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Torres-Vitolas CA, Trienekens SCM, Zaadnoordijk W, Gouvras AN. Behaviour change interventions for the control and elimination of schistosomiasis: A systematic review of evidence from low- and middle-income countries. PLoS Negl Trop Dis 2023; 17:e0011315. [PMID: 37163556 PMCID: PMC10202306 DOI: 10.1371/journal.pntd.0011315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 05/22/2023] [Accepted: 04/16/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND For the last two decades, schistosomiasis control efforts have focussed on preventive treatment. The disease, however, still affects over 200 million people worldwide. Behaviour change (BC) interventions can strengthen control by interrupting transmission through modifying exposure behaviour (water contact) or transmission practices (open urination/defaecation); or through fostering treatment seeking or acceptance. This review examines these interventions to assess their effectiveness in modifying risk practices and affecting epidemiological trends. METHODOLOGY/PRINCIPAL FINDINGS A systematic multi-database literature search (PROSPERO CRD42021252368) was conducted for peer-reviewed publications released at any time before June 2021 assessing BC interventions for schistosomiasis control in low- and middle-income countries. 2,593 unique abstracts were identified, 66 were assigned to full text review, and 32 met all inclusion criteria. A typology of intervention models was outlined according to their use of behaviour change techniques and overarching rationale: health education (HEIs), social-environmental (SEIs), physical-environmental (PEIs), and incentives-centred interventions (ICIs). Available evidence does not allow to identify which BC approach is most effective in controlling risk behaviour to prevent schistosomiasis transmission. HEIs' impacts were observed to be limited by structural considerations, like infrastructure underdevelopment, economic obligations, socio-cultural traditions, and the natural environment. SEIs may address those challenges through participatory planning and implementation activities, which enable social structures, like governance and norms, to support BC. Their effects, however, appear context-sensitive. The importance of infrastructure investments was highlighted by intervention models. To adequately support BC, however, they require users' inputs and complementary services. Whilst ICIs reported positive impacts on treatment uptake, there are cost-effectiveness and sustainability concerns. Evaluation studies yielded limited evidence of independent epidemiological impacts from BC, due to limited use of suitable indicators and comparators. There was indicative evidence, however, that BC projects could sustain gains through treatment campaigns. CONCLUSIONS/SIGNIFICANCE There is a need for integrated interventions combining information provision, community-based planning, and infrastructure investments to support BC for schistosomiasis control. Programmes should carefully assess local conditions before implementation and consider that long-term support is likely needed. Available evidence indicates that BC interventions may contribute towards schistosomiasis control when accompanied by treatment activities. Further methodologically robust evidence is needed to ascertain the direct epidemiological benefits of BC.
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Affiliation(s)
- Carlos A. Torres-Vitolas
- Unlimit Health, London, United Kingdom
- School of Public Health, Imperial College London, London, United Kingdom
| | - Suzan C. M. Trienekens
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Evaluating the feasibility and acceptability of a community dialogue intervention in the prevention and control of schistosomiasis in Nampula province, Mozambique. PLoS One 2021; 16:e0255647. [PMID: 34351982 PMCID: PMC8341517 DOI: 10.1371/journal.pone.0255647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schistosomiasis is a parasitic neglected tropical disease that ranks second only to malaria in terms of human suffering in the tropics and subtropics. Biomedical disease control interventions need to be complemented with effective prevention and health education strategies, that address the social and environmental determinants of disease. Malaria Consortium conducted an implementation research study between May 2014 and February 2016, in four districts of Nampula province, Mozambique, to test a Community Dialogue (CD) intervention to enhance schistosomiasis prevention and control. The study aimed to evaluate the acceptability and feasibility of using CD to improve communities' level of knowledge, attitudes and practices, and engagement in wider schistosomiasis prevention and control efforts. METHODS The feasibility and acceptability of the CD intervention was evaluated using qualitative and process evaluation data collected throughout the development and implementation phases. Qualitative data sets included key informant interviews (N = 4) with health system personnel, focus group discussions (N = 22) with Community Dialogue facilitators and participants, field observation visits (N = 11), training reports (N = 7), feedback meeting reports (N = 5), CD monitoring sheets (N = 1,458) and CD planning sheets (N = 152). FINDINGS The CD intervention was found highly acceptable and feasible, particularly well-suited to resource poor settings. Non-specialist community volunteers were able to deliver participatory CDs which resulted in increased knowledge among participants and triggered individual and communal actions for improved disease prevention and control. The visual flipchart was a key aid for learning; the use of participatory communication techniques allowed the correction of misconceptions and positioned correct prevention and control practices as the community recommendations, through consensus building. CONCLUSION The Community Dialogue Approach should be embedded within neglected tropical disease control programmes and the health system to create long-lasting synergies between the community and health system for increased effectiveness. However, for behavioural change to be feasible, community engagement strategies need to be supported by improved access to treatment services, safer water and sanitation.
