Mayuge District Research Articles

Epidemiology of periportal fibrosis and relevance of current Schistosoma mansoni infection within the context of repeated mass drug administration in rural Uganda: a population-based, cross-sectional study

WHO guidelines for schistosomiasis-related morbidity control and elimination rely on current infection as a proxy indicator for morbidity. We evaluated these guidelines within the context of repeated mass drug administration and periportal fibrosis attributable to chronic intestinal schistosomiasis. We examined 1442households randomly sampled from 38villages in Buliisa, Pakwach, and Mayuge districts of Uganda within the SchistoTrack cohort. Periportal fibrosis was diagnosed in 2834individuals aged 5-90years using ultrasound and image patterns C-F from the Niamey protocol. Schistosoma mansoni status and intensity were diagnosed by Kato-Katz microscopy and point-of-care circulating cathodic antigen tests. Schistosome infection, co-infections, and comorbidities were examined as exposures for periportal fibrosis. Multivariable logistic regressions were run with SEs clustered by household. Between Jan 6and Feb 3, 2022, 342 (12·1%) of 2834 participants were diagnosed with periportal fibrosis. ByKato-Katz microscopy, 1229 (43·4%) of 2834participants were infected. 1863 (65·7%) of 2834participants had trace positive point-of-care circulating cathodic antigen tests, which was higher than prevalence by Kato-Katz microscopy, and 1158 (40·9%) of 2834participants had trace negative point-of-care circulating cathodic antigen tests. Individual schistosome status, intensity, and prevalence of heavy intensity infections of less than 1% and less than 5% were not correlated with periportal fibrosis likelihood or village prevalence. Periportal fibrosis likelihood linearly increased with age from age 5 years to age 25years, non-linearly increased from age 26 years to age 45years, attenuated or remained unchanged from age 46 years to age 60years, and steadily decreased past 60years of age. History of liver diseases, HIV, and ultrasound-detected chronic hepatitis or early cirrhosis-like disease were associated with more than two-times increased periportal fibrosis likelihood. WHO guidelines reliant on current schistosome status and intensity are uninformative for identifying probable cases or communities with periportal fibrosis. History of HIV and underlying chronic hepatitis or early cirrhosis-like disease are risk factors that could be investigated for periportal fibrosis surveillance and management. NDPH Pump Priming Fund, Wellcome Trust, John Fell Fund, Robertson Foundation, and UK Research and Innovation Engineering and Physical Sciences Research Council.

‘The National Health Insurance scheme would be good and beneficial but I don’t trust the system …’: a cross-sectional mixed-methods study assessing the awareness and perceptions towards Uganda’s proposed National Health Insurance scheme among informal sector workers in Iganga and Mayuge districts, Uganda

BackgroundMost low-income countries have prioritised implementing national health insurance schemes (NHIs) as a solution to reducing the high out-of-pocket expenditures on health and enhancing access to healthcare, especially among informal...

Factors associated with hookworm and Schistosoma mansoni infections among school-aged children in Mayuge district, Uganda

BackgroundHookworm infection and schistosomiasis are two of sub-Saharan Africa's most common neglected tropical diseases. An annual mass drug administration (MDA) program against schistosomiasis and soil-transmitted helminths (STHs), including hookworm, has been implemented in Mayuge district, Uganda, since 2003 to date. However, hookworm and schistosomiasis remain prevalent in Mayuge district. Understanding the factors that predispose children to these infections in the context of MDA could inform interventions to reduce prevalence in Uganda and similar settings.MethodThis cross-sectional study took place in 33 randomly selected primary schools in the Mayuge district from January to February 2022. Children in primary classes 4 or 5, in the selected schools provided single stool samples and completed questionnaires. Stool specimens were examined using the Kato-Katz method to determine the prevalence of hookworm and schistosomiasis. We performed univariable and multivariable logistic regression to assess the associations of each infection with potential risk factors.ResultA total of 1,617 students (mean age 12.1 years, 50.1% male) were enrolled. The prevalence of hookworm infection and schistosomiasis was 21.8% (95% confidence interval (CI): 19.8–23.9%) and 18.7% (95% CI: 16.8–20.7%), respectively. In multivariable analysis, longer water fetching time (over 30 min versus less than 30 min) and working daily in the soil were associated with increased odds of hookworm infection (adjusted odds ratio (AOR): 1.49, 95% CI: 1.13–1.96 and 1.37, 95% CI: 1.03–1.82, respectively). Higher odds of schistosomiasis were linked to proximity to water bodies within a one-hour walking distance (AOR: 1.84, 95% CI: 1.35–2.50), and not always washing hands before eating (AOR: 2.00, 95% CI: 1.50–2.67). Swimming, bathing, or washing in water bodies twice a week, compared to never, also increased schistosomiasis odds (AOR: 2.91, 95% CI: 1.66–5.13).ConclusionConsistent with the mechanisms of acquisition, hookworm infection increased with exposure to soil, and schistosomiasis increased with exposure to unclean water. Our findings highlight the importance of Water, Sanitation, and Hygiene programs and strategies aimed at reducing exposure within the framework of Neglected Tropical Disease elimination programs.

