Knowledge, attitudes and practices related to schistosomiasis transmission and control in Leyte, Philippines

Socio-economic risk factors for intestinal helminthiases in selected endemic communities in Mindanao, the Philippines: a cross-sectional study

BACKGROUND

Parasitic neglected tropical diseases (NTDs) or 'infectious diseases of poverty' continue to affect the poorest communities in the world, including in the Philippines. Socio-economic conditions contribute to persisting endemicity of these infectious diseases. As such, examining these underlying factors may help identify gaps in implementation of control programs. This study aimed to determine the prevalence of schistosomiasis and soil-transmitted helminthiasis (STH) and investigate the role of socio-economic and risk factors in the persistence of these diseases in endemic communities in the Philippines.

METHODS

This cross-sectional study involving a total of 1,152 individuals from 386 randomly-selected households was conducted in eight municipalities in Mindanao, the Philippines. Participants were asked to submit fecal samples which were processed using the Kato-Katz technique to check for intestinal helminthiases. Moreover, each household head participated in a questionnaire survey investigating household conditions and knowledge, attitude, and practices related to intestinal helminthiases. Associations between questionnaire responses and intestinal helminth infection were assessed.

RESULTS

Results demonstrated an overall schistosomiasis prevalence of 5.7% and soil-transmitted helminthiasis prevalence of 18.8% in the study population. Further, the household questionnaire revealed high awareness of intestinal helminthiases, but lower understanding of routes of transmission. Potentially risky behaviors such as walking outside barefoot and bathing in rivers were common. There was a strong association between municipality and prevalence of helminth infection. Educational attainment and higher "practice" scores (relating to practices which are effective in controlling intestinal helminths) were inversely associated with soil-transmitted helminth infection.

CONCLUSION

Results of the study showed remaining high endemicity of intestinal helminthiases in the area despite ongoing control programs. Poor socio-economic conditions and low awareness about how intestinal helminthiases are transmitted may be among the factors hindering success of intestinal helminth control programs in the provinces of Agusan del Sur and Surigao del Norte. Addressing these sustainability gaps could contribute to the success of alleviating the burden of intestinal helminthiases in endemic areas.

Pseudotumoral Encephalic Schistosomiasis: A Literature Review

Pseudotumoral encephalic schistosomiasis (PES) is the chronic form of cerebral neuroschistosomiasis, and is rarely encountered in clinical practice. Clinically, PES closely resembles other intracranial space-occupying lesions including brain tumors. Laboratory investigations are usually inconclusive, and neuroradiologic findings are frequently reported as non-specific. Such diagnostic difficulties may result in delayed diagnosis and treatment. Across the literature, there is a paucity of information about and controversy over many aspects of the disease. Particularly, inconsistent magnetic resonance imaging (MRI) findings, a wide variation of medical treatment protocols, lacking consensus regarding the indications of surgery, and undetermined information regarding the impact of the extent of resection on prognosis. We herein review the pertinent literature with the aim of providing focused information regarding the pathogenesis of PES, its currently identified more distinctive neuroimaging features, and the indications and extent of surgery in light of the state-of-the-art operative neurosurgical practice. A distinctive multinodular arborizing pattern of PES lesions can often be observed on MRI in patients with PES. Praziquantel is considered by many authors to be the drug of choice in all cases, and seems to be effective at variable dose regimens. Although lesion excision utilizing current technology is generally safe, the indications and extent of surgery are still undetermined and should be decided on a case-by-case basis. Multicenter collaborative research is further needed to fill the existing gaps in the current knowledge on PES.

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.

MaxEnt modeling of the potential risk of schistosomiasis in the Philippines using bioclimatic factors

Schistosomiasis is a parasitic infection caused by Schistosoma japonicum. It remains a principal local health issue in the Philippines, demonstrating endemicity in 28 provinces and afflicting thousands of Filipino individuals annually. Despite this, no clear distribution maps for the disease have been comprehensively reported. Therefore, species distribution modeling (SDM) employing the MaxEnt algorithm and GIS application techniques was utilized to denote the potential risk of schistosomiasis in the country. With a high AUC score of 0.846, the SDM yielded a favorable and reliable correlative map illustrating a predicted schistosomal temporal distribution concentrated primarily on the country's eastern portion with a more pronounced wet than dry season. The precipitation of the driest quarter was determined to be the most significant contributing factor among the bioclimatic variables evaluated. This suggests a possible increase in adaptations concerning the rainfall and thermal tolerances of the parasites' vectors. Moreover, socioeconomic status between Philippine regions revealed an inverse proportion with the number of schistosomiasis cases. This study also discussed the potential role of climate change on the range shifts and the potential risk of parasite infection in the Philippines.