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Prevalence, Risk Factors, and Coinfection of Urogenital Schistosomiasis and Soil-Transmitted Helminthiasis among Primary School Children in Biase, Southern Nigeria. J Parasitol Res 2021; 2021:6618394. [PMID: 33791124 PMCID: PMC7984897 DOI: 10.1155/2021/6618394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022] Open
Abstract
Schistosomiasis and soil-transmitted helminthiasis (STH) are neglected tropical diseases (NTDs) that cause chronic infections and ill health. The study was carried out to determine the current infection status and risk factors associated with Schistosoma haematobium and soil-transmitted helminth (STH) coinfection among school children in Biase Local Government Area (LGA), Cross River State, Nigeria. A cross-sectional study was carried out. Urine and fecal samples were randomly collected from 630 school children in six villages of Biase LGA. Urine sedimentation and Kato-Katz techniques were used to diagnose urogenital schistosomiasis and STHs, respectively. A structured questionnaire was used to collect demographic information and risk factors. The prevalence of S. haematobium in Biase LGA was 6.03%, with males (27 pupils, 9.00%) significantly more (χ2 = 8.903, p value = 0.003, C.I. = −82.650–120.650) infected than the females (11 pupils, 3.33%), while the prevalence of STH infection was 11.27% with no significant difference (χ2 = 0.002, p value = 0.962, C.I. = −16.441–54.559) in prevalence between males (34 pupils, 11.33%) and females (37 pupils, 11.21%). Prevalence of S. haematobium and STHs ranged from 1.82 to 19.13% and from 4.55 to 19.05% within the communities, respectively, with Abini (22 pupils, 19.13%) and Adim (20 pupils, 19.05%) communities having the highest prevalence for S. haematobium and STHs, respectively. The most infected age group was 11–13 years (21 pupils, 9.68%) for S. haematobium and 14–16 years (5 pupils, 21.74%) for STHs. Ascaris lumbricoides, hookworms, and Trichuris trichiura had prevalence of 5.56%, 3.02%, and 2.70%, respectively. An overall prevalence of 7.14% and 8.41% was observed for haematuria and proteinuria, respectively. Prevalence of coinfection among the parasites was 4.76%. Male pupils (OR = 2.868, C.I.: 1.397–5.889), pupils of the age group of 11–13 years (OR = 2.496, C.I.: 1.287–4.838), school children that swim (OR = 1.527, C.I.: 0.784–2.974), those that cross streams to farm (OR = 25.286, C.I.: 4.091–156.283), those that visit stream or river severally (OR = 3.077, C.I.: 1.204–7.863), and those whose home is 1 km (OR = 3.116, C.I.: 1.292–7.518) from the stream are at higher odds of infection with S. haematobium. For STHs, male pupils (OR = 1.012, C.I.: 0.617–1.659), pupils of the age group of 11–13 years (OR = 2.609, C.I.: 1.582–4.302), pupils that walk barefoot (OR = 18.746, C.I.: 6.786–51.783), those that do not wash fruits and vegetables before eating (OR = 2.334, C.I.: 1.400–3.892), those that do not wash hands after using the toilet (OR = 1.200, C.I.: 0.730–1.973), those that eat soils (OR = 2.741, C.I.: 1.533–4.902), those that drink water from streams or rivers (OR = 189.509, C.I.: 24.807–1447.740), and those that use pit latrine (OR = 2.920, C.I.: 1.746–4.885) and/or open defecation (OR = 2.552, C.I.: 1.454–4.479) are at high odds of being infected with STHs. Urogenital schistosomiasis and soil-transmitted helminthiasis are still endemic diseases in Biase LGA. Although the degree of infection is quite low or moderate, there is a need to intensify and sustain control measures such as provision of sustainable clean water supply, health education intervention, and chemotherapy.
