Abstract
Over the past decade, a significant reduction in the prevalence of schistosomiasis has been achieved, partially explained by the large-scale administration of praziquantel. Yet, the burden of schistosomiasis remains considerable, and factors influencing intervention coverage are important. This study aimed to deepen the understanding of low treatment coverage rates observed in two schistosomiasis-endemic villages in Côte d’Ivoire. The research was conducted in August 2015, in Moronou and Bigouin, two villages of Côte d’Ivoire that are endemic for Schistosoma haematobium and S. mansoni, respectively. After completion of a clinical trial, standard praziquantel treatment (single 40 mg/kg oral dose) was offered to all village inhabitants by community health workers using a house-to-house approach. Factors influencing treatment coverage were determined by a questionnaire survey, randomly selecting 405 individuals. The overall treatment coverage rate was only 47.6% (2730/5733) with considerable intervillage heterogeneity (27.7% in Bigouin (302/1091) versus 52.3% in Moronou (2428/4642)). Among the 200 individuals interviewed in Moronou, 50.0% were administered praziquantel, while only 19.5% of the 205 individuals interviewed in Bigouin received praziquantel. The main reasons for low treatment coverage were work-related (agricultural activities), the bitter taste of praziquantel and previous experiences with adverse events. The most suitable period for treatment campaigns was reported to be the dry season. More than three-quarter of the interviewees who had taken praziquantel (overall, 116/140; Moronou, 84/100; Bigouin, 32/40) declared that they would not participate in future treatments (p < 0.001). In order to enhance praziquantel treatment coverage, careful consideration should be given to attitudes and practices, such as prior or perceived adverse events and taste of praziquantel, and appropriate timing, harmonized with agricultural activities. Without such understanding, breaking the transmission of schistosomiasis remains a distant goal.
Highlights
Schistosomiasis is a widespread neglected tropical disease with a considerable public health impact
779 million people are at risk of schistosomiasis, more than 250 million people are infected with blood flukes of the genus Schistosoma, and the global burden in 2016 was estimated at 1.864 million disability-adjusted life years [1,2,3]
Moronou and Bigouin are highly endemic for Schistosoma haematobium and S. mansoni, respectively [12]
Summary
Schistosomiasis is a widespread neglected tropical disease with a considerable public health impact. There is growing evidence of a positive relationship between schistosome infections and subtle morbidity, including educational, learning and memory deficits [5]. The global strategy is morbidity control, emphasizing periodic administration of praziquantel to at-risk populations without prior diagnosis. This strategy is phrased ‘preventive chemotherapy’ with the declared aim to achieve at least 75% of treatment coverage among school-aged children in schistosome-endemic areas [6]. Efforts are underway to eliminate schistosomiasis as a public health problem by 2025 [7,8,9]. In order to reach this ambitious goal, treatment with praziquantel needs to be administered repetitively with high coverage, in concert with ancillary measures, such as water, sanitation and hygiene (WASH), information, education and communication (IEC) and snail control [10,11,12,13,14,15]
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