodium falciparum and Schistosoma mansoni co-infection in a large-scale community-based study in rural Uganda

In the SchistoTrack cohort in rural Uganda, co-infection prevalence was 18.51%, peaking in school-aged children at 13 years, with shared and parasite-specific determinants separating via copula modeling.

• Why it matters: Co-endemic malaria and schistosomiasis may co-occur due to shared exposures or distinct biology, but it is unclear which factors drive co-infection beyond chance.
• What they did: Using recruitment data from 4290 individuals in 52 villages, a bivariate copula model estimated shared versus residual dependence; distance to a government health centre, age, male gender, and western district status were key shared factors.
• The result: Local water ecology affected each pathogen in opposing directions, fishing increased S. mansoni and co-infection risk but not P. falciparum, and a combined water-infrastructure scenario reduced co-infection prevalence by 32%.

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