Effectiveness of Schistosomiasis Control Programmes and Assessing Factors Contributing to Re-infections in Risk Populations in Uganda: A Grounded Theory and Qualitative Study

Abstract

Objective: This study's aim was to document risk population's, including school children’s perspectives regarding risk behaviours and effectiveness of therapeutic modes in management of schistosomiasis. Methods: A grounded theory and qualitative approach was employed in two risk districts in Uganda. Methods including interviews were conducted with selected school children, 21 fishermen and 17 sand miners. Key informants were 2 District Health Officers, 15 head-teachers, 4 Village Health teams, 8 science teachers, 4 professional health workers, 2 officials from the Ministry of Health /Vector Control Division (MOH/VCD). In addition data was collected through 6 focus group discussions with parents, guardians, school children. Observation was done by three researchers and research assistant in each selected school and surrounding communities and fishing villages. The team also observed risk behaviors for schistosomiasis and practices around lake Victoria in Wakiso district and river Pager in Kitgum district. Results: One hundred purposively selected school children participated in focus group discussions and in-depth interview. We observed risk practices around the lake and river shores - and then discussed with fishermen (n=21) and sand miners (n=17) their perspectives about schistosomiasis control and treatment. Challenges in the chemotherapeutic approach include irregular supply of Praziquantel (PZQ), drug fatigue, side effects of Praziquantel, poor sanitation and treated people depended on infected waters for their livelihood. Respondents recommended repairing boreholes, immunizing/vaccinating against bilharzia, sensitizing people at risk about the importance of taking Praziquantel regardless of the side-effects. Conclusions: Schistosomiasis still remains one of the endemic neglected diseases in Uganda. There are both river and lake variants of S. mansoni. The persistence of bilharzia could be attributed to challenges in the chemotherapeutic approach, re-infection and new infections upon exposure to infected waters.