Knowledge, attitudes, practices, and beliefs regarding prenatal alcohol consumption among women in Leyte, the Philippines

Objectives

Fetal alcohol spectrum disorder (FASD) captures the broad range of emotional, cognitive, behavioral, and congenital abnormalities associated with maternal alcohol consumption, and women living in resource-limited settings may be higher risk. This study aims to examine knowledge, attitudes, practices, and beliefs (KAPB) of women in Leyte, The Philippines regarding prenatal alcohol consumption.

Methods

One hundred postpartum women were recruited from a birth cohort in Leyte. A prenatal alcohol use KAPB survey was constructed in Waray, the local language. The survey was administered in June-September 2019. Descriptive statistics, chi-squared test, and Fisher's exact test were used to analyze responses.

Results

Seventy-five percent of subjects reported drinking tuba, a local palm wine, during pregnancy. Most participants (75%) did not believe tuba contained alcohol. Women who believed tuba contains no alcohol were more likely to drink tuba during pregnancy (81.3%) than women who believed tuba contains alcohol (56.0%), X2(1, N = 100) = 6.41, p = .011. Women who drank tuba during pregnancy were more likely to believe tuba has health benefits (60%) than women who did not drink tuba during pregnancy (12%), Fisher's exact p < .05, citing increased red blood cell count and unproven antiparasitic qualities. Fifteen percent of subjects reported having fed their babies tuba. Nearly all (98%) were willing to attenuate tuba/alcohol consumption if told that this practice negatively impacts pregnancies.

Conclusion

Misinformation about tuba appears widespread in Leyte. Educating women of reproductive age in Leyte regarding prenatal tuba use may lead to a reduction in tuba use.

Urinogenital schistosomiasis knowledge, attitude, practices, and its clinical correlates among communities along water bodies in the Kwahu Afram Plains North District, Ghana

BACKGROUND

Adequate knowledge and proper practices coupled with knowledge of the burden of disease are necessary for the eradication of Schistosoma infection. This study assessed knowledge, attitude, and practice (KAP) as well as health outcomes related to Schistosoma haematobium infection at Kwahu Afram Plains North District (KAPND).

METHODS

A cross-sectional survey using a structured questionnaire was carried out among 140 participants from four local communities in KAPND in August 2021. From these participants, 10ml of urine was collected for determination of the presence of S. haematobium and urine routine examination. In addition, 4ml of blood was collected and used for haematological examination. Descriptive statistics and logistic regression analysis using IBM SPSS were used to describe and represent the data collected.

RESULTS

The study reports a gap in knowledge about schistosomiasis in the study area with the majority indicating that they have not heard of schistosomiasis (60.7%), do not know the mode of transmission (49.3%), and do not know how the disease could be spread (51.5%). The overall prevalence of urinary schistosomiasis was 52.9%. This was associated with age, occupation, perceived mode of Schistosoma transmission, knowledge of Schistosoma prevention, awareness that schistosomiasis can be treated, frequency of visits to water bodies, and water usage patterns. In multivariate analysis, factors that remained significantly associated with S. haematobium infection were age 21-40 (OR  =  0.21, 95% CI: 0.06-0.76), 41-60 (OR  =  0.01, 95% CI: 0.01-0.52) and ≥ 60 (OR  =  0.02, 95% CI: 0.02-0.87), informal employment (OR  =  0.01, 95% CI: 0.01-0.69) and awareness of transmission by drinking water from river body (OR  =  0.03, 95% CI: 0.03-0.92). In Schistosoma infection, reduced haemoglobin, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, lymphocytes and eosinophils were observed. White blood cells, neutrophils, and monocytes were significantly elevated in infected states. Urine analysis revealed high pus cells and red blood cells counts among Schistosoma-positive participants.

CONCLUSION

Schistosoma infection is endemic among inhabitants in KAPND, and is associated with a gap in knowledge, awareness, and practice possibly due to inadequate education in the area. Poor clinical outcomes associated with Schistosoma infection have been demonstrated in the area. A well-structured public education, nutritional intervention, and mass drug administration will be necessary to eradicate this menace.

Critical medical ecology and intersectionality perspectives in schistosomiasis prevention and control in selected communities in Mindanao, the Philippines

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.

Knowledge, Attitude and Practices towards the Prevention of Schistosomiasis Mansoni in an Endemic Area of Alagoas, Northeast Brazil

We analyzed the knowledge, attitudes and practices (KAP) of schistosomiasis mansoni prevention in an endemic area of Brazil. This cross-sectional study was conducted between March and May 2021, with 412 participants living in the municipality of Feira Grande, Alagoas, Brazil. Data collection occurred through visits to the Health Center Urbano II and Massapê, through an interview with a structured questionnaire to identify the levels of KAP regarding schistosomiasis prevention. Of all respondents, 70.87% lived in rural areas, 22.66% reported a history of past schistosomiasis and 52.71% never participated in schistosomiasis control program actions. Factors associated with better KAP scores were being part of an older age group, not using rainwater and having no history of past schistosomiasis. Specifically, among the domains, attitude was the highest score and knowledge was the lowest. Participation in a health intervention program, knowing someone who had schistosomiasis and having been informed through a public health program seemed to have an important impact on the population's KAP. Our results contributed to broadening perceptions about schistosomiasis prevention, highlighting the positive impacts that health programs and interventions have on disease control.

