Transmission of Schistosoma mansoni depends on fecal eggs reaching water, but the way this happens is poorly understood. We studied the role of hygienic bathing after defecation in the contamination of water with S. mansoni eggs. Individuals in an endemic community in Northern Senegal (n=991) were examined for S. mansoni infection and a random sample (22%) was interviewed about stool disposal practices and hygienic behavior. We assessed the presence and viability of S. mansoni eggs adhering to the peri-anal region of 13 infected volunteers, by counting the miracidia in the water they had used for hygienic washing; for 10 of them (77%) miracidia were demonstrated. From the population infection distribution, average number of defecations per day, proportion of individuals bathing after defecation, and association between miracidial counts and infection intensity, we calculated a daily population miracidial output of approximately 30,000 through hygienic bathing. For comparison, one complete stool reaching the water was calculated to yield approximately 2500 miracidia. Thus, 12 individuals in this population should defecate into the water every day to produce the same number of miracidia as through hygienic bathing. Our results suggest a major role of hygienic bathing after defecation in the transmission of S. mansoni.
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