A mixed-methods approach to understanding water use and water infrastructure in a schistosomiasis-endemic community: case study of Asamama, Ghana

Abstract

BackgroundSurface water contaminated with human waste may transmit urogenital schistosomiasis (UGS). Water-related activities that allow skin exposure place people at risk, but public health practitioners know little about why some communities with access to improved water infrastructure have substantial surface water contact with infectious water bodies. Community-based mixed-methods research can provide critical information about water use and water infrastructure improvements.MethodsOur mixed-methods study assessed the context of water use in a rural community endemic for schistosomiasis.ResultsEighty-seven (35.2 %) households reported using river water but not borehole water; 26 (10.5 %) reported using borehole water but not river water; and 133 (53.8 %) households reported using both water sources. All households are within 1 km of borehole wells, but tested water quality was poor in most wells. Schistosomiasis is perceived by study households (89.3 %) to be a widespread problem in the community, but perceived schistosomiasis risk fails to deter households from river water usage. Hematuria prevalence among schoolchildren does not differ by household water use preference. Focus group data provides context for water preferences. Demand for improvements to water infrastructure was a persistent theme; however, roles and responsibilities with respect to addressing community water and health concerns are ill-defined.ConclusionsCollectively, our study illustrates how complex attitudes towards water resources can affect which methods will be appropriate to address schistosomiasis.

Schistosoma haematobium co-infection with soil-transmitted helminthes: prevalence and risk factors from two communities in the central region of Ghana

“…[1,2] It afflicts millions in endemic regions of SubSaharan Africa, parts of Asia, and South America, precipitating abject poverty in these already disadvantaged regions. Aside malaria, schistosomiasis is the second parasitic disease accounting for significant morbidity and mortality in endemic areas.…”

“…[8][9][10] Open defecation in water sources may also increase the risk of infections. [1] Annually, 150, 000 deaths attributable to chronic S. haematobium infection are recorded in Sub-Saharan Africa. [11,12] Also, decreased haemoglobin (Hb) in stunted children in a study in Ghana was linked to S. haematobium infection.…”

“…[19] In Ghana, efforts have been made in terms of community education, awareness on schistosomiasis, research (prevalence, diagnosis, risk factors, risk groups, and treatment), and national integrative control initiatives with regard to fight against schistosomiasis. [1,6,7,13,19] Nonetheless, the coverage with specific reference to the above efforts in some communities which hitherto were not prone to risk of S. haematobium infection but have now become high risk communities due to recent human and developmental activities remains poorly investigated. Putubiw and Apewosika are two communities located near the water catchment area (Birimsu water Dam), which treats and supply potable water to the inhabitants of Cape Coast Municipality and its environs.…”

Indicators of improved water access in the context of schistosomiasis transmission in rural Eastern Region, Ghana

“…Distance, water quality, and price of water are known to influence water use patterns and health benefits offered by improved water sources (Cairncross, 1987; DeGabriele, 2002; Fuest, 2005; Howard & Bartram 2003; Rogers et al, 2002; Overbo et al, 2016; Pickering & Davis, 2012). Households that self–report using an improved water source for the JMP indicator may still extensively rely on unimproved water sources, especially when the improved source is frequently in disrepair, is of poor perceived water quality for domestic purposes, or is too expensive to use exclusively (Kosinski et al, 2016; Kulinkina et al, 2016). Reliance on untreated surface water, even when temporary and sporadic, places populations at risk for waterborne and water–related diseases.…”

“…For example, in a rural Eastern Region community, Asamama, surface water use is extensive due to poor groundwater quality and lack of borehole maintenance. As a result, schistosomiasis prevalence in Asamama is >60% despite annual mass drug treatment through the public school system (Kosinski, et al, 2016). …”