Sociocultural aspects of mass delivery of praziquantel in schistosomiasis control: the Abeokuta experience.

BACKGROUND: Schistosomiasis is a public health problem in Nigeria. Although there is an ongoing national program for its control, disease control programs in other countries have shown the need to understand the sociocultural aspects of disease transmission, prevention, and treatment in endemic communities before control efforts are undertaken. OBJECTIVE: To describe sociocultural factors that influence the distribution process of praziquantel for the mass treatment of schistosomiasis infection. METHODS: Data for the study were collected through focus group discussions held separately with adult males and females, male and female adolescents (13-19 years), and male and female children (5-12 years). In-depth interviews were similarly held with the drug distributors of praziquantel for mass treatment and with community/opinion leaders of six hyperendemic communities in Ogun State, Southwest Nigeria on mass treatment using praziquantel. These focus group discussions and in-depth interviews were held both before and following the drug distribution. The data were analyzed using the textual analysis program, Textbase Beta. RESULTS: Following a 3-week period of mass treatment in six communities, we observed an increased awareness of rivers/streams as a source of schistosomiasis. In addition, the communities reported overwhelming support for the mass treatment after receiving treatment. The reasons for this acceptance appear to include the perceived efficacy of praziquantel against the disease and its availability free of charge. The drug's distributors adhered to the originally specified systems-based protocol for mass treatment in only two of the six communities. The systems-based protocol adhered to strict distribution through primary health centers and schools. The four other communities used a community-based approach for mass treatment with praziquantel and attained greater coverage of treatment as a result. CONCLUSION: Obtaining community support and involvement before the implementation of mass treatment of schistosomiasis with praziquantel contributes to an effective treatment strategy for this disease. A detailed assessment of a community's health needs, before the initiation of the control efforts against endemic infections, should be undertaken.

Height as a substitute for weight for estimating praziquantel dosage.

The study evaluated height and weight measurements of 750 school children from five rural communities in western Nigeria. The measurements were taken by 12 trained community members designated as distributors in determining treatment dose with praziquantel for these children. A very strong correlation value, r=0.97, was obtained for the weight of treated children measured by the distributors and the research team. The distributors obtained a correlation coefficient value of r=0.87 on weight and height measurements, showing that height can be used by community distributors in lieu of weight for correct dose determination.

An assessment of parent-child communication on sexuality in lagos, Nigeria.

This study is the first phase of a project designed to help parents acquire skills necessary for comfortable and effective communication about adolescents' sexuality. It assessed parent-child communication on sexuality among the in-school adolescents in Lagos, Nigeria. It was observed that a high proportion of the adolescents interviewed receive information on sexuality from friends and the mass media and also communicate more with their friends on sexuality than with their parents.

Post-intervention Survey on the Knowledge, Attitude, Beliefs and Practices of People in Lagos State, Nigeria about HIV/AIDS.

The purpose of this study was to evaluate the impact of a mass-education campaign on knowledge, attitudes and practice of people leaving in Lagos State, Nigeria. A pre- and post-intervention survey was conducted among 6000 respondents from 116 administrative wards randomly selected from all the 20 Local Government Areas (LGA) in Lagos State (300 respondents per LGA) in January 2002 to document the effect of a series of communication interventions on the prevention of HIV/AIDS implemented between May and December 2001 in the state and to describe the changes that may have occurred in the knowledge base, attitude, beliefs and practices. The result showed that the level of knowledge is relatively high as indicated in both the pre- and post-intervention survey, though there was a gain in knowledge in some areas after the intervention. Respondent's practices as they relate to issues that cause the spread of the disease did not change significantly after the intervention. The study demonstrated that mass campaigns using multiple channels can be effective in HIV/AIDS prevention, with the observed positive change and the sustained level of awareness.

Distribution of the molecular forms of Anopheles gambiae and pyrethroid knock down resistance gene in Nigeria.