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Jaiteh F, Okebe J, Masunaga Y, D'Alessandro U, Achan J, Gryseels C, de Vries D, Ribera JM, Grietens KP. Understanding adherence to reactive treatment of asymptomatic malaria infections in The Gambia. Sci Rep 2021; 11:1746. [PMID: 33462329 PMCID: PMC7813830 DOI: 10.1038/s41598-021-81468-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022] Open
Abstract
The impact of different types of reactive case detection and/or treatment strategies for malaria elimination depends on high coverage and participants’ adherence. However, strategies to optimise adherence are limited, particularly for people with asymptomatic or no infections. As part of a cluster-randomized trial to evaluate the effect of reactive treatment in The Gambia, all residents in the compound of a diagnosed clinical malaria patient received dihydro-artemisinin–piperaquine (DP). Using a mixed method approach, we assessed which factors contribute to adherence among the contacts of malaria cases that showed no symptoms. Adherence was defined as the proportion of compound members that (1) returned all medicine bags empty and (2) self-reported (3-day) treatment completion. Among the 273 individuals from 14 compounds who received DP, 227 (83.1%) were available for and willing to participate in the survey; 85.3% (233/273) returned empty medicine bags and 91.6% (208/227) self-reported treatment completion. Although clinical malaria was not considered a major health problem, reported adherence was high. The drivers of adherence were the strong sense of responsibility towards protecting the individual, compound and the village. Adherence can be optimised through a transdisciplinary implementation research process of engaging communities to bridge the gap between research goals and social realities.
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Affiliation(s)
- Fatou Jaiteh
- Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia. .,Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium. .,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.
| | - Joseph Okebe
- Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Yoriko Masunaga
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium.,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | - Umberto D'Alessandro
- Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Charlotte Gryseels
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Daniel de Vries
- Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands
| | | | - Koen Peeters Grietens
- Medical Anthropology Unit, Institute of Tropical Medicine, Antwerp, Belgium.,PASS Suisse, Neuchâtel, Switzerland.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Knowledge and perceptions of schistosomiasis, a water-borne disease, in two semi-arid rural areas of South Africa (Ndumo) and Zimbabwe (Ntalale). Food Waterborne Parasitol 2020; 21:e00091. [PMID: 33251346 PMCID: PMC7683237 DOI: 10.1016/j.fawpar.2020.e00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022] Open
Abstract
Schistosomiasis is a serious water-borne disease of public health importance in southern Africa and is characterised by high morbidity and negative socio-economic repercussions. Limited knowledge on the mode of transmission and treatment contribute towards increase in the risk of infection. This study assessed community knowledge levels, perceptions and the co-constructed realities of social actors with regards to schistosomiasis in rural resource-poor communities of Ndumo in South Africa and Ntalale in Zimbabwe. We hypothesised that there was association between community knowledge level on schistosomiasis and location of residency and socio-demographic factors. Two-hundred and eight questionnaires were used to gather quantitative data on socio-demographics and knowledge levels while 18 focus group discussions were used to collect qualitative data on perceptions and social constructs. The Fisher's exact and Chi-square tests were used to determine the differences in community knowledge levels based on localities, gender, religion and age. Results showed that awareness level of schistosomiasis was assessed as ‘good’ in both Ndumo (91%) and Ntalale (81%). Majority of the respondents identified schistosomiasis as a water-borne disease with significantly higher proportion in Ndumo (89%) compared to Ntalale (68%) (p = 0.005). A significant proportion of participants in both localities were aware of the symptoms of schistosomiasis especially the passing of urine with blood (82.5% in Ndumo and 77.0% in Ntalale; p = 0.039). However, presence of schistosomiasis eggs in human stool apart from urine as a sign of infection was highly acknowledged in Ntalale (57.4%) compared to Ndumo (11.7%; p < 0.001). Knowledge on the body parts affected by the infection was low in both localities with 36.9% in Ntalale compared to 1.0% in Ndumo (p < 0.001). In both study areas, local understanding of schistosomiasis was limited to passing urine with blood, a symptom only seen in cases of urinary schistosomiasis. All the participants associated schistosomiasis with being water-borne, but had divergent perceptions on the symptoms, lifecycle and treatment of the infection. Trends of schistosomiasis and at-risk populations were perceived differently in Ndumo and Ntalale. Although respondents from the two localities acknowledged schistosomiasis as water-borne disease, the study showed lack of in-depth knowledge on the life cycle of the diseases. We therefore recommend that health education be implemented together with other strategies such as improvement in access to water and sanitation in the two study areas to achieve effective control and prevention of the disease. Community awareness level of schistosomiasis as a water-borne disease was good Knowledge levels of the cause and risk factors of schistosomiasis was relatively low Communities from the two study localities were aware of the symptoms of Schistosoma haematobium and not the mode of transmission Knowledge on S. mansoni was poor in both areas In Ndumo, the understanding of schistosomiasis had changed over time
