Knowledge, attitudes, and practices regarding schistosomiasis infection and prevention: A mixed-methods study among endemic communities of western Uganda

Abstract

Introduction In Uganda, schistosomiasis (re)infections have continued to remain high despite the implementation of mass drug administration and sensitization campaigns aimed at controlling the disease. This could imply that there are some barriers to the implemented preventive measures. We conducted a mixed-methods study in Kagadi and Ntoroko districts around Lake Albert to assess knowledge, attitudes, and practices regarding schistosomiasis and to explore and understand perspectives regarding the disease. Materials and methods Semi-structured survey questionnaires were administered to 337 household adults selected through systematic random sampling. We also interviewed 12 participants and held 28 focus-group discussion sessions with 251 individuals respectively. Quantitative data was analysed using frequencies, percentages, and chi-square tests for associations, while themes and sub-themes were used to analyse qualitative data respectively. Findings A total of 98.5%, 81.3%, and 78.5% had heard about schistosomiasis, and knew the main transmission modes and symptoms, respectively. The majority (75.8%) said avoiding contact with water was a preventative way, while 67.5% said observing signs and symptoms was a form of diagnosis. Furthermore, 98.4% and 73.4% said it was important to defecate in latrines and to avoid contact with contaminated water respectively. However, it is difficult to avoid contact with lake water because it is the only source of livelihood, especially for fisher communities. Open defecation is commonly practiced along the lake due to insufficient space and difficulties in the construction of latrines. Myths and misconceptions reported include; lake water is safe, gassing in water causes transmission, fetching water early in the morning and from deep water is safe, and feces in the lake water act as a bait for catching fish. Conclusions and recommendations Despite adequate knowledge of schistosomiasis and a positive attitude towards its prevention, existing myths and misconceptions, coupled with persistent risky water, sanitation, and hygiene practices still pose a challenge. A more robust community-based awareness intervention using bottom-up participatory approaches, accompanied by the provision of clean and safe water sources and increasing latrine coverage, could provide lasting solutions to these barriers. Author summary Schistosomiasis is one of the leading neglected tropical diseases, second to malaria in prevalence. In Uganda, more than 10 million people (25.6%) are currently infected, with prevalence in some areas as high as 90%, and more than 55% of the population is at risk. The most at-risk populations are the fishing communities and school-aged children. Despite the government’s prevention and control programs such as mass drug administration (MDA) and sensitization, infections and re-infections have continued to occur, even in areas where MDA has been implemented. Previous studies have linked this with risky behavior. However, information from western Uganda is inadequate. We conducted a mixed-methods study to assess community knowledge, attitudes, and practices, and to understand their opinions and perspectives regarding the disease. The study found that, whereas there is adequate knowledge of schistosomiasis and although there is a positive attitude toward avoiding water contact and the use of latrines, it is difficult to do so, something that could explain the persistent risky practices. The risky practices could also be compounded by myths and misconceptions surrounding the disease. These findings shall form the basis for the design and implementation of contextualized, community-based, participatory communication tools for behavior change. Community involvement in schistosomiasis prevention programs could lead to increased awareness about disease prevention and could debunk existing myths and misconceptions, thereby improving behaviors, practices, and habits, ultimately lowering infection.