Knowledge, attitude, and practices on intestinal schistosomiasis among primary schoolchildren in the Lake Victoria basin, Rorya District, north-western Tanzania

Barriers and misconceptions hindering reduction of intestinal schistosomiasis in Mbita Sub-County, Western Kenya

BACKGROUND

Community and individual participation are crucial for the success of schistosomiasis control. The World Health Organization (WHO) has highlighted the importance of enhanced sanitation, health education, and Mass Drug Administration (MDA) in the fight against schistosomiasis. These approaches rely on the knowledge and practices of the community to be successful; however, where the community knowledge is low and inappropriate, it hinders intervention efforts. Hence, it is essential to identify barriers and misconceptions related to awareness of schistosomiasis, sources of infection, mode of transmission, symptoms, and control measures.

METHODS

This was a mixed-method cross-sectional study involving 1200 pre-school children randomly selected and examined for Schistosoma mansoni infection using the Kato-Katz technique. All parents/guardians of selected children were enrolled for a pre-tested questionnaire survey, while 42 were engaged in focus group discussions (FGDs). The level of knowledge and awareness among parents/guardians about schistosomiasis was evaluated in relation to the infection status of their pre-school children.

RESULTS

Among pre-school children, the prevalence of intestinal schistosomiasis was 45.1% (95% CI 41.7-48.5). A majority of parents/guardians (85.5%) had heard about schistosomiasis, and this awareness was associated with the participant's level of education (OR = 0.16, 95% CI 0.08, 0.34). In addition, a positive association was observed between higher educational attainment and knowledge of the causative agent (OR = 0.69, 95% CI 0.49, 0.96). Low education level was significantly associated with limited knowledge of transmission through lake water contact (OR = 0.71, 95% CI 0.52, 0.97) and infection from the lake (OR = 0.33, 95% CI 0.19, 0.57). Notably, parents/guardians who have heard of schistosomiasis could not recognize symptoms of S. mansoni infection, such as abdominal pain (91.8%, 815/888) and blood in the stool (85.1%, 756/888). Surprisingly, 49.8% (442/888) incorrectly identified hematuria (blood in urine), a key sign of S. haematobium, but not S. mansoni, in an endemic area for S. mansoni infection. The majority (82.6%, 734/888) of parents/guardians were unaware that dams are potential infection sites, despite 53.9% (479/888) of their pre-school-aged children testing positive for schistosome infection.

CONCLUSIONS

Despite the high level of awareness of intestinal schistosomiasis in the study area, we identified a low level of knowledge regarding its causes, modes of transmission, signs and symptoms and potential sites of transmission within the community. This study emphasizes the need for targeted educational interventions to address the misconceptions and knowledge gaps surrounding intestinal schistosomiasis through tailored community-based programs.

Point-of-care circulating cathodic antigen positivity and associated factors in school children one year after mass praziquantel administration in an endemic district in Ghana

Background

Mass drug administration of praziquantel is expected to reduce Schistosome carriage in treated children in endemic communities. However, the effectiveness of this annual exercise has not been assessed in Ghana. Therefore, this study aimed to detect viable Schistosoma mansoni infection using point-of-care circulating cathodic antigen (POC-CCA) positivity as proxy and associated factors in children previously treated with praziquantel in an endemic municipality in Ghana.

Materials and methods

This cross-sectional study was done in the Assin Central municipality in the Central Region of Ghana. School children, less than 16 years of age, treated with 40 mg/kg of praziquantel (treatment period: February-March 2019), provided early morning urine (∼40 mL) and stool (∼4 g) samples. Immediately, POC-CCA (ICT International, South Africa) was done, while S. mansoni ova were detected in formalin fixed samples using microscopy later. Additionally, participant's socio-demographic information and factors associated with S, mansoni infection transmission were collected from each child.

