Increasing the reach: Involving local Muslim religious teachers in a behavioral intervention to eliminate urogenital schistosomiasis in Zanzibar

Mike Celone,Bobbie Person,Said M Ali,Jameelat H Lyimo,Ulfat A Mohammed,Alippo N Khamis,Yussra S Mohammed,Khalfan A Mohammed,David Rollinson,Stefanie Knopp

doi:10.1016/j.actatropica.2016.08.004

Abstract

In Zanzibar, United Republic of Tanzania, Madrassa schools are influential institutions, where children and adults can learn about the interpretation of the Koran. We aimed to explore the involvement of Madrassa teachers for behavior change interventions in a randomized operational research trial designed to investigate the impact of multiple approaches to eliminate urogenital schistosomiasis transmission from Zanzibar. Madrassa teachers performing in the 30 communities of the behavior change study arm were trained in new interactive and participatory teaching methods by the local behavioral team and provided with schistosomiasis-teaching tools for teaching about transmission and prevention in their Madrassa. In July 2014, in a qualitative research study, we conducted 25 semi-structured interviews with Madrassa teachers to find out how they perceived their involvement in interventions against schistosomiasis. In 2014, 5926 among the 8497 registered Madrassa students in 30 communities on Unguja and Pemba islands received health education and participated in interactive behavior change exercises about schistosomiasis. Madrassa teachers reported that they valued their inclusion in the study and the opportunity to educate their students about schistosomiasis transmission, prevention, and treatment. They also perceived personal and community benefits as a result of their training and strongly supported the inclusion of additional Madrassa teachers in future intervention activities. Madrassa teachers are influential in the Zanzibari society, and hence are important change agents within our community-level behavioral intervention. They might constitute an untapped resource that can help to expand and increase acceptance of and participation in schistosomiasis and other neglected tropical disease control activities in African Muslim communities.

Highlights

In 2011, the Zanzibar Elimination of Schistosomiasis Transmission (ZEST) alliance was formed with the aims to eliminate urogenital schistosomiasis as a public health problem from Pemba island and to interrupt transmission of urogenital schistosomiasis in Unguja island (Knopp et al, 2012)
With the support of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) a randomized operational research trial is being conducted in 45 administrative areas on Unguja and Pemba, respectively, from 2011 until 2017, to assess the effectiveness of three schistosomiasis control interventions: (i) mass drug administration (MDA) with praziquantel; (ii) MDA and snail control; and (iii) MDA and behavior change activities (Knopp et al, 2012, 2013a)
Similar to other health intervention studies including religious leaders (Prihartono et al, 1994; Mfaume et al, 1997; Kanoa et al, 2006; Hipple and Duff, 2010; Pach et al, 2013; Sarma and Oliveras, 2013), the emergent data from our study suggested that following behavior change trainings, Madrassa teachers perceived themselves as influential change agents and trusted sources of information for their students and other people in the community in the fight against schistosomiasis

Summary

Introduction

In 2011, the Zanzibar Elimination of Schistosomiasis Transmission (ZEST) alliance was formed with the aims to eliminate urogenital schistosomiasis as a public health problem from Pemba island and to interrupt transmission of urogenital schistosomiasis in Unguja island (Knopp et al, 2012). With the support of the Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) a randomized operational research trial is being conducted in 45 administrative areas (shehias) on Unguja and Pemba, respectively, from 2011 until 2017, to assess the effectiveness of three schistosomiasis control interventions: (i) mass drug administration (MDA) with praziquantel; (ii) MDA and snail control; and (iii) MDA and behavior change activities (Knopp et al, 2012, 2013a)

Objectives

Methods

Results

Discussion

Conclusion