Community perception of school-based mass drug administration program for soil-transmitted helminths and Schistosomiasis in Ogun State, Nigeria

The impact of multiple infections and community knowledge on engagement with a historical deworming programme: hookworm and Ascaris in Jamaica, 1913-1936

INTRODUCTION

Community engagement with public health efforts often depends on existing knowledge of a health issue.

METHODS

Here, qualitative analysis of archival material from the Jamaica Hookworm Commission (1919-1936) and quantitative analysis of prevalence data are used to assess knowledge of and ecological interactions between different helminths during a historical hookworm eradication campaign.

RESULTS

Archival sources demonstrate that Jamaicans were familiar with Ascaris lumbricoides. Surveys revealed a high prevalence of hookworm (62% of individuals infected), Ascaris (30%) and Trichuris trichiura (32%) in communities targeted for hookworm control. Community prevalence of Trichuris was positively associated with the prevalence of Ascaris and hookworm. Many individuals were infected with more than one parasite. At an individual level, data from hospital patients and soldiers showed significant associations between all three parasites. The co-occurrence of hookworm and Ascaris, alongside folk treatment of Ascaris with the same plant used by the Hookworm Commission (Chenopodium ambrisoides) to treat hookworm, made biomedical claims about hookworm credible and biomedical treatment more acceptable. Expulsions of Ascaris following treatment also provided dramatic proof of the effectiveness of treatment, further facilitating engagement.

DISCUSSION/CONCLUSION

Knowledge of Ascaris and other helminths directly shaped engagement with hookworm treatment, demonstrating how folk medical knowledge, grounded in the biology of the worms, aided a biomedical public health program.

"Ich-Mupong", a swollen stomach: an ethnographic study of the daily lived experiences of schoolchildren in schistosomiasis high transmission areas along Lake Albert, Hoima District

BACKGROUND

Our primary focus was Schistosoma mansoni infection and schoolchildren. Within communities the social environment may promote individual risk of infection for the school-aged children. There will also be demographic groups who are not targeted or reached by preventive chemotherapy campaigns. The behaviours of these other groups will interact with those of school-aged children, resulting in further infection risk through exposure-related behaviours. Furthermore, perception of the disease may significantly influence the schoolchildren's lived experience of the infection and associated disease. It is therefore crucial to document the daily experiences of schoolchildren living in schistosomiasis high transmission areas along Lake Albert, Hoima District.

METHODS

An ethnographic study explored schoolchildren's perspectives and daily life organisations that shape their risk of schistosomiaisis and their perceptions of the disease. The study was conducted between November 2022 and August 2023. It involved in-depth interviews with schoolchildren and their parents, key informant interviews, focus group discussions with schoolchildren, and participant observations. Data was analysed using a reflexive thematic analysis. Code reports were generated inductively using ATLAS.ti (Version 7).

RESULTS

The study revealed a significant level of knowledge and awareness about schistosomiasis among schoolchildren. They had understanding of the risk factors, continued exposure, and experiences of illness, though they had little autonomy to address these through their own behaviour as they were influenced by the behaviour of others and macro-factors such as WASH provision and economic need. Study participants experienced individual-level effects of schistosomiasis such as educational impacts and isolation as a significant form of stigma.

CONCLUSIONS

There is a need for continued community sensitisation and awareness campaigns to address social stigma, educational impact, and contamination and exposure-related behaviours. National and regional policies and programmes on WASH, livelihood and poverty eradication programmes need to be revisited in schistosomiasis high transmission areas to help provide alternatives and improve schoolchildren's lived experiences.

CLINICAL TRIAL NUMBER

Not applicable.

Acceptability of a nationwide scabies mass drug administration (MDA) program in Fiji: a qualitative interview-based study

Background

Fiji has among the highest global reported prevalence of scabies. Mass drug administration (MDA) has been identified as a potentially effective strategy to control scabies, but acceptability of MDA from the perspectives of people receiving and delivering scabies MDA programs remains underexplored in Fiji and globally.

Methods

A qualitative study was conducted after completion of the national MDA campaign. Participants included 44 community members and 12 key informants across the Central and Western Divisions of Fiji. Semi-structured face-to-face and virtual interviews were conducted in August and September 2023. An interpretive research approach was adopted, and data were analysed using deductive and inductive techniques.