Mixed-methods community assessment of drowning and water safety knowledge and behaviours on Lake Victoria

BackgroundDrowning is a major cause of death in Uganda, especially among young adults with water-based occupations and livelihoods. Information about drowning and other water-related deaths and injuries is limited. To...

Agronomic Suitability for Oil Palm Growing in Uganda

The ever-increasing demand for vegetable oils with its products in Uganda, calls for new areas to be put under oil palm cultivation. A study was conducted to investigate the agronomic suitability of oil palm cultivation in six areas located within a 30 km radius off-shore, on the island and more than 30 km radius off-shore on the mainland. The experiment was superimposed on 45 × 45 m plots in oil palm adaptive trial plantations established in 2008 in Bugiri, Mayuge, Buvuma, Mukono, Kibaale and Masaka districts. The experiment was laid out in a randomized complete block design with three replications. Data on number of oil palm bunches, bunch weight and yield was collected while climatic data (rainfall, temperature, relative humidity and radiation) was acquired from meteorological stations near the experimental locations. Rainfall data analyzed and dry season duration suggested that Mayuge, Masaka, Mukono, Buvuma and Kibaale were moderately favorable for oil palm growing, while temperature and radiation data indicated that all study locations were suitable for oil palm growing. Furthermore, based on relative humidity, Buvuma, Mayuge and Bugiri were suitable for oil palm cultivation but Kibaale, Masaka and Mukono were moderately suitable. Oil palm yield varied significantly (P < 0.05) across locations. The yield was much greater in Mukono (17.7 t/ha/yr) followed by Buvuma (13.8 t/ha/yr) and Kibaale (12.9 t/ha/yr) then Mayuge (10.7 t/ha/yr), Bugiri (10.2 t/ha/yr), and Masaka (10.3 t/ha/yr). The significantly high yield of oil palm observed in Mukono was attributed to the high rainfall received in this location. Based on research findings, Mukono, Masaka, Bugiri, Buvuma, Kibaale and areas within the 30 km radius of Lake Victoria are agronomically suitable for oil palm cultivation.

Current Safety and Hygiene Practices and Trends in Primary Schools in the Midlands Province of Zimbabwe

The study sought to establish the influence of structured classroom debates on the proficiency of the English language among pupils in selected public primary schools in Mayuge District. A cross-sectional design was used to conduct a study about debate and proficiency in English. The researcher prepared a set of structured questions for teachers in public primary schools. The interview guided interactions between the researcher and each head teacher. Four interview sessions, each not exceeding one hour per primary school, were held with each head teacher. Head teachers were asked to provide documented information about pupil performance. A focus discussion guide was prepared in line with the specific objectives of the study and used to obtain findings from learners. A strong positive statistically significant relationship (r =.478**; P =.000) exists between structured class debating and proficiency in English for primary school pupils in Mayuge District. This find.ing suggests that engaging primary school pupils in structured class debating activities can significantly improve their proficiency in English. The correlation coefficient of 0.478 indicates a moderate strength of the relationship, while the p-value of 0.000 indicates a high level of statistical significance. Therefore, it can be concluded that incorporating debate exercises into the curriculum can be an effective strategy for enhancing English language skills among primary school pupils in Mayuge District. To enhance the influence of structured classroom debating on English proficiency among pupils: Teachers can provide a diverse range of debate topics that cater to different interests and levels of language proficiency

Acceptability of Integrated Community-Based HIV and Cervical Cancer Screening in Mayuge District, Uganda.

