Biosocial Determinants of Persistent Schistosomiasis among Schoolchildren in Tanzania despite Repeated Treatment

Abstract

Schistosomiasis is a parasitic disease endemic to Tanzania and other countries of the global south, which is currently being addressed through preventive chemotherapy campaigns. However, there is growing recognition that chemotherapy strategies will need to be supplemented to sustainably control and eventually eliminate the disease. There remains a need to understand the factors contributing to continued transmission in order to ensure the effective configuration and implementation of supplemented programs. We conducted a cross-sectional questionnaire, to evaluate the biosocial determinants facilitating the persistence of schistosomiasis, among 1704 Tanzanian schoolchildren residing in two districts undergoing a preventive chemotherapeutic program: Rufiji and Mkuranga. A meta-analysis was carried out to select the diagnostic questions that provided a likelihood for predicting infection status. We found that self-reported schistosomiasis continues to persist among the schoolchildren, despite multiple rounds of drug administration.Using mixed effects logistic regression modeling, we found biosocial factors, including gender, socio-economic status, and water, sanitation, and hygiene (WASH)-related variables, were associated with this continued schistosomiasis presence. These findings highlight the significant role that social factors may play in the persistence of disease transmission despite multiple treatments, and support the need not only for including integrated technical measures, such as WASH, but also addressing issues of poverty and gender when designing effective and sustainable schistosomiasis control programs.

A Systematic Review of Water and Gender Interlinkages: Assessing the Intersection With Health

“…In total, 16 (48%) studies assessed childhood health and childhood infectious diseases, mainly centering on under-five mortality (15%), schistosomiasis/intestinal parasites (18%), and childstunting (12%). Concretely, studies showed that maternal, or household access to clean water significantly reduced the risk of under-five mortality (Ahmed et al, 2016;Acheampong et al, 2017Acheampong et al, , 2018, child stunting (Akombi et al, 2017;Vos et al, 2017;Marinda et al, 2018), schistosomiasis (Atalabi et al, 2016;Donohue et al, 2017), and hookworm infections (Baker et al, 2018). Household piped water was one of the three stability factors needed to reduce HIV transmission for newborn infants (Doherty et al, 2007).…”

“…Outside of the home, exposure to open water near schools increases the risk of schistosomiasis (Kapito-Tembo et al, 2009). Other aspects of WASH, including improved sanitation and handwashing, likewise reduced underfive mortality (Ahmed et al, 2016;Dendup et al, 2018), and schistosomiasis (Donohue et al, 2017), or acquiring other soiltransmitted helminths and parasites (Baker et al, 2018). In addition to the availability of sustainable WASH resources, maternal factors contributed to health burdens.…”

“…In assessing whether women and girls were at higher risk for health burdens, most studies focused on children determining that boys were at greater risk for contracting both schistosomiasis (Kapito-Tembo et al, 2009;Ugbomoiko et al, 2009;Atalabi et al, 2016;Donohue et al, 2017) and hookworm infections (Baker et al, 2018) as well as stunting (Akombi et al, 2017) which is in line with a well-documented propensity for increased mortality among male children (World Health Organization, 2011). A single study directly analyzed the effect of gender on the frequency of waterborne diseases in adults, and found no gender differences (Al-Delaimy et al, 2014).…”

“…Maternal and household access to improved WASH reduced the risk for childhood infections, stunting, and mortality. Doherty et al, 2007;Kapito-Tembo et al, 2009;Ahmed et al, 2016;Atalabi et al, 2016;Acheampong et al, 2017Acheampong et al, , 2018Akombi et al, 2017;Donohue et al, 2017;Vos et al, 2017;Baker et al, 2018;Marinda et al, 2018 Maternal socioeconomic, demographic, and health indicators reduce the risk for childhood disease. Nasr et al, 2013;Atalabi et al, 2016;Hasan and Richardson, 2017;Akachi et al, 2018;Dendup et al, 2018;Marinda et al, 2018;Prado et al, 2019 Boys were at greater risk than girls for childhood disease.…”

“…Nasr et al, 2013;Atalabi et al, 2016;Hasan and Richardson, 2017;Akachi et al, 2018;Dendup et al, 2018;Marinda et al, 2018;Prado et al, 2019 Boys were at greater risk than girls for childhood disease. Kapito-Tembo et al, 2009;Ugbomoiko et al, 2009;Atalabi et al, 2016;Akombi et al, 2017;Donohue et al, 2017;Baker et al, 2018 Women's role as the primary water purveyor increased the risk for musculoskeletal disorders and facilitated exposure to waterbourne toxins, including heavy metals (e.g., lead), Dichlorodiphenyldichloroethylene (DDE) and Dichloroduphenyltrichloroehtane (DDT). Gaspar et al, 2017;Geere et al, 2018;Guy et al, 2018 Among adults, sex did no impact the risk for disease.…”