Diagnostic accuracy of rapid and point-of-care tests for Schistosoma haematobium in African populations: a systematic review and meta-analysis

Background Accurate and accessible point-of-care testing for urogenital schistosomiasis (UGS) is vital for control and prevention in sub-Saharan Africa. Point-of-care (POC) rapid diagnostic tests with high sensitivity for both high and low parasite burdens have been developed. These tests need to be assessed for their applicability in poorly resourced UGS-endemic areas so that control programs can be initiated, and improved screening and routine diagnosis can be implemented. Methods This diagnostic test accuracy (DTA) review evaluates the sensitivity and specificity of eligible field-based index tests compared to laboratory-based reference tests for the diagnosis of UGS among individuals from Africa. Four databases were systematically searched for DTA studies on S. haematobium -exposed patients in endemic settings from 2000 to 2026. Methodological quality was assessed using the QUADAS-2 tool. Using the variability of test thresholds, a bivariate or HSROC model was used to calculate the diagnostic performance for each eligible test. Heterogeneity and subgroup analyses were conducted for the following variables: reference-standard comparators, age groups, and prevalence settings. Results Twenty-nine studies were evaluated, in which nine different POC and rapid tests were eligible, and four were included in a meta-analysis. Two field-based molecular tests, loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA), demonstrated high accuracy (sensitivity, 94.7%; specificity, 66.4%; and sensitivity, 94.1%; specificity, 96.6%, respectively). The immunochromatographic-rapid diagnostic test (ICT-RDT) and S. mansoni cercarial transformation fluid RDT (SmCTF-RDT) serological tests are easy-to-use POC cassettes and have high sensitivity (98.6% and 98.4%, respectively) but require a portable centrifuge to obtain serum samples. Other serological tests: dipstick dye immunoassay (DDIA) and indirect haemagglutination assay (IHA) had lower sensitivities (64.8% and 59.5%, respectively). The POC circulating cathodic antigen test (POC-CCA) demonstrated a sensitivity of 49.8% and specificity of 77.0% and has low diagnostic accuracy for S. haematobium . Portable and mobile-phone microscopes (sensitivity, 81.5%, specificity, 91.4%) were less sensitive than conventional microscopy but can have benefits in field-based low-resource laboratories. Conclusion Further validation with improved reference standards is required to assess the diagnostic accuracy of many of the tests identified. RPA and LAMP emerged as promising field-applicable rapid tests for schistosomiasis control.