Results

A total of 520 children participated in the study (males-51.9%, majority age range [9-11 years, 34.4%]). Overall, 244 (46.9%) were positive for urinary CCA with no S. mansoni detected by microscopy. POC-CCA positivity was higher in females (48.4%), children with 2-3 siblings (49.3%), children aged 6-8-year range (55.4%) and residents of Brofoyedur (52%). However, age (x2 = 16.1, p = 0.0003) and town of residence (x2 = 11.7, p = 0.019) associated with CCA positivity. Further, location of water body (x2 = 16.4, p = 0.008), frequency of water contact (x2 = 12.3, p = 0.015) and handling of the Biomphalaria intermediate host (x2 = 5.1, p = 0.024) associated with POC-CCA outcome.

Conclusion

About 47% of the school children were positive for CCA, one year after mass praziquantel administration in the Assin Central municipality. Varied factors associated with the post-praziquantel administration POC-CCA positivity. This study should be replicated in other endemic areas to identify groups at risk of parasite persistence or reinfection to inform modification of control and preventive measures.

Knowledge, attitude and practice towards intestinal schistosomiasis among school-aged children and adults in Amhara Regional State, northwest Ethiopia. A cross-sectional study

BACKGROUND

Schistosoma mansoni causes intestinal schistosomiasis (SCH) in all regions of Ethiopia. Despite many years of mass treatment, the prevalence has not dropped significantly. The reduction of SCH transmission demands the integration of deworming with safe water, sanitation, and hygiene (WASH) activities. Adequate knowledge and a positive attitude towards SCH are critical to practicing those interventions. However, data on the knowledge, attitude, and practice (KAP) level in school and community settings is limited in Ethiopia.

METHODS

School and community-based cross-sectional studies were conducted from February to June 2023 among 634 school-aged children (SAC) and 558 adults. A pre-tested questionnaire was used to collect socio-demographic and KAP data. Records were entered and analyzed using SPSS software version 21. Correct responses for each of the KAP questions were scored as one, while incorrect or 'I don't know' responses were scored as zero. Good knowledge, a positive attitude and good practice were declared if percentage scores were ≥ 80%, ≥ 90% and ≥ 75%, respectively.

RESULTS

Only 229 (19.2%) respondents, comprising 91 (14.4%) SAC and 138 (24.7%) adults, had ever heard of SCH. Adults, males, and urban residents had higher awareness level compared to their respective counterparts (p < 0.05). Only 28.4% of aware respondents knew that swimming or bathing in freshwater is a risk factor for schistosoma infection; 10.9% knew the etiologic agent; and 14.4% mentioned at least one sign and symptom associated with SCH. The majority (97.8%) of the respondents were willing to take therapeutic drugs, but only 37.6% believed that SCH is a serious disease. Regarding risky practices, 89.5% practiced swimming or bathing in freshwater, and 25.3% had no access to piped water. Among the aware respondents, only 18 (7.9%) had good knowledge, while 30 (13.1%) had a positive attitude towards SCH. Ninety-nine (43.2%) respondents had good Schistosoma infection prevention practices.

CONCLUSIONS

The knowledge, attitude, and preventive practice level towards schistosomiasis are low in the study area. Therefore, strengthening school and community-based health education, along with mass drug administration (MDA), WASH, and a vector control program, is recommended for preventing SCH.

Knowledge, attitudes, practices and acceptability of a school preventive chemotherapy programme for schistosomiasis and soil-transmitted helminths control in Angola

