Abstract
BackgroundThe Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015.Methodology/Principal findingsCross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14–2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01–1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67–2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40–3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread.Conclusions/SignificanceGiven its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes.
Highlights
Schistosomiasis is one of the most common parasitic diseases, with approximately 190 million people infected worldwide [1], causing over 100,000 deaths [2] and the loss of over 1.8 million disability-adjusted life years every year [3]
The study was conducted in Nampula province (Fig 1A), which records the highest provincial schistosomiasis prevalence figures in Mozambique, with around 78% of school-age children infected with S. haematobium [6]
As the study area shares many characteristics of predominantly rural, resource-poor areas in sub-Saharan Africa and our findings reflect those of other studies in similar settings, the results reported in this paper are thought to have wider applicability
Summary
Schistosomiasis is one of the most common parasitic diseases, with approximately 190 million people infected worldwide [1], causing over 100,000 deaths [2] and the loss of over 1.8 million disability-adjusted life years every year [3]. The cercariae go through several stages and eventually grow into adult worms, which live in infected people’s blood vessels. They undergo sexual reproduction, producing and releasing eggs into the lumen of the gut, bladder or urinary tract. The Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015
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