Microscopically detectable maternal schistosomiasis at delivery in Eastern Uganda: Prevalence, microscopy-based species distribution and associated household WASH characteristics in a hospital-based cross-sectional study

Schistosomiasis remains an important but neglected public health problem in Uganda. We estimated its prevalence, microscopy-based species distribution and associated factors among women delivering at Jinja Regional Referral Hospital. A hospital-based analytical cross-sectional study included 392 women from 1 September to 30 December 2025. One stool and one urine specimen per participant were examined microscopically for Schistosoma mansoni and S. haematobium, respectively. Multivariable logistic regression assessed associated factors; parsimonious conventional and Firth penalized models were used in sensitivity analyses. Microscopically detectable schistosomiasis was present in 44/392 women (11.2%; 95% CI: 8.5-14.8). Among microscopy-positive women, S. haematobium accounted for 63.6% of infections (95% CI: 48.2-76.7), S. mansoni for 29.5% (95% CI: 17.7-45.0), and mixed infection for 6.8% (95% CI: 2.1-19.6). Unimproved main water source (adjusted odds ratio [aOR] = 3.11; 95% CI: 1.46-6.64; p = 0.003), unimproved toilet facility (aOR = 4.40; 95% CI: 2.01-9.67; p < 0.001) and absence of a handwashing facility (aOR = 2.12; 95% CI: 1.02-4.41; p = 0.043) remained associated with microscopy-detected infection after adjustment. Women reporting fewer than four antenatal care contacts had higher adjusted odds than those reporting four to seven contacts (aOR = 8.43; 95% CI: 3.21-22.18; p < 0.001). The principal WASH associations remained consistent in sensitivity analyses. S. haematobium predominated among microscopy-classified infections. Household WASH characteristics remained associated with microscopy-detected infection, while the antenatal care association requires cautious interpretation. These cross-sectional findings do not establish causality but support further evaluation of context-appropriate schistosomiasis risk assessment within maternal health services and coordinated WASH and schistosomiasis-control strategies in endemic settings.