Schistosomiasis and soil-transmitted helminth (STH) control programs require target population engagement, assessed through knowledge, attitudes and practices (KAP) surveys. We report the results of a KAP survey of Angolan schoolchildren supported by a school preventive chemotherapy (PC) programme, without or with a school water, sanitation and hygiene (WASH) programme (PC+/WASH- and PC+/WASH+, respectively); and schoolchildren without a school PC or WASH program (PC-/WASH-). Schoolchildren from PC+/WASH- (N = 218), PC+/WASH+ (N = 250) and PC-/WASH- (N = 254) schools were interviewed. Descriptive statistics were used to report demographics and survey responses. Chi-square or Fisher's exact test was used to compare PC+/WASH- schoolchildren with (i) PC+/WASH+ and (ii) PC-/WASH- schoolchildren. A lower proportion of PC+/WASH- schoolchildren used latrines and a higher proportion practised open defecation at school compared with PC+/WASH+ schoolchildren. A lower proportion of PC+/WASH- schoolchildren always washed their hands after toileting and before meals at school compared with PC+/WASH+ schoolchildren. However, the PC+/WASH- schoolchildren reported better toileting and handwashing practices at school compared to PC-/WASH- schoolchildren. Over 90% of PC+ schoolchildren agreed with schistosomiasis and STH control and accepted schoolteacher PC delivery. Expanding the integration of both school PC and WASH programs will improve health behaviours relevant to reduce the risk of schistosomiasis and STHs in schoolchildren. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Assessing the knowledge, attitudes, practices, and perspectives of stakeholders of the deworming program in rural Rwanda

BACKGROUND

Worm infections are among the most prevalent neglected tropical diseases worldwide. Schistosomiasis and soil-transmitted helminths infections, most common worm infections affecting Rwandan school-aged children, are addressed by the national deworming program since 2014. To date, no published studies have assessed the knowledge, attitudes, and practices of the key implementers of the national deworming program conducted at village and school level in Rwanda. This study aimed to assess key stakeholders' knowledge, attitudes, practices, and perspectives about the decentralized national deworming program.

METHODS/PRINCIPAL FINDINGS

We carried out a quantitative, cross-sectional study with complementary in-depth interviews in two districts of Rwanda in June 2021. From the 852 surveyed community health workers and teachers, 54.1% had a knowledge score considered good (≥80%). The mean knowledge score was 78.04%. From the multivariate analysis, lack of training was shown to increase the odds of having poor knowledge (OR 0.487, 95% CI: 0.328-0.722, p <0.001). The in-depths interviews revealed poor water access and hesitance from caregivers as perceived challenges to the success of the deworming program.

CONCLUSION

Our findings demonstrate the importance of training community health workers and schoolteachers on worm infections as they are the key implementers of the deworming program. This would enhance their capacity to provide health education and sensitization on misconceptions and misinformation towards deworming. Moreover, research is needed to assess the impact of poor access to water, sanitation and hygiene facilities on the prevalence of worm infections in Rwanda.

Awareness Status of Schistosomiasis among School-Aged Students in Two Schools on Pemba Island, Zanzibar: A Cross-Sectional Study

Schistosomiasis elimination has been set as a target in the Neglected Tropical Disease Roadmap of 2021 to 2030. The present study assessed the level of understanding, awareness and behaviors of schistosomiasis among students in Zanzibar and explored the influencing factors as the basis for reliable suggestions for the follow-up policy on schistosomiasis prevention and control. A Knowledge, Attitude and Practices (KAP) survey on students’ perceptions of schistosomiasis was conducted on students from grades 4−9 at two selected schools on Pemba, Zanzibar, from May through September in 2021. A total of 217 valid participants responded to the questionnaires. T-test and chi-squared tests were used to examine the association between the dependent and explanatory variables. Multiple linear regressions were used to analyze the influencing factors of KAP. The findings indicated a lack of knowledge about schistosomiasis among the participants. Although respondents were aware of the risks of infection, they continued to engage in high-risk activities. Age, family size and presence of hematuria were found as contributing factors. Elder students performed better on knowledge (p = 0.02) and attitude (p < 0.01) scores, and students with a smaller family received higher attitude scores (p = 0.04). Practice was significantly correlated with gender (p < 0.01) and hematuria (p < 0.01). Several kinds of health education should be adopted to raise students’ basic knowledge of schistosomiasis. It is also critical to make the community aware regarding schistosomiasis. Future efforts for the prevention and control of schistosomiasis should employ an integrated strategy combining communities with schools to encourage behavioral change.

