Non-Participation Undermines Mass Drug Administration Effectiveness and Sustains Urogenital Schistosomiasis Transmission in an Endemic Community in Ghana.

Non-participation in MDA undermines schistosomiasis control and sustains local transmission hotspots in Ghana despite national progress. Schistosomiasis, a neglected tropical disease caused by parasitic flatworms of the genus Schistosoma, remains prevalent in sub-Saharan Africa due to poverty, poor access to clean water and sanitation, and low awareness. This study evaluated the impact of non-participation on MDA effectiveness in the Abee community, Central Region, while identifying barriers to uptake and strategies to improve community engagement. A cross-sectional study was conducted among 298 participants. Schistosomiasis prevalence was assessed by urine microscopy and PCR, and multivariate logistic regression was used to identify factors influencing infection and MDA participation (p [≤] 0.05). Results showed a prevalence of 17.1% by microscopy and 20.1% by PCR. Only 48.7% of participants had ever participated in MDA, with 31.5% never treated. Awareness of schistosomiasis was 60.4%. Multivariate analysis revealed that non-participation in MDA and lack of disease education significantly increased infection risk, while awareness strongly predicted MDA uptake. Microhaematuria and leukocyturia were detected in 6.7% and 8.4% of participants, respectively. These WASH gaps facilitate environmental contamination with Schistosoma haematobium eggs, sustaining transmission despite ongoing MDA efforts. In conclusion, low MDA participation driven by limited awareness and weak WASH infrastructure sustains focal transmission hotspots (17.1-20.1% prevalence) in Abee. Strengthening community engagement, targeted health education, improved MDA access, and integrated WASH interventions is essential to increase coverage and achieve the WHO 2030 elimination targets.