To assess the acceptability of integrated screening for cervical cancer and HIV in the community setting. We developed surveys for patients and community health workers (CHWs) who participated in the Advances in Screening and Prevention in Reproductive Cancers (ASPIRE) Mayuge trial that compared self-collected human papillomavirus testing at home versus community health meetings in Mayuge district, Uganda. Quantitative data were summarized using descriptive statistics. Open-ended questions were analyzed using an inductive approach with thematic content analysis. We conducted 102 patient surveys and 31 CHW surveys between June and August 2021. Ninety-nine percent of patients and 100% of CHWs indicated that they would find the addition of an HIV test to their self-collected cervical cancer test acceptable. The most frequently stated reasons in favor of adding an HIV test to the ASPIRE Mayuge cervical cancer screening pathways were time-saving, privacy, and support from other women and CHWs. The most frequently stated reasons against integrated screening were related to concerns about confidentiality, most often in reference to women's family members and other women in their village. Integrated community-based cervical cancer and HIV testing would be highly acceptable to both women and CHWs.

Re-Examining the Factors Influencing the Adoption of ICT for Agricultural Information Dissemination in Uganda (Rubanda, Mayuge Districts and Mbarara City)

Re-Examining the Factors Influencing the Adoption of ICT for Agricultural Information Dissemination in Uganda (Rubanda, Mayuge Districts and Mbarara City)

LOCAL GOVERNMENT PAYROLL MANAGEMENT INFORMATION SYSTEM MODEL: A CASE OF MAYUGE DISTRICT

: Globally employers are struggling to maintain effective and efficient payroll and protect employee data, their organisations against fraud through the use of information communication technology (ICT). The aim of the research was to identify the key elements of an effective integrated personnel and payroll system (IPPS) that would aid in the development of improved model for payroll management in the local government and specifically Mayuge district. This research employed design science approach in the methodology which was deemed appropriate since the end result was to develop an artifact or a model. The findings brought out several elements amongst which include payroll, time and attendance management, employee data management, recruitment, selection, learning management, training system, performance management, employee self-service and leave management, furthermore the research discovered that the existing system was prone to manipulation at several points and there is need to develop a model to eliminate the anomalies. In conclusion there is need to improve on the IPPS in order to curb on the fraudulent activities within the payroll. Finally all districts across Uganda specifically the Chief Administrative Officers (COAs) must check and monitor their payroll systems and the ministry of local government the findings of this research to reduce financial loss by the government through fraudulent acts.

Influence of Managerial Technical Competences on Performance of Teachers in Public Primary Schools

This study investigated the influence of managerial competencies and performance of teachers in upper primary in selected public schools in Mayuge District. The study used a descriptive cross-sectional survey design to examine the relationship between managerial competences and teacher performance. A sample of 92 respondents was categorized as school managers, head teachers, teachers, and management committee members. The study used simple random techniques and purposive sampling techniques. The study analyzed quantitative data collected using structured, closed-ended items in questionnaires and coded using a five-point Linkert response scale. Raw data was analyzed using descriptive statistics and Pearson product moment correlation to determine the influence of managerial competences on the performance of teachers. The study found out that managers' managerial competencies play a role in influencing the performance of teachers in public primary schools. Level of education, professional qualification of head teachers, and managerial human relations competencies all influence performance. The study concluded that poor managerial technical competences affect the performance of teachers in a negatively in form of less preparation of schemes of work and lesson planning, not following the timetable, and many others. The study recommended that there is need to encourage professional growth and training in both managerial technical competences and human relations competences in order to improve the performance of teachers in the schools. The study further recommended that for Managerial competences and performance of teachers to be effective in upper primary schools, head teachers should continue to motivate their teachers to improve on their performance, the school should hire external expertise that can facilitate professional development experiences and external expertise.

Re-examining the factors influencing the adoption of ICT for agricultural information dissemination in Uganda (Rubanda, Mayuge districts, and Mbarara city)

Re-examining the factors influencing the adoption of ICT for agricultural information dissemination in Uganda (Rubanda, Mayuge districts, and Mbarara city)

Extent, levels and suitability of ICT usage for agricultural information dissemination in Uganda: A case of Rubanda, Mayuge districts, and Mbarara city

Extent, levels and suitability of ICT usage for agricultural information dissemination in Uganda: A case of Rubanda, Mayuge districts, and Mbarara city

Factors related to teenage pregnancy during the COVID-19 pandemic: a case of selected villages in Mayuge District, Eastern Uganda

Factors related to teenage pregnancy during the COVID-19 pandemic: a case of selected villages in Mayuge District, Eastern Uganda

Understanding perceptions of schistosomiasis and its control among highly endemic lakeshore communities in Mayuge, Uganda.