Prevalence of Schistosoma mansoni infection among fishermen in Busega district, Tanzania

BACKGROUND

Schistosoma (S.) mansoni infection is endemic in all regions around Lake Victoria and affects all age groups to different degrees. In most endemic areas, less attention has been paid to determining the prevalence of infection, sanitation status, and knowledge about intestinal schistosomiasis (KIS) in fishermen. Therefore, the purpose of this study was to establish the prevalence of S. mansoni infection and associated factors among fishermen in the Busega district.

MATERIALS AND METHODS

A cross-sectional study was conducted among fishermen in July, 2020 in five fishing villages in the Busega district located along Lake Victoria. A total of 352 fishermen were interviewed with regard to their sanitation status and level of KIS. A single stool sample from fishermen was examined for S.mansoni eggs by using the Formalin-Ether Concentration technique. The potential factors associated with S. mansoni infection were explored using multivariable logistic regression.

RESULTS

The prevalence of S. mansoni infection was high (65.0%) among fishermen and varied with age, whereby fishermen aged ≤36 years had the highest prevalence. Fishermen had a low level of KIS and the majority of them reported practicing open defecation during fishing (81%). These fishermen with a low level of KIS and who reported defecating in open areas during fishing had 2.8 times (95% CI: 1.0-7.2) and 2.1 times (95% CI: 1.1-3.9) higher odds of being infected with S. mansoni than those with a high level of KIS and those who did not report defecating in open areas during fishing, respectively.

CONCLUSION

S. mansoni infection was high among fishermen in the Busega district. Furthermore, fishermen had a low level of KIS and were reported to have defecated in open areas during fishing. Infection with S. mansoni was associated with age, a low level of KIS and open defecation behaviour during fishing. Therefore, mass drug administration (MDA) with praziquantel, health education, and sanitation behaviour change interventions were needed.

Urogenital schistosomiasis prevalence, knowledge, practices and compliance to MDA among school-age children in an endemic district, southern East Tanzania

Background

Tanzania has a high prevalence of urogenital schistosomiasis. Praziquantel is administered to school-age children on an annual basis as part of efforts to reduce transmission and morbidity associated with heavy infections. We investigated the prevalence, knowledge, and practices of urogenital schistosomiasis transmission, as well as compliance with mass drug administration (MDA) among schoolchildren in Masasi District.

Materials and methods

A cross-sectional survey was conducted in five primary schools. A pre-tested questionnaire was used to assess knowledge and practice related to the transmission of urogenital schistosomiasis, as well as compliance with MDA. Collected urine samples were examined macroscopically for macrohematuria. They were then tested for microhematuria and Schistosoma haematobium (S. haematobium) eggs with urine dipsticks and filtration technique, respectively.

Findings

The study included 389 primary school children in total. Overall, 27 (6.9%) of children had S. haematobium infection, and 37 (9.5%) had microhematuria. The mean (SD) intensity was 123.4 (247.4) eggs per 10 ml of urine. A total of 10 (2.6%) had heavy intensity of infection. The majority (94.9%) reported having complied to the previous round of MDA six months prior to this study, and 308 (79.2%) were aware that water contact is associated with an increased risk of urogenital schistosomiasis infection. Nevertheless, 182 (46.8%) of the participants engaged in swimming activities, with 92 (50.9%) of the participants being female. The prevalence of urogenital schistosomiasis was higher (10.9%) among children who participated in swimming activities versus those who did not (3.4%) (P = 0.003).

Conclusion

Despite high MDA compliance, urogenital schistosomiasis is still prevalent among primary school children in Masasi District. Children who swim in freshwater bodies such as rivers and ponds are more likely to contract urogenital schistosomiasis.

Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review

Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.