Knowledge, attitudes and practices related to neglected tropical diseases (schistosomiasis and fascioliasis) of public health importance: A cross-sectional study

Background

Snails play an important role as an intermediate host in various parasitic diseases, which are referred to as snail-borne parasitic diseases (SBPDs). The prevalence of the SBPDs, schistosomiasis and fascioliasis is low in Pakistan compared to other countries. The present study investigated knowledge, attitudes, and practices related to these two SPBDs and risk factors associated with them among the humans living in close contact with livestock and pets from three regions of Pakistan: Punjab, Islamabad and Azad Jammu and Kashmir (AJK).

Methods

A cross-sectional survey was conducted using a structured questionnaire to assess participants' knowledge, attitude and practices related to schistosomiasis and fascioliasis during 2021-2022.

Results

The majority of the 507 participants who were interviewed had good knowledge of schistosomiasis and fascioliasis: 43% were aware of schistosomiasis and 57% were aware of fascioliasis, but only 25% knew about snails as an intermediate host. Most respondents had a positive attitude toward treatment, prevention and control of the diseases but they did not have any healthcare facilities.

Conclusion

This study highlights the importance of the public's awareness for the need to control SBPDs. It also draws attention to the need for health education for risk reduction and the prevention of SBPDs in endemic areas.

The status of schistosomiasis japonica control in the Philippines: The need for an integrated approach to address a multidimensional problem

Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Adequate and updated information is essential to enhance policy and service delivery toward control and elimination. Despite the efforts on schistosomiasis control in the Philippines, some challenges remain in these dimensions. An integrated surveillance system is recommended to determine the prevalence of infection in humans, animal reservoirs, and snail intermediate hosts, allowing the identification of high-priority areas for targeted interventions. This will entail the enhancement of laboratory diagnosis capacity through the use of more sensitive techniques, complemented by capacity building of concerned human and animal health professionals. Given the zoonotic nature of schistosomiasis japonica, adopting the One Health approach is essential to influence policies and interventions that may accelerate control and elimination. This can be achieved through the attainment of mass drug administration coverage targets and intensified case finding and management, robust implementation and integration of veterinary public health activities, the conduct of snail control measures, provision of safe water, sanitation, and hygiene services, and health promotion and education into the national schistosomiasis control and elimination program. This review aimed to describe the status of schistosomiasis japonica control in the Philippines in the context of human health, animal health, vector ecology and management, environmental health, and sociocultural dimensions.

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.

Knowledge, attitudes and practices pertaining to urogenital schistosomiasis in Lambaréné and surrounding areas, Gabon

Background

Control of schistosomiasis remains a priority in endemic areas. Local epidemiological data are necessary for a tailored control programme, including data on population behaviour in relation to the disease. The objective of this study was to assess schistosomiasis-related knowledge, attitudes and practices in the general population of Lambaréné, a small city in Gabon, in order to optimise the design and implementation of a local control programme that is tailored to need.

Methods

The study was cross-sectional in nature. Eligible adults and children living in the study area who volunteered (with informed consent) to participate in the study were interviewed using standardised questionnaires, one of which was a simplified version of the primary questionnaire for participants aged 6–13 years. Data on the participants’ knowledge, attitudes and practices that enhance the risk for contracting schistosomiasis were collected.

Results

A total of 602 participants were included. The mean (± standard deviation) age was 21.2 (± 15.0) years, the female:male gender ratio was 1.6 and 289 (48%) participants completed the simplified version the questionnaire. Of the 602 participants, 554 (92%) reported past or current contact with freshwater, 218 (36%) reported a history of a diagnosis of schistosomiasis and 193 (32%) reported past intake of praziquantel medication. The overall levels of knowledge and adequate attitudes toward schistosomiasis among young adults and adults were 68 and 73%, respectively. The proportion of participants pursuing risk-enhancing practices (REP) was 60% among the whole study population. Location was significantly associated with differences in knowledge and REP levels. A history of confirmed schistosomiasis and larger family size were significantly associated with an increase in good knowledge and REP levels. However, the indication of freshwater-associated activities was only associated with a significant increase in the REP level.

Conclusions

The results of this survey reveal a high level of population exposure to schistosomiasis, which is in line with known prevalence of schistosomiasis in Lambaréné and its surroundings. The local population has a reasonable level of knowledge of and adequate attitudes toward schistosomiasis but the level of REP is high, particularly in areas where piped water is absent. In terms of interventions, improving hygiene should have the highest priority, but in a context where provision of safe water is difficult to achieve, the effectiveness of praziquantel treatment and the education of at-risk populations on the need for protective behaviours should be a prominent feature of any local control programme.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s13071-021-04905-0.