Authors
M Kenneth Anyolitho2; K Poels1; T Huyse3; J Tumusiime2; F Mugabi2; C Tolo2; C Masquillier1; V Nyakato2; 1 University of Antwerp, Belgium; 2 Mbarara University of Science and Technology, Uganda; 3 Royal Museum for Central Africa, Tervuren, Belgium, Belgium Discussion
Introduction: In Uganda, the continued schistosomiasis infections and re-infections might indicate that there are some barriers to implemented interventions like the Mass Drug Administration and sensitisation. We conducted a study in Kagadi and Ntoroko districts of the southwest of Lake Albert, to assess the community’s knowledge, attitudes and practices regarding schistosomiasis, and to explore and understand their perspectives about the disease in order to inform the design and implementation of contextualised awareness campaigns.
Materials and methods: We used systematic random sampling to select 337 household adults to whom we administered semi-structured survey questionnaires. We also purposively sampled 12 participants for an in-depth interview and 251 individuals with whom we held 28 focus group discussion sessions respectively. We analysed quantitative data using frequency, percentages and Chi-square tests of associations and analysed qualitative data thematic-wise.
Findings: Knowledge: From the survey sample, 98.5% of the respondents had heard about schistosomiasis, 81.3% mentioned contact with water as the main transmission mode, 78% said belly enlargement was a symptom, while 75.8% and, 67.5% mentioned avoiding contact with water as a preventive way and signs and symptoms as a form of diagnosis respectively. Attitude: 98.4% of the respondents acknowledged that it is important to use latrines, 96.6% agreed that the disease is serious, while only 73.4% felt that it is important to avoid contact with water. Furthermore, participants in the qualitative phase reported that whereas it is important to avoid contact with the lake, it is not possible to do so because the lake is their only source of livelihoods. Practice: 46% of the respondents in the survey mentioned the lake as their common source of water. Open defecation was reported to be a common practice, especially along the lake due to insufficient space and difficulties in construction. Statements that lake water is safe since it has been used for a long time, and defecating in the lake enables the faeces to act as a bait for fish catch were some of the reported myths by participants in the qualitative phase.
Conclusions and recommendation: Although there is sufficient knowledge of signs and symptoms, and the transmission modes regarding schistosomiasis, inadequate knowledge especially of diagnosis is still a challenge. Further, despite the positive attitudes regarding schistosomiasis prevention, the existing myths and misconceptions surrounding the disease could be socio-cultural barriers contributing to the persistent risky water, sanitation and hygiene practices. Therefore, there is a need for a more robust community-based awareness intervention to address these barriers by considering the local contexts that concern the deeply rooted habits and beliefs. Further research to integrate insights from an ethnographical method like participant observation and habit change strategies from behavioural sciences could form a fruitful approach to develop interventions that use bottom-up approaches for behavioural change. 