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Integrating the Prevention and Control of Rheumatic Heart Disease into Country Health Systems: A Systematic Review and Meta-Analysis. Glob Heart 2020; 15:62. [PMID: 33150127 PMCID: PMC7500229 DOI: 10.5334/gh.874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: National and international political commitments have been made recently on rheumatic heart disease (RHD), a preventable heart condition that is endemic in low-resource countries. To inform best practice and identify evidence gaps, we assessed the effectiveness of RHD prevention and control programmes and the extent and nature of their integration into local health systems. Methods: We conducted a systematic review and meta-analysis using a previously published protocol that included electronic and manual searches for studies published between January 1990 and July 2019 reporting on prevention and control programmes for populations at risk for streptococcal pharyngitis, rheumatic fever, and/or RHD. We analysed programme integration according to a previously published framework and programme effectiveness using a results-chain framework. We meta-analysed secondary prophylaxis adherence using random-effects models. Study quality was assessed using peer-reviewed checklists (CASP and PRISM). PROSPERO registration: CRD42017076307. Findings: Five observational studies met with the inclusion criteria. Studies were similar in extent and nature of integration into health systems; no programme was completely integrated or non-integrated. A single study reported on programme impact. Secondary prophylaxis adherence improved among partially integrated RHD programmes (RR, 1.18 [95% CI, 1.03 to 1.36], 3 studies, n = 618). Risk of bias was low in two studies, and indeterminable in the remaining three studies. Interpretation: There is evidence that partially integrated RHD programmes are beneficial for a range of intermediate health outcomes. This review provides a starting point for the design and implementation of future RHD programmes by outlining current best practice for integration and identifying key gaps in knowledge. Funding: National Research Foundation of South Africa.
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Malishev M, Civitello DJ. Modelling how resource competition among snail hosts affects the mollusciciding frequency and intensity needed to control human schistosomes. Funct Ecol 2020. [DOI: 10.1111/1365-2435.13602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gunn JKL, Ernst KC, Center KE, Bischoff K, Nuñez AV, Huynh M, Okello A, Hayden MH. Current strategies and successes in engaging women in vector control: a systematic review. BMJ Glob Health 2018; 3:e000366. [PMID: 29515913 PMCID: PMC5838394 DOI: 10.1136/bmjgh-2017-000366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/13/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vector-borne diseases (VBDs) cause significant mortality and morbidity in low-income and middle-income countries and present a risk to high-income countries. Vector control programmes may confront social and cultural norms that impede their execution. Anecdotal evidence suggests that incorporating women in the design, delivery and adoption of health interventions increases acceptance and compliance. A better understanding of programmes that have attempted to increase women's involvement in vector control could help shape best practices. The objective of this systematic review was to assess and critically summarise evidence regarding the effectiveness of women participating in vector control. METHODS Seven databases were searched from inception to 21 December 2015. Two investigators independently reviewed all titles and abstracts for relevant articles. Grey literature was searched by assessing websites that focus on international development and vector control. RESULTS In total, 23 articles representing 17 unique studies were included in this review. Studies discussed the involvement of women in the control of vectors for malaria (n=10), dengue (n=8), human African trypanosomiasis (n=3), schistosomiasis (n=1) and a combination (malaria and schistosomiasis, n=1). Seven programmes were found in the grey literature or through personal communications. Available literature indicates that women can be successfully engaged in vector control programmes and, when given the opportunity, they can create and sustain businesses that aim to decrease the burden of VBDs in their communities. CONCLUSION This systematic review demonstrated that women can be successfully engaged in vector control programmes at the community level. However, rigorous comparative effectiveness studies need to be conducted.
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Affiliation(s)
- Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Kristi Bischoff
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Annabelle V Nuñez
- University of Arizona Health Sciences Library, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Megan Huynh
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Amanda Okello
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Mary H Hayden
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
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Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. HUMAN RESOURCES FOR HEALTH 2017; 15:29. [PMID: 28407810 PMCID: PMC5390445 DOI: 10.1186/s12960-017-0200-9] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/29/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Task shifting has become an increasingly popular way to increase access to health services, especially in low-resource settings. Research has demonstrated that task shifting, including the use of community health workers (CHWs) to deliver care, can improve population health. This systematic review investigates whether task shifting in low-income and middle-income countries (LMICs) results in efficiency improvements by achieving cost savings. METHODS Using the PRISMA guidelines for systematic reviews, we searched PubMed, Embase, CINAHL, and the Health Economic Evaluation Database on March 22, 2016. We included any original peer-review articles that demonstrated cost impact of a task shifting program in an LMIC. RESULTS We identified 794 articles, of which 34 were included in our study. We found that substantial evidence exists for achieving cost savings and efficiency improvements from task shifting activities related to tuberculosis and HIV/AIDS, and additional evidence exists for the potential to achieve cost savings from activities related to malaria, NCDs, NTDs, childhood illness, and other disease areas, especially at the primary health care and community levels. CONCLUSIONS Task shifting presents a viable option for health system cost savings in LMICs. Going forward, program planners should carefully consider whether task shifting can improve population health and health systems efficiency in their countries, and researchers should investigate whether task shifting can also achieve cost savings for activities related to emerging global health priorities and health systems strengthening activities such as supply chain management or monitoring and evaluation.