Knowledge, attitudes, and practices regarding schistosomiasis infection and prevention: A mixed-methods study among endemic communities of western Uganda

INTRODUCTION

In Uganda, schistosomiasis (re)infections have continued to remain high despite the implementation of mass drug administration and sensitization campaigns aimed at controlling the disease. This could imply that there are some barriers to the implemented preventive measures. We conducted a mixed-methods study in Kagadi and Ntoroko districts around Lake Albert to assess knowledge, attitudes, and practices regarding schistosomiasis and to explore and understand perspectives regarding the disease.

MATERIALS AND METHODS

Semi-structured survey questionnaires were administered to 337 household adults selected through systematic random sampling. We also interviewed 12 participants and held 28 focus-group discussion sessions with 251 individuals respectively. Quantitative data was analysed using frequencies, percentages, and chi-square tests for associations, while themes and sub-themes were used to analyse qualitative data respectively.

FINDINGS

A total of 98.5%, 81.3%, and 78.5% had heard about schistosomiasis, and knew the main transmission modes and symptoms, respectively. The majority (75.8%) said avoiding contact with water was a preventative way, while 67.5% said observing signs and symptoms was a form of diagnosis. Furthermore, 98.4% and 73.4% said it was important to defecate in latrines and to avoid contact with contaminated water respectively. However, it is difficult to avoid contact with lake water because it is the only source of livelihood, especially for fisher communities. Open defecation is commonly practiced along the lake due to insufficient space and difficulties in the construction of latrines. Myths and misconceptions reported include; lake water is safe, gassing in water causes transmission, fetching water early in the morning and from deep water is safe, and feces in the lake water act as a bait for catching fish.

CONCLUSIONS AND RECOMMENDATIONS

Despite adequate knowledge of schistosomiasis and a positive attitude towards its prevention, existing myths and misconceptions, coupled with persistent risky water, sanitation, and hygiene practices still pose a challenge. A more robust community-based awareness intervention using bottom-up participatory approaches, accompanied by the provision of clean and safe water sources and increasing latrine coverage, could provide lasting solutions to these barriers.

From the One Health Perspective: Schistosomiasis Japonica and Flooding

Schistosomiasis is a water-borne parasitic disease distributed worldwide, while schistosomiasis japonica localizes in the People’s Republic of China, the Philippines, and a few regions of Indonesia. Although significant achievements have been obtained in these endemic countries, great challenges still exist to reach the elimination of schistosomiasis japonica, as the occurrence of flooding can lead to several adverse consequences on the prevalence of schistosomiasis. This review summarizes the influence of flooding on the transmission of schistosomiasis japonica and interventions responding to the adverse impacts from the One Health perspective in human beings, animals, and the environment. For human and animals, behavioral changes and the damage of water conservancy and sanitary facilities will increase the intensity of water contact. For the environment, the density of Oncomelania snails significantly increases from the third year after flooding, and the snail habitats can be enlarged due to active and passive diffusion. With more water contact of human and other reservoir hosts, and larger snail habitats with higher density of living snails, the transmission risk of schistosomiasis increases under the influence of flooding. With the agenda set for global schistosomiasis elimination, interventions from the One Health perspective are put forward to respond to the impacts of increased flooding. For human beings, conducting health education to increase the consciousness of self-protection, preventive chemotherapy for high-risk populations, supply of safe water, early case finding, timely reporting, and treating cases will protect people from infection and prevent the outbreak of schistosomiasis. For animals, culling susceptible domestic animals, herding livestock in snail-free areas, treating livestock with infection or at high risk of infection, harmless treatment of animal feces to avoid water contamination, and monitoring the infection status of wild animals in flooding areas are important to cut off the transmission chain from the resources. For the environment, early warning of flooding, setting up warning signs and killing cercaria in risk areas during and post flooding, reconstructing damaged water conservancy facilities, developing hygiene and sanitary facilities, conducting snail surveys, using molluscicide, and predicting areas with high risk of schistosomiasis transmission after flooding all contribute to reducing the transmission risk of schistosomiasis. These strategies need the cooperation of the ministry of health, meteorological administration, water resources, agriculture, and forestry to achieve the goal of minimizing the impact of flooding on the transmission of schistosomiasis. In conclusion, flooding is one of the important factors affecting the transmission of schistosomiasis japonica. Multi-sectoral cooperation is needed to effectively prevent and control the adverse impacts of flooding on human beings, animals, and the environment.

