Community Knowledge, Perceptions, and Practices Associated with Urogenital Schistosomiasis among School-Aged Children in Zanzibar, United Republic of Tanzania

Abstract

BackgroundOn the Zanzibar islands, United Republic of Tanzania, elimination of urogenital schistosomiasis is strived for in the coming years. This qualitative study aimed to better understand community knowledge, perceptions, and practices associated with schistosomiasis among school-aged children on Unguja and Pemba islands, in order to inform the development of behavior change interventions contributing to eliminate urogenital schistosomiasis.MethodologyIn 2011, we conducted 35 children’s discussion groups, 41 in-depth interviews with parents and teachers, and 5 focus group discussions with community members in Zanzibar. Using a modified-grounded theory approach, we transcribed and coded the narrative data followed by thematic analysis of the emergent themes.Principal FindingsUrogenital schistosomiasis is a common experience among children in Zanzibar and typically considered a boys’ disease. Children engage in multiple high-risk behaviors for acquiring schistosomiasis because of poor knowledge on disease transmission, lack of understanding on severity of disease-associated consequences, and lack of alternative options for water related activities of daily living and recreational play. Local primary school teachers had little to no training about the disease and no teaching tools or materials for students.Conclusions/SignificanceConducting activities in open natural freshwater contaminated by S. haematobium larvae compromises the health of school-aged children in Zanzibar. The perception of urogenital schistosomiasis as a minor illness rather than a serious threat to a child’s well-being contributes to the spread of disease. Understanding community perceptions of disease along with the barriers and facilitators to risk reduction behaviors among children can inform health promotion activities, campaigns, and programs for the prevention, control, and elimination of urogenital schistosomiasis in Zanzibar.

Perceptions about interventions to control schistosomiasis among the Lake Victoria island communities of Koome, Uganda

“…The communities are willing to participate in sustaining the interventions and they provided suggestions such as setting up stringent byelaws, the need for health education and community engagement. Indeed, health education is important because knowledge about the transmission, severity and consequence of schistosomiasis may be poor [36]. As demonstrated elsewhere, the communities need to be involved in designing the interventions in order to promote ownership of the intervention [24].…”

Urinary schistosomiasis among preschool-age children in an endemic area of Kinondoni municipality, Dar es Salaam, Tanzania 2016

“…Although the large majority (91.7%) was aware of schistosomiasis disease, a high percentage (76.0%) did not consider it as a health problem, perhaps because only a small percentage (12.7%) was reported for a child who was passing blood in urine, the main symptom of urinary schistosomiasis. The notion that urinary schistosomiasis is not a health problem may negatively affect national control efforts [14]. The intensive praziquantel preventive chemotherapy campaign seems to induce positive perceptions that anybody can get urinary schistosomiasis disease and that cross-points are the common sites of making contact with cercariae infested water bodies [3,10].…”

“…the intermediate host of S. haematobium, awareness and level of knowledge of parents or guardians on urinary schistosomiasis disease in terms of symptoms, mode of transmission, availability of modern treatment and preventive measures. The study also sought to establish perceived risk of S. haematobium infection of mothers or caregivers in different age groups and water contact sites and practices might lead to exposure to S. haematobium infection in young children [14]. The goal was to generate information that would guide policy decision to consider inclusion of preschool children in praziquantel preventive chemotherapy and targeted health education messages to mothers or caregivers regarding control of schistosomiasis among young children.…”

Mass drug administration and the sustainable control of schistosomiasis: Community health workers are vital for global elimination efforts

“…Poor knowledge of disease transmission, prevention, and treatment has been observed in Nigeria, Mozambique, and Kenya (Dawaki et al, 2015;Mwai et al, 2016;Rassi et al, 2016). The most common misconception is that schistosomiasis is acquired by drinking or eating contaminated food and water (Acka et al, 2010;Kabatereine et al, 2014;Musuva et al, 2014;Odhiambo et al, 2016;Person et al, 2016). Others believe it is transmitted through sexual contact (Rassi et al, 2016;Mwanga et al, 2004).…”