We investigated the distribution of the molecular M and S forms of Anopheles gambiae and the knock down resistance (kdr) gene associated with pyrethroid and DDT resistance in A. gambiae s.s. at 13 localities across Nigeria. Two-three days old adult female mosquito reared from larval collections were tested using standard WHO procedures, diagnostic test kits and impregnated papers to assess their pyrethroid resistance status. Specimens were identified by PCR assays and characterized for the kdr gene. DNA from adult A. gambiae s.s. collected from human dwellings were also tested for the presence of the kdr gene. The overall collection was a mix of the molecular M and S forms across the mangrove (63:37%), forest (56:44%), and transitional (36:64%) ecotypes, but almost a pure collection of the S form in the Guinea and Sudan-savanna. Results of insecticide susceptibility tests showed that mosquitoes sampled at seven localities were susceptible to permethrin, deltamethrin, and DDT, but populations of A. gambiae resistant to these insecticides were recorded at six other localities mainly in the transitional and Guinea-savanna ecotypes. The kdr gene was found only in the molecular S forms, including areas where both forms were sympatric. The overall kdr frequency was low: <47% in forest, 37-48% in the transitional, and 45-53% in Guinea-savanna. The data suggest that pyrethroid resistance in A. gambiae in Nigeria is not as widespread when compared to neighbouring West African countries.

Effectiveness of different approaches to mass delivery of praziquantel among school-aged children in rural communities in Nigeria.

Schistosomiasis is hyperendemic in Nigeria. The national policy on schistosomiasis control has adopted praziquantel as the main drug of use in the control strategy aimed at reducing morbidity. However, the best delivery channel for praziquantel in schistosomiasis control in Nigeria is yet to be determined. This study assessed different channels for praziquantel delivery in a mass treatment effort. Three groups, each of two communities, were assigned to one of the following three channels: health facility (HF), school, and community for mass delivery of praziquantel to school-aged children. Distributors were trained on all aspects of praziquantel distribution and sufficient praziquantel tablets were provided for the drug distribution within 3 weeks following which an evaluation of the drug distribution by the different treatment channels was conducted. Overall, the community channel of delivery achieved the best coverage of 72.2% (range: 69-73%) compared to 44.3% (range: 39.5-62%) and 28.5% (range: 26.3-74.5%) for the HF and school channels, respectively. Community channel of praziquantel delivery as shown in this study ensures good coverage of both in and out-of-school children.

Local knowledge and attitudes about onchocerciasis in Oji-River local government area of Enugu State, Nigeria.

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure. The majority are aware of the disease which they recognize once their body starts itching or musculoskeletal pain develops but only 64.4, 34.0, 1.4 and 3.6%, respectively attributed chronic itching, nodules, bad vision and leopard skin to blackfly bite. Other perceived causes mentioned include ageing, the type of food eaten, farm work and 'bad blood'. Only 0.8% knew diagnosis could be made through skin snips. Neither Oji-River nor any of the river systems were associated with any of the complications of onchocerciasis. Significant differences in most socio-demographic characteristics were associated with differences in the level of knowledge about the disease.

Knowledge and beliefs about causes, transmission, treatment and control of human onchocerciasis in rural communities in south western Nigeria.

Descriptive and quantitative information on onchocerciasis transmission and control were collected using focus group discussions and structured questionnaire to determine what changes if introduced, could upset the established human-vector-parasite relationship in limiting transmission. People's knowledge of cause of infection and transmission was very poor. Of the 1012 people interviewed, only 3% related the clinical manifestations of onchocerciasis to Simulium bites. Thirty six percent had no idea of the cause of infection while the rest attributed the clinical symptoms of the disease to many other causes. People's knowledge of the current treatment and control measures was also poor. However an impressive knowledge of the daily and seasonal distribution of Simulium flies was observed. The study identifies the need for health education campaigns aimed at relating the clinical manifestations of onchocerciasis to Simulium bites. This could help people in taking personal protective measures and seeking appropriate treatment.