Abstract
Over 240 million people are infected with schistosomiasis, the majority in sub-Saharan Africa. In Uganda, high infection rates exist in communities on the shores of Lake Victoria. Praziquantel mass drug administration (MDA) delivered by village health teams is the mainstay of schistosomiasis control. However, treatment uptake remains suboptimal, with many people unaware of treatment or thinking it is only for children. Furthermore, people are often rapidly reinfected post-treatment due to continued exposure. In three Schistosoma mansoni high endemicity lake-shore communities in Mayuge district, Eastern Uganda, we investigated the sources of schistosomiasis information, remembered content of information, and the perception of information and related practices towards the control of schistosomiasis. Data were collected from September 2017 to March 2018 using a rapid ethnographic assessment that included transect walks, observations, individual in-depth interviews and focus group discussions. Data were analysed thematically using iterative categorisation. We found that the main sources of schistosomiasis information included health workers at government facilities, village health teams, teachers, and radio programmes produced by the Ministry of Health. These messages described the symptoms of schistosomiasis, but did not mention the side effects of praziquantel treatment. Despite this messaging, the main cause of the disease and transmission was unclear to most participants. The translation of schistosomiasis on the radio into the local language 'ekidada'-meaning swollen stomach-increased, rather than reduced, confusion about the cause(s) of schistosomiasis, due to believed links between ekidada and witchcraft, and prompted a reluctance to engage with treatment or preventative efforts. This study highlights gaps in schistosomiasis messaging. We recommend MDA is complemented by effective, evidence-based messaging on schistosomiasis transmission, prevention, and treatment, that is sensitive to local language and context issues, resulting in clear, concise, and consistent messages, to increase effectiveness.
Highlights
Schistosomiasis, commonly known in East Africa as Bilharzia, is a neglected tropical disease (NTD) caused by parasitic flatworms of the genus Schistosoma [1]
We found that the main sources of schistosomiasis information included health workers at government facilities, village health teams, teachers, and radio programmes produced by the Ministry of Health
In three heavily affected communities on the shores of Lake Victoria, we explored the sources of schistosomiasis information, how messages were relayed to community members, the remembered content of these messages and the way messages were perceived
Summary
Schistosomiasis, commonly known in East Africa as Bilharzia, is a neglected tropical disease (NTD) caused by parasitic flatworms of the genus Schistosoma [1]. In this paper we focus on intestinal schistosomiasis cause by Schistosoma mansoni, which is spread by parasite eggs excreted in stool from infected humans. The ongoing World Health Organization strategy for populations in endemic areas is to reduce morbidity, prevalence, and transmission through mass drug administration (MDA), with the anthelmintic praziquantel. Over 235 million people required praziquantel treatment in 2019, with 90% of those living in Africa [2]. Over 240 million people are infected with schistosomiasis, the majority in sub-Saharan Africa. Praziquantel mass drug administration (MDA) delivered by village health teams is the mainstay of schistosomiasis control. In three Schistosoma mansoni high endemicity lake-shore communities in Mayuge district, Eastern Uganda, we investigated the sources of schistosomiasis information, remembered content of information, and the perception of information and related practices towards the control of schistosomiasis
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