Schistosomiasis, a neglected tropical disease, poses a significant public health challenge in over 78 countries, affecting approximately 240 million people globally, with 90% of cases in sub-Saharan Africa. The disease primarily impacts children due to their frequent exposure to contaminated water sources. Interventions such as MDA, snail control, safe water provision, and health education are implemented to combat schistosomiasis. Praziquantel is the primary drug used in treatment, administered through MDA or targeted treatment programs. MDA treats an entire population, regardless of infection status, while targeted treatment focuses on specific groups (often school-aged children). This review focuses on the impact of these strategies on schistosomiasis prevalence and intensity in African school-aged children, specifically targeting *Schistosoma haematobium* and *Schistosoma mansoni* infections. The aim is to understand the influence of various delivery strategies—treatment duration, frequency, mode of delivery, and complementary interventions—to inform strategies for reducing the schistosomiasis burden in line with WHO's goal of elimination by 2025.

The review examined peer-reviewed articles from Google Scholar, Medline, PubMed, and EBSCOhost databases, focusing on studies published between 2010 and 2022. The search criteria included studies focusing on the impact of targeted treatment or MDA using praziquantel on schistosomiasis prevalence and intensity in African primary school children aged 5-19 years. Studies had to explicitly report changes in prevalence and intensity post-MDA, restrict infection types to *S. haematobium* and *S. mansoni*, and be published in English. Studies lacking baseline prevalence or intensity data, or those conducted outside Africa, were excluded. The search terms included various combinations of 'schistosomiasis,' 'bilharzia,' 'targeted treatment,' 'mass drug administration,' 'prevalence,' 'intensity,' 'African children,' and 'primary school.'

The literature search yielded 846 articles, after removing duplicates and irrelevant articles, 27 articles met the inclusion criteria for this scoping review. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram guided the screening and selection process. Data extraction was conducted using a standardized form encompassing study identification, methodology, outcomes, and conclusions. Two independent researchers summarized data using Microsoft Excel spreadsheets, and discrepancies were resolved through discussion. Quality assessment employed the Mixed Methods Appraisal Tool (MMAT), evaluating various aspects of the included studies, including study design, data collection, analysis, and reporting. The MMAT assessed the studies based on a scoring system, classifying papers as good, average, or bad based on their overall score.

The 27 studies included showed a consistent decrease in schistosomiasis prevalence post-treatment. Prevalence change varied across studies, with 5 studies showing a change below 40%, 18 studies between 40-80%, and 4 studies above 80%. Infection intensity post-treatment also varied, with 24 studies reporting a decrease and 2 studies reporting an increase. The impact of targeted treatment was influenced by treatment frequency, complementary interventions (e.g., snail control, health education, clean water provision), and community uptake. High treatment coverage (above 90%) correlated with a significant (80%) drop in prevalence and intensity. Conversely, low treatment coverage resulted in minimal change and high reinfection rates. Studies indicated that annual MDA was insufficient in high-endemic areas, with multiple rounds being more effective in controlling the infection. School-based treatment was more frequently used than community-based treatment, although no significant difference in effectiveness was observed between the two methods. The frequency of treatment was a significant factor, with more frequent treatments leading to greater reductions in prevalence and intensity. The presence of additional interventions also showed a positive effect on reducing the infection burden.

This review demonstrates that targeted treatment alone is not sufficient to eliminate schistosomiasis. While it effectively reduces the prevalence and intensity of active infections, high reinfection rates necessitate ongoing MDA programs. The findings emphasize the importance of high treatment coverage (above 75%), as recommended by the WHO, to achieve significant reductions in infection. The effectiveness of MDA is amplified by the inclusion of complementary interventions such as snail control, improved sanitation, safe water access, and health education to address transmission sources. The study highlights the need for strategies that address not just treatment but also preventative measures and socioeconomic factors that contribute to the persistence of schistosomiasis. The development of effective schistosomiasis vaccines is crucial for a sustainable approach.

This review confirms that targeted treatment and MDA can significantly control schistosomiasis, but elimination requires sustained MDA programs coupled with strong preventative and health promotional strategies. High treatment uptake is critical, and complementary interventions enhance effectiveness. The reliance on praziquantel warrants further research into alternative prophylactic methods and vaccines. Future research should focus on optimizing MDA strategies, integrating preventative measures, and addressing socioeconomic factors.

Access to some articles was limited due to purchase requirements and restricted institutional access during the pandemic. This may have impacted the comprehensiveness of the review.