Knowledge, Attitudes, and Practices on Urinary Schistosomiasis among Primary Schoolchildren in Nelson Mandela Bay, South Africa

Background

Schistosomiasis remains a public health concern in South Africa (SA), with the highest prevalence of infection found among schoolchildren under the age of 15 years. Knowledge, attitude, and practices (KAP) studies on schistosomiasis among schoolchildren under the age of 15 years are lacking in the study area. The study therefore assessed primary schoolchildren in Grades 4–7 to determine their knowledge regarding schistosomiasis in the various ages represented in these grades.

Methods

The study employed a quantitative descriptive, cross-sectional survey research design approach. A structured, close-ended, Likert-scale, self-administered questionnaire was used to collect data from 458 learners in Grades 4 to 7 aged from 9 to 16 years. Data were analysed using Statistica version 13 software. Bivariate and multivariate techniques were further used to analyse and describe the data and significant associations at p = 0.05 were further interrogated using Cohen's d and Cramér's V, to determine the practical significance.

Results

Of the 458 learners who completed the questionnaire, 248 (54%) acknowledged having heard of schistosomiasis previously. There was a positive correlation between knowledge and attitude (0.779). The KAP scores were calculated as a percentage ranging between 0% and 100%, and this range was split into five equal width intervals 0–19%, 20–39%, 40–60%, 61–80%, and 81–100%. For knowledge, 210 (46%) of the participants obtained a score in the interval 0–19%. For attitudes, 237 (52%) of the participants obtained a score in the interval 0–19%. Therefore, the overall knowledge and attitudes among the study participants towards schistosomiasis were poor. There was a significant difference (p = 0.0005, V = 0.42 medium) between male and female participants relating to their practices. It was observed that a high percentage, 69 (15%) of males reported to swimming in slow-moving water compared to a significantly lower percentage, 9 (5%) of females. Furthermore, 23% of the participants reported that there was a river on the way to school.

Conclusion

The study revealed that there was a positive correlation between knowledge and attitude. The overall knowledge and attitudes on schistosomiasis were poor. Furthermore, a gender-related difference based on practices emerged significant in the study. The findings are thus valuable in designing effective and targeted schistosomiasis control programmes.

Adherence to diagnosis followed by selective treatment of schistosomiasis mansoni and related knowledge among schoolchildren in an endemic area of Minas Gerais, Brazil, prior to and after the implementation of educational actions

Introduction

Brazilian guidelines for schistosomiasis elimination recommend regular search of infection carriers and their timely treatment. This study evaluates the effect of educational actions (EAs) among schoolchildren on adherence to diagnosis and treatment, as well as on knowledge of the disease.

Methods

In April/2013, a questionnaire was applied to 6th-to-8th-grade pupils of eight public schools to evaluate prior knowledge of disease and self-reported risk behavior. Baseline parasitological survey (PS) was done in May/2013, followed by selective treatment and cure assessment. The schools were then randomly allocated to experimental (EG) and control (CG) groups, with and without EAs, respectively. EAs were conducted for 3 months from August/2013. Questionnaire was reapplied in November/2013, April/2014, October/2014, and October/2015 to evaluate changes in knowledge about the disease and self-reported risk behavior. Two further annual PSs (May/2014 and May/2015), each followed by treatment of positives, allowed to evaluate between-group differences and intra-group changes in adherence to diagnosis and treatment, and to follow-up prevalence and intensity of infection.

