Background: Schistosomiasis is a common public health problem throughout the world and Schistosoma mansoni is the most prevalent species in Africa. Most endemic countries use Kato Katz (KK) stool smear examination for diagnosis, mapping and monitoring of intervention programs. However, its poor sensitivity calls an urgency to evaluate and use more accurate diagnostic tools, of which detection of circulating cathodic antigens (CCA) in urine seem promising.

Objective: To assess the accuracy of urine point of care CCA (POC-CCA) detection test against KK and polymerase chain reaction (PCR) tests through systematic review and meta-analysis.

Methods: Studies published until May 2022 were searched from PubMed, Google Scholar and green literatures for systematic review and meta-analysis following PRISMA guideline. Eligible studies were selected based on pre-set inclusion and exclusion criteria. Quality of included studies was assessed using the QUADAS 2 tool. Heterogeneity between studies was assessed using Cochrane Q test and I² test statistics. Data were analyzed using Review Manager 5.4.1 and Meta-DiSc 1.4 softwares.

Findings: Thirty seven studies published in 29 papers, and enrolling 21159 study participants were included for analysis. Overall analysis of POC-CCA test against KK reference standard revealed a pooled sensitivity and specificity of 0.86 (95%CI: 0.85–0.87) and 0.66 (95%CI: 0.65–0.67), respectively.  Subgroup analysis among 24 studies comparing single CCA with single KK revealed high sensitivity (0.88) but low specificity (0.66). The systematic receiver operating characteristics (SROC) curve from those 24 studies showed an area under the curve (AUC) of 0.7805 interpreted as POC-CCA test fairly discriminates infected participants from those without the disease. Higher sensitivity estimates of 0.93 and 0.90 were reported when comparisons were made between 2 urine and 1 stool samples, and 3 urine and 3 stool samples, respectively. Single POC-CCA resulted a pooled sensitivity estimate of 0.81 (95%CI: 0.78-0.84) as evaluated by PCR reference test.

Conclusion: The POC-CCA test has higher sensitivity than KK and may serve as routine diagnostic alternative for disease diagnosis, mapping and monitoring of interventions. However, its accuracy should further be evaluated at different transmission settings and infection intensity.