HEALTH EDUCATION AND THE CONTROL OF UROGENITAL SCHISTOSOMIASIS: ASSESSING THE IMPACT OF THE JUMA NA KICHOCHO COMIC-STRIP MEDICAL BOOKLET IN ZANZIBAR.

Endeavours to control urogenital schistosomiasis on Unguja Island (Zanzibar) have focused on school-aged children. To assess the impact of an associated health education campaign, the supervised use of the comic-strip medical booklet Juma na Kichocho by Class V pupils attending eighteen primary schools was investigated. A validated knowledge and attitudes questionnaire was completed at baseline and repeated one year later following the regular use of the booklet during the calendar year. A scoring system (ranging from 0.0 to 5.0) measured children's understandings of schistosomiasis and malaria, with the latter being a neutral comparator against specific changes for schistosomiasis. In 2006, the average score from 751 children (328 boys and 423 girls) was 2.39 for schistosomiasis and 3.03 for malaria. One year later, the score was 2.43 for schistosomiasis and 2.70 for malaria from 779 children (351 boys and 428 girls). As might be expected, knowledge and attitudes scores for schistosomiasis increased (+0.05), but not as much as originally hoped, while the score for malaria decreased (-0.33). According to a Kolmogorov-Smirnov test, neither change was statistically significant. Analysis also revealed that 75% of school children misunderstood the importance of reinfection after treatment with praziquantel. These results are disappointing. They demonstrate that it is mistaken to assume that knowledge conveyed in child-friendly booklets will necessarily be interpreted, and acted upon, in the way intended. If long-term sustained behavioural change is to be achieved, health education materials need to engage more closely with local understandings and responses to urogenital schistosomiasis. This, in turn, needs to be part of the development of a more holistic, biosocial approach to the control of schistosomiasis.

Some social determinants of urinary schistosomiasis in Northern Cameroon: implications for schistosomiasis control.

The present study was designed to assess the perceptions of hematuria, the most conspicuous sign of urinary schistosomiasis, in selected communities of the sudano-sahelian zone of Cameroon. Study questionnaires related to knowledge, beliefs and stigma associated with hematuria were administered to 964 pupils from 15 randomly selected schools. In order to ascertain children perceptions, we interviewed 143 adults living less than 2 kilometers from the target school. School children provided urine samples that were examined using the dip stick and sedimentation methods. Exposure to sun was the most reported cause of hematuria (53% adult and 62% children respondents), followed by drinking of dirty water (18% adults and 41% children). Only 15% of adult and 26% school children could relate hematuria to wading, a common means of exposure to urinary schistosomiasis. More than half of the school children stated that hematuria was a sign of disease (56%). Few pupils perceived hematuria to be a sign of strength (6%), while others related it to puberty (30%). Most pupils (80%) reported that hematuria was preventable while others (20% ) ascribed it to witchcraft. Pupils reported that hematuria could be cured in the hospital (65%), by the traditional healer (21%), or by reading Holy Scriptures (14%). Some respondents (35% of adult, and 40% of school children) stated that it was shameful to have blood in urine. Almost half of the adult respondents and 26% of the school children reported that hematuria was contagious. Boys and girls had similar levels of oviuria (OR=0.79 p>0.05), but boys were 4 times more likely to report hematuria (OR= 3.62, p<0.001). There was a poor understanding of the means of exposure, transmission and treatment of hematuria. Some aspects of the perceptions of hematuria reported herein corroborate with previous studies carried out in Cameroon, Niger, Ghana, Kenya and Tanzania. They should be considered, together with other socioeconomic and cultural determinants in the design of educational messages applicable to the study region.

Schistosomiasis and the use of indigenous plant molluscicides: a rural South African perspective.

In the last decade plant molluscicides have received considerable attention in the search for cheaper alternatives to chemotherapy and synthetic molluscicides in schistosomiasis control. The attraction of a locally grown molluscicidal plant is based on the development of a philosophy of self-reliance and community involvement. This approach is dependent on community recognition of the infection as a public health problem and their acceptance of proposed control measures. The objectives of this study were: (i) firstly, to assess the knowledge of schistosomiasis in a rural community and their attitude to the use of indigenous plant molluscicides; (ii) secondly, to assess the prevalence and intensity of infection in relation to its severity as perceived within the community. Study sites were located at Mtwalume (KwaZulu-Natal, South Africa). Sixty-nine community members were interviewed during six focus-group interviews and two depth interviews. Urine and stool samples (354 and 306, respectively) from children and young adults (2-25 years old) were analysed for Helminth and Protozoal infections. Results indicate that despite a poor understanding of schistosomiasis, it is a primary health concern for those dependent on river-water for their water requirements. Concern for schistosomiasis is indeed matched by a prevalence of 75.14% for Schistosoma haematobium. Oral antischistosomal drugs are inaccessible primarily due to the cost of transport and secondarily, due to the cost of treatment. The concept of molluscicidal control, as an alternative, was enthusiastically received by all respondents.