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Affiliation(s)
- Gabriel Seidman
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 United States of America
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 United States of America
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Campbell SJ, Stothard JR, O'Halloran F, Sankey D, Durant T, Ombede DE, Chuinteu GD, Webster BL, Cunningham L, LaCourse EJ, Tchuem-Tchuenté LA. Urogenital schistosomiasis and soil-transmitted helminthiasis (STH) in Cameroon: An epidemiological update at Barombi Mbo and Barombi Kotto crater lakes assessing prospects for intensified control interventions. Infect Dis Poverty 2017; 6:49. [PMID: 28238285 PMCID: PMC5327519 DOI: 10.1186/s40249-017-0264-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/17/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The crater lakes of Barombi Mbo and Barombi Kotto are well-known transmission foci of schistosomiasis and soil-transmitted helminthiasis having had several important control initiatives previously. To collect contemporary epidemiological information, a cross-sectional survey was undertaken inclusive of: signs and symptoms of disease, individual treatment histories, local water, sanitation and hygiene (WASH)-related factors and malacological surveillance, with molecular characterisation of specimens. METHODS At each lake, a community cross-sectional survey was undertaken using a combination of stool and urine parasitological sampling, and interview with pro-forma questionnaires. A total of 338 children and adults participated. Material from snail and parasite species were characterised by DNA methods. RESULTS Egg-patent prevalence of urogenital schistosomiasis was 8.7% at Barombi Mbo (all light-intensity infections) and 40.1% at Barombi Kotto (21.2% heavy-intensity infections). Intestinal schistosomiasis was absent. At Barombi Kotto, significantly more women reported signs and symptoms associated with female genital schistosomiasis. While there had been extensive recent improvement in WASH-related infrastructure at Barombi Mbo, water contact risk scores were higher among schistosomiasis-infected participants (P < 0.001) and at Barombi Kotto in general (P < 0.001). Across both lakes, mean prevalence of STH was very low (6.3%) evidencing an impressive decrease of 79.0% over the last decade; neither Strongyloides stercoralis nor Ascaris lumbricoides were found. A total of 29 freshwater sampling sites were inspected for snails, 13 in Barombi Mbo and 16 in Barombi Kotto; water chemistry differed significantly (P < 0.0001) between lakes for both mean pH (7.9 v. 9.6) and mean conductivity (64.3 μS v. 202.1 μS) respectively. Only two Bulinus camerunensis found on the central island of Barombi Kotto were observed to shed schistosome cercariae, but schistosome DNA was later detected in Bulinus sampled from both lakes as well as in Indoplanorbis exustus, an invasive species from Asia. CONCLUSIONS STH is currently at very low levels while urogenital schistosomiasis is of greatest concern at Barombi Kotto. This assessment highlights a unique opportunity for further study of the epidemiological dynamics at these crater lakes, to evaluate future intensified interventions both in terms of gaining and sustaining control at Barombi Kotto or in moving towards local interruption of transmission of both diseases at Barombi Mbo.