Schistosomiasis is a neglected tropical disease and a serious global-health problem with over 230 million people requiring treatment, of which the majority live in Africa. In Uganda, over 4 million people are infected. Extensive parasitological data exist on infection prevalence, intensities and the impact of repeated praziquantel mass drug administration (MDA). However, how perceptions of schistosomiasis shape prevention and treatment practices and their implications for control measures are much less well understood. Rapid ethnographic appraisals were performed for six weeks in each of three Schistosoma mansoni high endemicity communities on the shores of Lake Victoria, Mayuge District, Uganda. Data were collected between September 2017 and April 2018. Data were collected through structured observations, transect walks, and participant observation, and sixty in-depth interviews and 19 focus group discussions with purposively recruited participants. Data were analyzed thematically using iterative categorization, looking at five key areas: perceptions of 1) the symptoms of schistosomiasis; 2) the treatment of schistosomiasis; 3) how schistosomiasis is contracted; 4) how schistosomiasis is transmitted onwards and responsibilities associated with this; and 5) how people can prevent infection and/or onward transmission. Observations revealed open defecation is a common practice in all communities, low latrine coverage compared to the population, and all communities largely depend on lake water and contact it on a daily basis. Perceptions that a swollen stomach was a sign/symptom of 'ekidada' (caused by witchcraft) resulted in some people rejecting free praziquantel in favour of herbal treatment from traditional healers at a fee. Others rejected praziquantel because of its perceived side effects. People who perceived that schistosomiasis is caught from drinking unboiled lake water did not seek to minimize skin contact with infected water sources. Community members had varied perceptions about how one can catch and transmit schistosomiasis and these perceptions affect prevention and treatment practices. Open defecation and urinating in the lake were considered the main route of transmission, all communities attributed blame for transmission to the fishermen which was acknowledged by some fishermen. And, lastly, schistosomiasis was considered hard to prevent due to lack of access to safe water. Despite over 15 years of MDA and associated education, common misconceptions surrounding schistosomiasis exist. Perceptions people have about schistosomiasis profoundly shape not only prevention but also treatment practices, greatly reducing intervention uptake. Therefore, we advocate for a contextualized health education programme, alongside MDA, implementation of improved access to safe-water and sanitation and continued research.

Information Communication Technology Devices for Agricultural Information Dissemination among Smallholder Farmers in Uganda (Rubanda, Mayuge Districts, and Mbarara City)

Agriculture continues to be the main source of livelihood in developing countries and smallholder farming is the most common type of agriculture practice supporting more than 70% of the population. On the other hand, information and communication technology (ICT) is quickly growing as its helping to connect easier and faster; thus, a dire need to harness it in promoting the agricultural sector. This study investigated the Information Communication Technology Devices for Agricultural Information Dissemination among Smallholder Farmers in Uganda (Rubanda, Mayuge Districts, And Mbarara City). The study adopted a cross-sectional research design that comprised a mixed methods approach of quantitative and qualitative. The instrument for this study consisted of structured questionnaires and interviews. More so, available reports and records were explored. The questionnaire was subjected to face and content validity and reliability test. Data collected were analysed using descriptive statistics of frequency counts and percentages. Findings show that the leading types of ICT devices for agricultural information dissemination in Rubanda District, Mayuge District, and Mbarara City were mobile phones and radios. The study recommends that the most important information to farmers should always be disseminated via phone conversation, texting, and radio for broadcast agricultural-related programs in respective local languages

An evaluation of a peer supervision pilot project among community health workers in rural Uganda

Living Goods operates a Community Health Worker (CHW) program in 19 districts of Uganda, where CHWs are supervised by full time Community Health Supervisors. This model is effective, but expensive. Evidence indicates that peer supervision can be a substitute and cheaper model for CHW supervision. We describe our experience and outcomes while implementing peer supervision among CHWs in Mayuge district. 1. To compare health services delivery outcomes between the two supervision models. 2. To compare costs of the two supervision models.. Internal organizational records from January to December 2019 were reviewed. Focus group discussions and in-depth interviews with participating CHWs were also conducted. Qualitative analysis was performed using thematic content analysis. Quantitative data was summarized to generate averages, percentages and graphs. CHWs under the peer supervision performed better than those under standard supervision against all key performance indicators. The total cost to maintain the peer supervision model for 1 year was USD $176 per CHW versus USD $273 among CHWs under the standard supervision model. Peer supervision thus resulted in overall cost savings of 36%. There was lower attrition among CHWs under peer supervision compared to standard supervision (10% versus 17%). Peer supervision is a feasible and more affordable model of supervising CHWs.