Findings

We identified several barriers and facilitators to scabies MDA acceptability. Facilitators included prior experiences of scabies and knowledge of the potential health benefit of MDA, community attitudes to MDA and neighbours' adherence practices, endorsement of MDA by community leaders, community consultation and exposure to community sensitisation, and involvement of local key informants during planning and implementation. Barriers included a lack of trust in MDA campaigns, religious beliefs, limited reach of community sensitisation, and challenges to implementing MDA in urban locations.

Interpretation

This is the first qualitative study documenting acceptability of a nationwide scabies-MDA globally. It identified diverse socio-structural factors that influenced MDA implementation and acceptability. Future MDA programs could benefit from widespread community sensitisation, tailored approaches to urban and rural MDA design and delivery, and the inclusion of communities in the co-design and implementation of MDA programs.

Funding

The National Health and Medical Research Council (NHMRC) investigator grant-LR and the Macquarie Group Foundation 50th Celebration Awards-AS.

Health workers' perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria

BACKGROUND

Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) are among the most prevalent neglected tropical diseases (NTDs), affecting 1.5 billion globally, with a significant burden in sub-Saharan Africa, particularly Nigeria. These diseases impair health and contribute to socio-economic challenges, especially in children, undermining educational and future economic prospects. The 2030 NTD Roadmap highlights Mass Drug Administration (MDA) as a critical strategy for controlling these NTDs, targeting vulnerable populations like school-age children. Despite some successes, challenges persist, indicating the need for deeper insights into program implementation. This study focuses on the perspectives of health workers implementing MDA in selected local government areas (LGAs) of Ogun State, Nigeria, aiming to identify challenges and enablers that align with the broader NTD 2030 goals.

METHODOLOGY/PRINCIPAL FINDINGS

The study used a qualitative research approach involving focus group discussions and in-depth interviews with health workers engaged in neglected tropical disease control programs in Ogun State, Nigeria, between July and September 2022. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found that the school-based MDA control program's efficacy largely relies on strong collaborations and partnerships, particularly with educators, community heads, and other stakeholders. These alliances and strategic communication methods, like town announcements and media campaigns, have been pivotal in reaching communities. However, the program does grapple with hurdles such as parental misconceptions, limited funds, insufficient staffing, and misalignment with the Ministry of Education. It is recommended to boost funding, foster early stakeholder involvement, enhance mobilization techniques, and consider introducing a monitoring card system similar to immunization.

CONCLUSIONS/SIGNIFICANCE

The MDA Integrated Control Programs for STH and SCH in Ogun State schools demonstrate a holistic approach, integrating knowledge, collaboration, communication, and feedback. Health workers have shown commitment and adeptness in their roles. However, achieving maximum efficacy requires addressing critical barriers, such as parental misconceptions and funding challenges. Adopting the recommended strategies, including proactive communication, increased remuneration, and introducing a tracking system, can significantly enhance the program's reach and impact. The involvement of all stakeholders, from health workers to community leaders and parents, is essential for the program's sustainability and success.

Gender considerations in One Health: a framework for researchers

One Health research and intervention outcomes are strongly influenced by gender dynamics. Women, men, girls, and boys can be negatively affected by gender-based disadvantage in any of the three One Health domains (animal, human, and environmental health), and where this occurs in more than one domain the result may be a compounding of inequity. Evidence worldwide shows that women and girls are more likely to suffer from such gender-based disadvantage. A thoughtfully implemented One Health intervention that prioritizes gender equity is more likely to be adopted, has fewer unintended negative consequences, and can support progress toward gender equality, however there is limited evidence and discussion to guide using a gender lens in One Health activities. We propose a framework to identify key gender considerations in One Health research for development - with a focus on Low-and Middle-Income Countries. The framework encourages developing two types of research questions at multiple stages of the research process: those with a bioscience entry-point and those with a gender entry-point. Gender considerations at each stage of research, institutional support required, and intervention approaches is described in the framework. We also give an applied example of the framework as it might be used in One Health research. Incorporation of gender questions in One Health research supports progress toward more equitable, sustainable, and effective One Health interventions. We hope that this framework will be implemented and optimized for use across many One Health challenge areas with the goal of mainstreaming gender into One Health research.