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Affiliation(s)
- Suzy J Campbell
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - J Russell Stothard
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Faye O'Halloran
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Deborah Sankey
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Timothy Durant
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | | | | | - Bonnie L Webster
- Department of Life Sciences, Parasites and Vectors Division, Natural History Museum, London, SW7 5BD, UK
- London Centre for Neglected Tropical Disease Research, London, UK
| | - Lucas Cunningham
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - E James LaCourse
- Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Louis-Albert Tchuem-Tchuenté
- Centre for Schistosomiasis and Parasitology, Yaoundé, Cameroon
- Laboratory of Parasitology and Ecology, Faculty of Sciences, University of Yaoundé I, Yaoundé, Cameroon
- National Programme for the Control of Schistosomiasis and Intestinal Helminthiasis, Ministry of Public Health, Yaoundé, Cameroon
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Macharia JW, Ng'ang'a ZW, Njenga SM. Factors influencing community participation in control and related operational research for urogenital schistosomiasis and soil-transmitted helminths in rural villages of Kwale County, coastal Kenya. Pan Afr Med J 2016; 24:136. [PMID: 27642474 PMCID: PMC5012741 DOI: 10.11604/pamj.2016.24.136.7878] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/15/2016] [Indexed: 11/11/2022] Open
Abstract
Introduction helminthic infections caused by soil-transmitted helminths (STH) and schistosomes are among the most prevalent afflictions of humans who live in areas of poverty. An operational research was undertaken in 5 villages of Kwale County during a pilot control programme which included both the adults and school going children. Willingness of community members to participate in the treatment as well as in the research is critical. A cross sectional study sought to determine factors influencing community participation in control and related operational research and assess the treatment coverage for urogenital schistosomiasis and hookworms in rural villages of Kwale County. Methods cross-sectional survey utilized quantitative and qualitative methods of data collection. A total of 220 households were recruited and household heads interviewed. Bivariate analysis was used to test association between different independent and dependent factors. Multivariate analysis was done using binary logistic regression to control for confounders and effect modification. Qualitative data was transcribed, coded and analyzed thematically. Results religion and levels of income were significantly (P =0.04 and P = 0.026 respectively) associated with participation in the research and control programme, history of ever suffering from schistosomiasis and intestinal worms was found to be significantly (P = 0.008) associated with participation in the research. The study established that 82% (178) of the respondents received treatment for urogenital schistosomiasis and hookworms and 67% (146) of the respondents had participated in the research. Conclusion this information will be useful in promoting health, enhancing learning and behaviour changes which will lead to increased community participation in similar disease control.
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Affiliation(s)
- Jacinta Wairimu Macharia
- Institute of Tropical Medicine and Infectious Diseases, Jomo Kenyatta University of Agriculture and Technology
| | - Zipporah W Ng'ang'a
- Department of Applied sciences, Department of Academics, Deputy Vice Chancellor office, Southern and Eastern Kenya University, Kitui, Kenya
| | - Sammy Michugu Njenga
- Eastern and Southern Africa Centre of International Parasite Control Centre, Kenya Medical Research Institute, Nairobi, Kenya
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Kosinski KC, Kulinkina AV, Abrah AFA, Adjei MN, Breen KM, Chaudhry HM, Nevin PE, Warner SH, Tendulkar SA. A mixed-methods approach to understanding water use and water infrastructure in a schistosomiasis-endemic community: case study of Asamama, Ghana. BMC Public Health 2016; 16:322. [PMID: 27076042 PMCID: PMC4831178 DOI: 10.1186/s12889-016-2976-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 03/23/2016] [Indexed: 12/20/2022] Open
Abstract
Background Surface 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. Methods Our mixed-methods study assessed the context of water use in a rural community endemic for schistosomiasis. Results Eighty-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. Conclusions Collectively, our study illustrates how complex attitudes towards water resources can affect which methods will be appropriate to address schistosomiasis.
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Affiliation(s)
- Karen Claire Kosinski
- Department of Community Health, Tufts University, 574 Boston Avenue, Medford, Massachusetts, 02155, USA.
| | - Alexandra V Kulinkina
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, 02155, USA
| | | | | | | | | | - Paul E Nevin
- Department of Global Health, University of Washington, Seattle, Washington, 98112, USA
| | | | - Shalini Ahuja Tendulkar
- Department of Community Health, Tufts University, 574 Boston Avenue, Medford, Massachusetts, 02155, USA
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Price A, Verma A, Welfare W. Are health education interventions effective for the control and prevention of urogenital schistosomiasis in sub-Saharan Africa? A systematic review. Trans R Soc Trop Med Hyg 2015; 109:239-44. [PMID: 25669840 DOI: 10.1093/trstmh/trv008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An estimated 129 million people are infected with urogenital schistosomiasis in sub-Saharan Africa. Current control recommendations endorse mass administration of praziquantel. Health education is an important component of effective schistosomiasis prevention and control, but there has been limited research on its effectiveness. This paper reviews the effectiveness of health education as an intervention in the prevention and control of urogenital schistosomiasis in sub-Saharan Africa. The outcomes of interest were prevalence, incidence or transmission of schistosomiasis, behaviour change associated with infection, or changes in knowledge of the disease. The findings from this review suggest that health education has a beneficial impact on knowledge and understanding of schistosomiasis within the target groups. However, further research is needed due to the poor quality of the included studies.