Farmer-led protected zero-grazed dairy cattle initiative in tsetse-infested areas of Southeast Uganda

A farmer-led protected zero-grazed dairy cattle initiative, involving pyrethroid treated netting around zero-grazing cowsheds, was implemented over a four-year period in tsetse-infested areas of Southeast Uganda. The pyrethroid treated netting was intended to prevent dairy cattle against tsetse bites and consequently transmission of trypanosomosis, while boosting milk production as an economic venture. A longitudinal study was conducted in six districts, including Budaka, Busia, Iganga, Manafwa, Mayuge and Tororo, during which a total of 184 protected zero-grazing units holding 289 dairy cattle were visited five times. The prevalence of trypanosomosis, mortality, mean packed cell volume (PCV), status of netting, spraying practices, and pasture and legume feed status, cowshed hygiene status, and milk yield were monitored. The findings revealed low prevalence of trypanosomosis among dairy cattle (1.0-5.5%), due to Trypanosoma brucei (0.0-0.4%), Trypanosoma congolense (0.0-0.7%) and Trypanosoma vivax (0.4-3.4%) infections. Only 25 adult cattle and 40 calves were reported dead. Dairy cattle had good health, given high mean PCV values (27.7 - 30.6). 99.2% and 100.0% of the zero-grazing units had lost netting by visit IV and V, respectively. By the second to the fourth year, prevention of dairy cattle from tsetse or tick bites hugely relied on spraying because all zero-grazing units had lost netting. Dual tsetse and tick control was practised by 66.9% of the 184 zero-grazing units, while only 33.1% of the units applied tick-selective control. Correct spraying intervals were observed by 57.8% of the zero-grazing units. Most zero-grazing units (range 67.9-97.5%) had sufficient pasture, while few units (range 17.9-34.8%) had sufficient legumes. Poorest cowshed hygiene was observed in zero-grazing units in Budaka district (93.1%), followed by Busia district (33.3%), Iganga district (31.1%), Mayuge district (12.1%), Tororo district (10.0%) and Manafwa district (6.3%).The best average milk yield per cow per day was registered in Iganga district (6.2 L-8.7 L), followed by Mayuge district (4.5 L- 8.2 L), Manafwa district (4.5 L-6.2 L), Busia district (4.0 L-6.3 L), Tororo district (3.3 L-6.7 L), and Budaka district (3.7 L-6.0 L). Overall average milk yield per cow per day of 5.0 L to 6.4 L across visits with a minimum of 0.5 L and maximum of 19.0 L per cow per day were achieved. In conclusion, pyrethroid treated netting around zero-grazing units supplemented with spraying of cattle effectively protected dairy cattle against trypanosomosis and maintained their good health. However, farmers’ observation indicated that as netting became older, it became more fragile. Larger nets of 1.5 m high had a longer duration of 6 to 8 months than smaller nets of 1.0 m high (shorter duration of 3 to 4 months). Replacement of netting for all zero-grazing units was desirable after the first year of installation, however, farmers could not afford the cost of 100,000 Uganda shillings (approx. USD 30) per zero-grazing unit.

Understanding Factors That Support Community Health Worker Motivation, Job Satisfaction, and Performance in Three Ugandan Districts: Opportunities for Strengthening Uganda's Community Health Worker Program.

