Low Prevalence of Intestinal Schistosomiasis Among Fisherfolk Living Along the River Nile in North-Western Uganda: A Biosocial Investigation

Abstract

SummaryMass drug administration has been less successful as a technique for controlling intestinal schistosomiasis (S. mansoni) than anticipated. In Uganda, the mass distribution of praziquantel has been provided to populations at risk of infection since the early 2000s, but prevalence mostly remains high. This is the case, for example, at locations in north-western and south-eastern Uganda. However, there is a remarkable exception. Among Madi fishing populations and their immediate neighbours, living close to the border with South Sudan, the rate of infection has dropped dramatically. A parasitological survey carried out at twelve fishing sites in 2013 identified only three cases of S. mansoni among 383 adults tested. This article asks: why is the prevalence of S. mansoni so low among fisherfolk in northern Uganda? Taking a biosocial approach, it suggests that the mass distribution of drugs, free of charge, has had an impact. However, the low prevalence of infection cannot be attributed to this alone. Other important factors may also have contributed to the decline in infection. These include changing fishing livelihoods, local attitudes to public health interventions, access to water and sanitation facilities, hygiene practices and the use of anti-malarial treatments. Above all, the article highlights the importance of investigating both social and biological dimensions of infection simultaneously, and of recognizing the local complexities of sustainably treating this debilitating parasitic disease.

Schistosomiasis mansoni in families of fishing workers of endemic area of Alagoas

“…The adherence rate to the drug treatment in this research was satisfactory, above the rate advised by the (80%) Ministry of Health even having initially aversion to the use of the Praziquantel drug due to its side effects (headache, vomiting, diarrhea, fever, muscular and articular pain, among others), condition also reported in fishermen population resident in endemic areas for the schistosomiasis in the African continent. 49 The reluctance to the use of Praziquantel may be related to the sharing, in the community under study in Alagoas, of the sensations and experiences lived by individuals who adhered and were in drug treatment, provoking in those who did not adhere to the chemotherapy a ripple effect of fear to the anti-parasite drug.…”

Deworming Delusions? Mass Drug Administration in East African Schools

“…However, in 2013, one of our research team documented the prevalence of S. mansoni among these fishing families, and found it to be below 4%. The prevalence of soil-transmitted helminths was also low -ranging from 0% at the majority of sites to 11% at the worst affected location (Pearson, 2016). Thus, despite the variable coverage levels in schools and in the general population, the prevalence of infection with intestinal helminths is at a lower level than might be expected.…”

“…In other words, deworming alone was largely ineffective. Since 2005, research undertaken by the authors and their students has found comparable problems in other parts of East Africa (Aldis, 2008;Wingate-Saul & Shira, 2008;Parker et al, 2008Parker et al, , 2012Parker & Allen, 2011, 2013aOzunga, 2014;Pearson, 2016;Hastings, 2016). Field sites were located in north-western Uganda (Nebbi, Buliisa, Adjumani and Moyo Districts), south-eastern Uganda (Busia District -just across the border from where Miguel and Kremer studied deworming in Kenya), Tanzania's Ukerewe Island in Lake Victoria, Tanga Region in northern coastal Tanzania, and Morogoro Region, which lies to the west of Dar es Salaam (see Fig.…”

Understanding perceptions on 'Buruli' in northwestern Uganda: A biosocial investigation

“…The broader study included an epidemiological-parasitology survey conducted in collaboration with the District Vector Control Division of the Ministry of Health. This was of adults at twelve fish landing sites, one from each sub-county along the river and one island, investigating another neglected disease, schistosomiasis, (documented elsewhere [ 26 ]).This article presents findings that emerged from the ethnographic fieldwork related to Buruli ulcer, as documented in ethnographic fieldnotes, interviews and discussions.…”