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Affiliation(s)
- Amy Price
- University of Manchester Medical School
| | - Arpana Verma
- Manchester Academic Health Sciences Centre, Institute of Population Health, Stopford Building, MAHSC, University of Manchester, Manchester, M13 9PT, UK
| | - William Welfare
- Manchester Academic Health Sciences Centre, Institute of Population Health, Stopford Building, MAHSC, University of Manchester, Manchester, M13 9PT, UK
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Atkinson JA, Vallely A, Fitzgerald L, Whittaker M, Tanner M. The architecture and effect of participation: a systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination. Malar J 2011; 10:225. [PMID: 21816085 PMCID: PMC3171376 DOI: 10.1186/1475-2875-10-225] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 08/04/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community engagement and participation has played a critical role in successful disease control and elimination campaigns in many countries. Despite this, its benefits for malaria control and elimination are yet to be fully realized. This may be due to a limited understanding of the influences on participation in developing countries as well as inadequate investment in infrastructure and resources to support sustainable community participation. This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign. METHODS Evidence derived from quantitative research was considered both independently and collectively with qualitative research papers and case reports. All papers included in the review were systematically coded using a pre-determined qualitative coding matrix that identified influences on community participation at the individual, household, community and government/civil society levels. Colour coding was also carried out to reflect the key primary health care period in which community participation programmes originated. These processes allowed exhaustive content analysis and synthesis of data in an attempt to realize conceptual development beyond that able to be achieved by individual empirical studies or case reports. RESULTS Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. Due to inherent differences in their design, interventions and outcome measures, results could not be compared. However, these studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources are common and important elements of the success of the interventions in these studies. In addition, qualitative synthesis of all 60 papers elucidates the complex architecture of community participation for communicable disease control and elimination which is presented herein. CONCLUSIONS The current global malaria elimination campaign calls for a health systems strengthening approach to provide an enabling environment for programmes in developing countries. In order to realize the benefits of this approach it is vital to provide adequate investment in the 'people' component of health systems and understand the multi-level factors that influence their participation. The challenges of strengthening this component of health systems are discussed, as is the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. It is recommended that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonize efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.
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Affiliation(s)
- Jo-An Atkinson
- Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia.
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Obregón R, Waisbord S. The complexity of social mobilization in health communication: top-down and bottom-up experiences in polio eradication. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 1:25-47. [PMID: 20455165 DOI: 10.1080/10810731003695367] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Polio Eradication Initiative (PEI) has been one of the most ambitious global health efforts in recent times. Social mobilization (SM) has been a strategic component of the PEI. Yet, a close-up analysis of SM dynamics seems to be lacking in the health communication literature. We examine critical aspects of the PEI experience in an attempt to move from dominant informational perspectives to a focus on emerging challenges in polio eradication efforts and new levels of complexity to SM. We examine available literature on communication and public health, available data on SM experiences that support polio eradication in Africa and Asia, and field work conducted by the authors where polio eradication efforts are ongoing. Our analysis suggests that (1) SM should not be casually approached as a top-down informational strategy to advance pre-established health goals; (2) centralized strategies hardly amount to SM; and (3) hybrid options that combine both activist and pragmatic SM are concrete possibilities for global health initiatives. In the context of renewed global democratization and persistent conflicts rooted in ethnicity, religion, and economics, it cannot be assumed that communities will either diligently espouse global goals or necessarily oppose them. Communication and SM strategies should rely on a clear understanding of the motives and agendas of involved actors. Resistance or opposition are important analytical dimensions as they may uncover new opportunities for effective health interventions. Further studies using these perspectives should be a priority for global health programs, including studies of the trust level, or lack thereof, among social actors.
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Affiliation(s)
- Rafael Obregón
- School of Media Arts & Studies, Ohio University, Athens, Ohio 45701, USA.
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Atun R, de Jongh T, Secci F, Ohiri K, Adeyi O. A systematic review of the evidence on integration of targeted health interventions into health systems. Health Policy Plan 2009; 25:1-14. [PMID: 19959485 DOI: 10.1093/heapol/czp053] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes. This debate has long been characterized by polarization of views and ideologies, with protagonists for and against integration arguing the relative merits of each approach. However, all too frequently these arguments have not been based on hard evidence. The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach, but the relative merits of integration in various contexts and for different interventions have not been systematically analysed and documented. In this paper we present findings of a systematic review that explores a broad range of evidence on: (i) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions, (ii) how the integration or non-integration of health programmes into critical health systems functions in different contexts has influenced programme success, (iii) how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated. Instead, there exists a highly heterogeneous picture both for the nature and also for the extent of integration. Health systems combine both non-integrated and integrated interventions, but the balance of these interventions varies considerably.
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Affiliation(s)
- Rifat Atun
- Imperial College Business School, Imperial College London, London SW7, UK.