Uganda's community health worker (CHW) program experiences several challenges related to the appropriate motivation, job satisfaction, and performance of the CHW workforce. This study aims to identify barriers in the effective implementation of financial and non-financial incentives to support CHWs and to strengthen Uganda's CHW program. The study was implemented in Uganda's Lira, Wakiso, and Mayuge districts in May 2019. Ten focus group discussions (FGDs) were held with 91 CHWs, 17 in-depth interviews (IDIs) were held with CHW supervisors, and 7 IDIs were held with policy-level stakeholders. Participants included stakeholders from both the Ugandan government and non-governmental organizations (NGOs). Utilizing a thematic approach, themes around motivation, job satisfaction, incentive preferences, and CHW relationships with the community, healthcare facilities, and government were analyzed. CHWs identified a range of factors that contributed to their motivation or demotivation. Non-monetary factors included recognition from the health system and community, access to transportation, methods for identification as a healthcare worker, provision of working tools, and training opportunities. Monetary factors included access to monthly stipends, transportation-related refunds, and timely payment systems to reduce refund delays to CHWs. Additionally, CHWs indicated wanting to be considered for recruitment into the now-halted rollout of a salaried CHW cadre, given the provision of payment. It is imperative to consider how to best support the current CHW program prior to the introduction of new cadres, as it can serve to exacerbate tensions between cadres and further undermine provision of community health. Providing a harmonized, balanced, and uniform combination of both monetary incentives with non-monetary incentives is vital for effective CHW programs.

Reporting of sexual and gender-based violence and associated factors among survivors in Mayuge, Uganda.

Reporting of Sexual and Gender-Based Violence (SGBV) allows survivors to access support services to minimize the impact of the violence on their lives. However, research shows that most SGBV survivors do not report. We aimed to determine the proportion of survivors of SGBV in Mayuge District, Uganda, who report SGBV and the factors associated with reporting. Using a cross-sectional study design, we analyzed data of SGBV survivors in eight villages in Mayuge district collected in a baseline survey of a larger experimental study. Data were analysed using Modified Poisson Regression. Of the 723 participants, 65% were female. Only 31.9% had reported the SGBV experienced. Reporting was 43% lower among survivors aged 45 years and older (p-value = 0.003), and 41% lower among survivors with higher than a primary school education (p-value = 0.005). Likewise, reporting was 37% lower among survivors who relied on financial support from their partners (p-value = 0.001). Female survivors were also 63% more likely to report (p-value = 0.001), while survivors who were separated/widowed were 185% more likely to report than those who were never married (p-value = 0.006). Reporting of SGBV by survivors in Mayuge was found to below.

Variation in water contact behaviour and risk of Schistosoma mansoni (re)infection among Ugandan school-aged children in an area with persistent high endemicity

BackgroundAnnual mass drug administration with praziquantel has reduced schistosomiasis transmission in some highly endemic areas, but areas with persistent high endemicity have been identified across sub-Saharan Africa, including Uganda. In these areas many children are rapidly reinfected post treatment, while some children remain uninfected or have low-intensity infections. The aim of this mixed-methods study was to better understand variation in water contact locations, behaviours and infection risk in school-aged children within an area with persistent high endemicity to inform additional control efforts.MethodsData were collected in Bugoto, Mayuge District, Uganda. Two risk groups were identified from a longitudinal cohort, and eight children with no/low-intensity infections and eight children with reinfections were recruited. Individual structured day-long observations with a focus on water contact were conducted over two periods in 2018. In all identified water contact sites, four snail surveys were conducted quarterly over 1 year. All observed Biomphalaria snails were collected, counted and monitored in the laboratory for Schistosoma mansoni cercarial shedding for 3 weeks.ResultsChildren came into contact with water for a range of purposes, either directly at the water sources or by coming into contact with water collected previously. Although some water contact practices were similar between the risk groups, only children with reinfection were observed fetching water for commercial purposes and swimming in water sources; this latter group of children also came into contact with water at a larger variety and number of sites compared to children with no/low-intensity infection. Households with children with no/low-intensity infections collected rainwater more often. Water contact was observed at 10 sites throughout the study, and a total of 9457 Biomphalaria snails were collected from these sites over four sampling periods. Four lake sites had a significantly higher Biomphalaria choanomphala abundance, and reinfected children came into contact with water at these sites more often than children with no/low-intensity infections. While only six snails shed cercariae, four were from sites only contacted by reinfected children.ConclusionsChildren with reinfection have more high-risk water contact behaviours and accessed water sites with higher B. choanomphala abundance, demonstrating that specific water contact behaviours interact with environmental features to explain variation in risk within areas with persistent high endemicity. Targeted behaviour change, vector control and safe water supplies could reduce reinfection in school-aged children in these settings.Graphical