Results

Adherence to diagnosis did not differ significantly between EG (84.1%) and CG (81.1%) at baseline but was significantly higher in EG in subsequent PSs. Overall, adherence to treatment was higher than 90% in all three PSs; cure was 98.4%, egg-reduction was 99.8% and reinfection, 2.8%. Prevalence fell significantly in EC (from 23.5% to 6.8%) and CG (from 21.8% to 2.4%), the same occurring with intensity (from 54.2 to 4.6 epg in EG and from 38.4 to 1.3 epg in CG). Disease knowledge increased significantly in EG and CG; knowledge about disease transmission increased significantly more in the EG. Self-reported risk behavior remained above 67% and did not differ significantly between EG and CG.

Conclusion

EAs increased adherence of schoolchildren and improved knowledge about the disease, confirming that EAs are an important tool to enhance schoolchildren participation in control campaigns.

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Educational actions improved adherence to stool testing.

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Disease knowledge also improved with educational actions.

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Risk behavior stayed high despite educational actions.

Prevalence and correlates of intestinal schistosomiasis infection among school-aged children in North-Western Tanzania

BACKGROUND

Schistosomiasis is a neglected tropical disease that continues to cause morbidity and mortality in Sub Saharan Africa. Due to its endemicity, co-infection with malaria is common. The diseases cause anaemia and impaired nutritional status among children. We investigated the prevalence of intestinal schistosomiasis and its association with malaria, anaemia and nutritional status among school children.

METHODS

This was a cross sectional survey among 830 children in Nyamikoma village along Lake Victoria in Tanzania. A pre-tested questionnaire was used to collect socio-demographic data, history of drug use, and clinical data. Two faecal samples were collected on two consecutive days and analyzed using thick smears Kato Katz method. Diagnosis of malaria was done by malaria rapid diagnostic test, and haemoglobin concentration was determined using HemoCue. Nutritional status was assessed by anthropometric measurements.

RESULTS

The overall prevalence of intestinal schistosomiasis was 90.6% (95% CI = 88.6% - 92.6%). Intensity of infection was light 24.1% (200/830), moderate 38.4% (319/830) and heavy 28.1% (233/830). Pre-adolescents (≤12 years) were more infected with intestinal schistosomiasis (93.2%) than adolescents (>12 years) (84.7%) (p < 0.001). Prevalence of malaria was 1.7% (14/824), and that of intestinal schistosomiasis-malaria co-infection was 1.6% (13/824). The overall prevalence of anaemia was 24.6% (95%CI = 18.7% - 30.5%). Severe anaemia was found in 2.3% (19/824) of study participants. The prevalence of stunting and wasting were 29.0% and 11.3%, respectively. On both univariate and multivariate regression analysis, only lower age was significantly associated intestinal schistosomiasis infection, but not anemia, malaria, stunting or wasting. However among those infected, a negative binomial regression analysis indicated independent significant association of male sex, loose stool consistency, and stunting with high eggs count/gram of stool.

CONCLUSIONS

Despite several rounds of annual mass praziquantel administration, intestinal schistosomiasis is highly prevalent among school children particularly in younger children living in the study area. Biannual targeted mass praziquantel treatments or alternative regimens may be considered in future in the study area to redress the situation.

Is there a gap between health education content and practice toward schistosomiasis prevention among schoolchildren along the shores of Lake Victoria in Kenya?