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Social science perspectives on schistosomiasis control in Africa: past trends and future directions. Parasitology 2009; 136:1747-58. [DOI: 10.1017/s0031182009006404] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARYNew ways of integrating and scaling up control of neglected tropical diseases (including schistosomiasis) are presently underway. In this context consideration of social science perspectives is essential. In this article, we review social science publications of relevance to sustained control of schistosomiasis in Africa including diagnosis and screening, treatment, supply of clean water and improved sanitation, as well as health communication. Studies of community involvement and links between schistosomiasis control programmes and broader health care systems are also explored. Directions for future social science of relevance to sustainable schistosomiasis control are outlined, including ways of ensuring equitable access to health services as well as involvement of endemic communities and local health care systems based on equal partnership.
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Gazzinelli MF, Reis DCD, Kloos H, Velásquez-Melendez G, Dutra IR, Gazzinelli A. The impact of two education methods on knowledge of schistosomiasis transmission and prevention among schoolchildren in a rural community in northern Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2008; 101 Suppl 1:45-53. [PMID: 17308747 DOI: 10.1590/s0074-02762006000900008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 06/26/2006] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to analyse the effect of using two health education approaches on knowledge of transmission and prevention of schistosomiasis of school children living in a rural endemic area in the state of Minas Gerais, Brazil. The 87 children participating in the study were divided into three groups based on gender, age and presence or absence of Schistosoma mansoni infection. In the first group the social representation model and illness experience was used. In the second group, we used the cognitive model based on the transmission of information. The third group, the control group, did not receive any information related to schistosomiasis. Ten meetings were held with all three groups that received a pre-test prior to the beginning of the educational intervention and a post-test after the completion of the program. The results showed that knowledge levels in Group 1 increased significantly during the program in regard to transmission (p = 0.038) and prevention (p = 0.001) of schistosomiasis. Groups 2 and 3 did not show significant increase in knowledge between the two tests. These results indicate that health education models need to consider social representation and illness experience besides scientific knowledge in order to increase knowledge of schistosomiasis transmission and prevention.
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Affiliation(s)
- Maria Flávia Gazzinelli
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil
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An exploratory study of community factors relevant for participatory malaria control on Rusinga Island, western Kenya. Malar J 2007; 6:48. [PMID: 17456231 PMCID: PMC1871595 DOI: 10.1186/1475-2875-6-48] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 04/24/2007] [Indexed: 11/23/2022] Open
Abstract
Background Capacity strengthening of rural communities, and the various actors that support them, is needed to enable them to lead their own malaria control programmes. Here the existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention. Methods Focus group discussions and semi-structured individual interviews were carried out in 1,451 households to determine (1) demographics of respondent and household; (2) socio-economic status of the household; (3) knowledge and beliefs about malaria (symptoms, prevention methods, mosquito life cycle); (4) typical practices used for malaria prevention; (5) the treatment-seeking behaviour and household expenditure for malaria treatment; and (6) the willingness to prepare and implement community-based vector control. Results Malaria was considered a major threat to life but relevant knowledge was a chimera of scientific knowledge and traditional beliefs, which combined with socio-economic circumstances, leads to ineffective malaria prevention. The actual malaria prevention behaviour practiced by community members differed significantly from methods known to the respondents. Beside bednet use, the major interventions implemented were bush clearing and various hygienic measures, even though these are ineffective for malaria prevention. Encouragingly, most respondents believed malaria could be controlled and were willing to contribute to a community-based malaria control program but felt they needed outside assistance. Conclusion Culturally sensitive but evidence-based education interventions, utilizing participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease. Community-based organizations and schools need to be equipped with knowledge through partnerships with national and international research and tertiary education institutions so that evidence-based research can be applied at the grassroots level.
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[Sociodemographic and behavioral factors related to schistosomiasis in a rural village of the sugar cane belt in Pernambuco State, Brazil]. CAD SAUDE PUBLICA 1998; 14:107-15. [PMID: 9592216 DOI: 10.1590/s0102-311x1998000100018] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Failure of intensive chemotherapy to control schistosomiasis in a highly endemic area of Northeast Brazil led to the hypothesis that sociodemographic and/or behavioral variables could be involved in the persistent transmission. A univariate analysis of such variables in relation to infection by Schistosoma mansoni showed that water contact patterns for recreation and personal hygiene are important risk factors in the area. However, sociodemographic variables were not related to infection, probably because the local population lives under evenly precarious socioeconomic and sanitary conditions. We thus recommend that chemotherapy be combined with other measures like snail control, health education, and improved sanitation and water supply.
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