Schistosomiasis infection in pre-school aged children in Uganda: a qualitative descriptive study to identify routes of exposure

Abstract

Background Prevalence of schistosomiasis is high among children under five years in Uganda. Schistosomiasis control efforts over time have included periodic mass treatments in endemic areas for adults and school going children aged 5 years and above. This study explores behaviour practices of children age 2–4 years that increase the risk of schistosomiasis infection in this age group. Methods A qualitative descriptive study was conducted using in-depth interviews with 30 caregivers of children aged 2–4 years who tested positive for schistosomiasis in a national prevalence survey in 2017. Observations were done at water bodies where young children go with caretakers or other older children. The study was conducted in three Ugandan sub-regions of West Nile and East-central, and South-western with high, and low prevalence of schistosomiasis, respectively. Data were thematically analysed. Anonymised supporting photos from observations are also presented. Results Knowledge about schistosomiasis transmission was poor among caregivers, who concurrently had mixed right and wrong information. Reported avenues for contracting schistosomiasis included both correct: contact activities with infested water, and incorrect modes: contact with dirty water, sharing bathrooms, witchcraft, polluted air and contaminated food. The children in this study could have contracted schistosomiasis through the contact with infested water during activities such as bathing and playing, while their caregivers washed clothes, collected snail shells for poultry feeds, fetched water at the water bodies. These activities were reported by caregivers and observed in all study areas. Evidence of open defecation and urination in and near water bodies by adults and children was also observed. Conclusions Pre-school children age 2–4 years are at a high risk of exposure to schistosomiasis while caretakers conduct activities in infested water bodies. There is need for prevention interventions to target children in their early stages of life to control schistosomiasis in this vulnerable population.

The prevalence of schistosomiasis in Uganda: A nationally representative population estimate to inform control programs and water and sanitation interventions

“…The high prevalence rate among children aged 2 to 4 years old also provides insight into how national control campaigns, that focus on drug delivery to school aged children, may have shifted the peak of age-based infection profiles to the preschool age groups, which previously peaked among school-aged children [1, 22, 48]. Preschool aged children may be spreading schistosomiasis as they engage in high risk activities for contaminating water bodies such as bathing and playing in surface water while their caregivers wash clothes [49]. The practical implication of this is that school-based treatments may be insufficient to reduce the disease burden in children [50] and there is a need to formulate a child-appropriate praziquantel tablet that can be safely administered to preschool aged children in control programs [51].…”

Prevalence of intestinal schistosomiasis in pre-school aged children: a pilot survey in Marolambo District, Madagascar

“…Across sub-Saharan Africa there is increasing recognition of schistosome infection among PSAC [ 20 , 21 ]. Untreated, chronic infection leads to significant and detrimental effects on health, including stunting, wasting, anaemia, reduced exercise tolerance, impaired cognitive development or even death from the consequences of periportal liver fibrosis [ 4 , 10 ].…”

“…In Marolambo, communities rely on the Nosivolo river as their main water source, for drinking, washing, cooking and transport; safer, alternative water sources are limited [ 3 ]. PSAC are at increased risk of infection and re-infection through passive water contact if caregivers regularly come into contact with infested water sources [ 21 ]. Strategies to combat this will have important impacts on transmission in children, particularly those less than 3-years of age [ 32 ].…”

Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

“…Moreover, carrying out MDAs through schools also relies on the strength of the education system -and indeed, deworming coverage in Kenya varies by county, according to the quality of education system (Nikolay et al, 2015). Additionally, school-based MDAs exclude children below school age -and, for example, as Kibira et al (2019) note, these children are at high risk of schistosomiasis and have the highest rates of schistosomiasis infection in Uganda.…”

“…Tailor MDA delivery systems to the local region and the disease treated: For example, consider whether a school-based MDA will effectively and equitably ensure high coverage, or whether a community-based approach would be better suited to the region (Amazigo et al, 2012). This could depend on the rates of schooling in the area, the strength of the education system (Nikolay et al, 2015), and the age-group most affected by the specific disease (Kibira et al, 2019). Such effective targeting of MDAs is key to achieving equitable coverage (i.e.…”