Despite provision of preventive measures against schistosomiasis such as mass drug administration (MDA), the prevalence of Schistosoma mansoni remains high in communities living near Lake Victoria. This study aimed to analyse the status of schistosomiasis, including its prevalence, health education, knowledge, attitudes, and practices (KAP) among pupils, and water use in schools in Mbita situated along the shores of Lake Victoria. Four primary schools were selected as target schools and pupils in classes six and seven were recruited as study participants. The prevalence of S. mansoni was examined by Kato-Katz method. Simultaneously, a KAP survey toward schistosomiasis was conducted among the pupils. Health education contents were extracted from textbooks. All primary schools in the study site were surveyed regarding how each secured water used for daily school life. The prevalence of S. mansoni was 56% and 36% in 2015 and 2016, respectively. 60–70% of pupils chose a correct answer for the mode of transmission. More than 70% of pupils answered that bathing in Lake Victoria causes Schistosoma infection; however, more than 70% of pupils bathed in Lake Victoria sometimes or every day. According to the science textbook, “avoiding contact with contaminated water” is the way to prevent schistosomiasis; however, 66% of schools asked pupils to bring water from Lake Victoria. The prevalence of S. mansoni among pupils remains high. Schoolchildren are taught to avoid contact with contaminated water but are often asked to fetch water from the lake. From the school health viewpoint, health education that reflects the social and cultural context of the community in the contents and teaching methods are needed. In addition to this, provision of sanitation infrastructure is needed. A comprehensive and innovative approach which harmonises central and local governments and other stakeholders, as well as community is important to prevent schistosomiasis.

According to WHO, it is estimated that at least 206 million people required preventive treatment for schistosomiasis in 2016 and of those at least 90% live in Africa. Moreover, school-age children are most affected by this worm. In Kenya, despite preventive measures against schistosomiasis such as mass drug administration (MDA) in primary schools, it remains a major public health problem, especially along the shores of Lake Victoria. Our study revealed that the prevalence of Schistosoma mansoni was high among pupils despite their knowledge about schistosomiasis transmission. This can be attributed to lack of safe water supply and latrines. A comprehensive approach which harmonises central and local governments and other stakeholders, as well as community is needed to prevent schistosomiasis. For example, the combination of health education (in which schools play as focal point) with provision of water infrastructure, encouragement to use and construct toilets in both schools and community/households, snail control, and MDA with monitoring can be employed to control and prevent schistosomiasis. From the school health viewpoint, it is necessary to develop health education contents and teaching methods that reflect the social and cultural context of the community in order to improve their behaviour and change the social norm.

Evaluating community’s knowledge on integrated malaria, schistosomiasis and soil transmitted helminth (STH) infections in a Lake Victoria island, Kenya: A mixed method approach

Background: The burden of malaria, schistosomiasis and soil transmitted helminthes (STH) in the islands of Lake Victoria, Kenya, poses a considerable public health challenge. Although many studies have been conducted on the co-infection arising from these parasites, few have evaluated communities’ knowledge of the same. Increasing the level of knowledge about a disease or preventive chemotherapy is important, but efforts need to be focused on community perception and understanding of the problem so as to encourage engagement with the proposed control measures. This study aimed at understanding a community’s knowledge of malaria, schistosomiasis and STH in Lake Victoria island where an integrated preventive chemotherapy intervention was implemented. Methods: This study was conducted in Ngodhe Island in Lake Victoria in Homa Bay County, western Kenya region between April and May 2016. The study adopted a mixed method approach where both qualitative and quantitative data collection was performed concurrently.  Results: A total of 239 people participated in this study. All the respondents reported that they had heard about malaria, 89.1% had heard about schistosomiasis while 87.4% had heard about STH. The majority of the respondents (93.3%) drew their drinking water directly from the lake and 80.3% reported bathing in the lake. Out of all the respondents, 96.2% knew about the ongoing preventive chemotherapy. Most respondents (94.1%) said they would participate in a preventive chemotherapy again, while 0.4% was not sure. The majority of the respondents (86.6%) reported that integrated strategy is the most effective approach to control the three infections in the Island. Conclusion: The findings show a very high knowledge about these diseases. Although this study found majority of the respondents are aware of the co-infection of malaria, schistosomiasis and STH, their behaviors such as bathing in the lake exacerbates the problem.