Rumours, Riots and the Rejection of Mass Drug Administration for the Treatment of Schistosomiasis in Morogoro, Tanzania

Abstract

SummaryIn 2008 in Morogoro region, Tanzania, mass drug administration (MDA) to school-aged children to treat two neglected tropical diseases (NTDs) – urinary schistosomiasis and soil-transmitted helminths – was suspended by the Ministry of Health and Social Welfare after riots broke out in schools where drugs were being administered. This article discusses why this biomedical intervention was so vehemently rejected, including an eyewitness account. As the protest spread to the village where I was conducting fieldwork, villagers accused me of bringing medicine into the village with which to ‘poison’ the children and it was necessary for me to leave immediately under the protection of the Tanzanian police. The article examines the considerable differences between biomedical and local understandings of one of these diseases, urinary schistosomiasis. Such a disjuncture was fuelled further by the apparent rapidity of rolling out MDA and subsequent failures in communication between programme staff and local people. Rumours of child fatalities as well as children’s fainting episodes and illnesses following treatment brought about considerable conjecture both locally and nationally that the drugs had been either faulty, counterfeit, hitherto untested on humans or part of a covert sterilization campaign. The compelling arguments by advocates of MDA for the treatment of NTDs rest on the assumption that people suffering from these diseases will be willing to swallow the medicine. However, as this article documents, this is not always the case. For treatment of NTDs to be successful it is not enough for programmes to focus on economic and biomedical aspects of treatment, rolling out ‘one size fits all’ programmes in resource-poor settings. It is imperative to develop a biosocial approach: to consider the local social, biological, historical, economic and political contexts in which these programmes are taking place and in which the intended recipients of treatment live their lives. If this is not done, the world’s poor will continue to be neglected.

Understanding hard-to-reach communities: local perspectives and experiences of trachoma control among the pastoralist Maasai in northern Tanzania

“…Additionally, rumours and refusals were evident in the community, partly owing to misinformation. Rumours may also have historical or political origins or result from cultural beliefs (Parker et al, 2008Hastings, 2016. Rumours of health interventions causing sterility or containing contraceptives have been documented since the 1920s in Africa, including vaccinations, malaria treatment and vitamin supplementation.…”

“…The Maasai have a very strong sense of cultural identity, which is expressed in beliefs, norms and traditions. There is a tendency for public health interventions to expect communities to place high importance on their programme with poor consideration of how interventions fit into the communities' priorities and the complexity of livelihoods (Parker et al, 2008;Bardosh, 2014b;Hastings, 2016;Martineau et al, 2017). Communities are a social network influencing norms and behaviours.…”

Deworming Delusions? Mass Drug Administration in East African Schools

“…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.…”

“…Such experiences and stories led to widespread anxiety and fear, and fostered rumours about the real purpose of the treatments. They also prompted a different kind of resistance in the form of a refusal to distribute or take the tablets, and occasionally confrontations with angry parents (Parker & Allen, 2011;Hastings, 2016).…”

Schistosomiasis in Nigeria: Gleaning from the past to improve current efforts towards control

“…Sub-Saharan African countries with about 90% of the world's total cases are the most affected regions [ 3 ]. In Nigeria, 20 million people need to be treated annually, thus, it is the most affected country in the world [ 4 ]. School-based deworming with Praziquantel (PZQ) is the main intervention for schistosomiasis in Nigeria.…”