Understanding perceptions of schistosomiasis and its control among highly endemic lakeshore communities in Mayuge, Uganda.

BACKGROUND: Schistosomiasis is a neglected tropical disease and a serious global-health problem with over 230 million people requiring treatment, of which the majority live in Africa. In Uganda, over 4 million people are infected. Extensive parasitological data exist on infection prevalence, intensities and the impact of repeated praziquantel mass drug administration (MDA). However, how perceptions of schistosomiasis shape prevention and treatment practices and their implications for control measures are much less well understood. METHODS: Rapid ethnographic appraisals were performed for six weeks in each of three Schistosoma mansoni high endemicity communities on the shores of Lake Victoria, Mayuge District, Uganda. Data were collected between September 2017 and April 2018. Data were collected through structured observations, transect walks, and participant observation, and sixty in-depth interviews and 19 focus group discussions with purposively recruited participants. Data were analyzed thematically using iterative categorization, looking at five key areas: perceptions of 1) the symptoms of schistosomiasis; 2) the treatment of schistosomiasis; 3) how schistosomiasis is contracted; 4) how schistosomiasis is transmitted onwards and responsibilities associated with this; and 5) how people can prevent infection and/or onward transmission. RESULTS: Observations revealed open defecation is a common practice in all communities, low latrine coverage compared to the population, and all communities largely depend on lake water and contact it on a daily basis. Perceptions that a swollen stomach was a sign/symptom of 'ekidada' (caused by witchcraft) resulted in some people rejecting free praziquantel in favour of herbal treatment from traditional healers at a fee. Others rejected praziquantel because of its perceived side effects. People who perceived that schistosomiasis is caught from drinking unboiled lake water did not seek to minimize skin contact with infected water sources. Community members had varied perceptions about how one can catch and transmit schistosomiasis and these perceptions affect prevention and treatment practices. Open defecation and urinating in the lake were considered the main route of transmission, all communities attributed blame for transmission to the fishermen which was acknowledged by some fishermen. And, lastly, schistosomiasis was considered hard to prevent due to lack of access to safe water. CONCLUSION: Despite over 15 years of MDA and associated education, common misconceptions surrounding schistosomiasis exist. Perceptions people have about schistosomiasis profoundly shape not only prevention but also treatment practices, greatly reducing intervention uptake. Therefore, we advocate for a contextualized health education programme, alongside MDA, implementation of improved access to safe-water and sanitation and continued research.

Is it up to business, governments, or individuals to tackle the marine plastic problem? A hybrid mixed logit approach.

Marine plastic pollution is one of the most talked about environmental issues of our time. While marine plastic pollution generally originates from mismanaged waste from land, waste from ships and fishing gear produce a unique threat to the global seas. Using a choice experiment, we explore preference for a marine debris removal and prevention programme focusing on derelict fishing gear. Additionally, we explore preferences for increasing removal efforts of debris in the North Western Hawaiian Islands. We find overwhelming support for these interventions; however, we find evidence that change, and therefore subsequent action, is strongest for individuals who believe that governments hold the majority of the responsibility for reducing and cleaning plastic pollution in marine environments.

Impacts of host gender on Schistosoma mansoni risk in rural Uganda-A mixed-methods approach.

BACKGROUND: The World Health Organization identified Uganda as one of the 10 highly endemic countries for schistosomiasis. Annual mass drug administration (MDA) with praziquantel has led to a decline in intensity of Schistosoma mansoni infections in several areas. However, as hotspots with high (re)infection rates remain, additional research on risk factors and implementing interventions to complement MDA are required to further reduce disease burden in these settings. Through a mixed-methods study we aimed to gain deeper understanding of how gender may impact risk and reinfection in order to inform disease control programmes and ascertain if gender-specific interventions may be beneficial. METHODOLOGY/PRINCIPAL FINDINGS: In Bugoto, Mayuge District, Eastern Uganda we conducted ethnographic observations (n = 16) and examined epidemiology (n = 55) and parasite population genetics (n = 16) in school-aged children (SAC), alongside a community-wide household survey (n = 130). Water contact was frequent at home, school and in the community and was of domestic, personal care, recreational, religious or commercial nature. Qualitative analysis of type of activity, duration, frequency, level of submersion and water contact sites in children showed only few behavioural differences in water contact between genders. However, survey data revealed that adult women carried out the vast majority of household tasks involving water contact. Reinfection rates (96% overall) and genetic diversity were high in boys (pre-He = 0.66; post-He = 0.67) and girls (pre-He = 0.65; post-He = 0.67), but no differences in reinfection rates (p = 0.62) or genetic diversity by gender before (p = 0.54) or after (p = 0.97) treatment were found. CONCLUSIONS/SIGNIFICANCE: This mixed methods approach showed complementary findings. Frequent water exposure with few differences between boys and girls was mirrored by high reinfection rates and genetic diversity in both genders. Disease control programmes should consider the high reinfection rates among SAC in remaining hotspots of schistosomiasis and the various purposes and settings in which children and adults are exposed to water.

Non-monetary numeraires: Varying the payment vehicle in a choice experiment for health interventions in Uganda.

Schistosomiasis is a serious health problem in many parts of Africa which is linked to poor water quality and limited sanitation resources. We administered a discrete choice experiment on water access and health education in rural Uganda, focussing on interventions designed to reduce cases of the disease. Unlike previous studies, we included a payment vehicle of both labour hours supplied per week and money paid per month within each choice set. We were thus able to elicit both willingness to pay and willingness to work for alternative interventions. Respondents exhibit high demand for new water sources. From the random parameter model, only households with knowledge about water-borne parasites are price sensitive and exhibit willingness to pay values. Through a latent class model specification, higher income respondents exhibit higher willingness to pay values for all programme attributes; however, lower income participants have higher willingness to work values for certain new water sources. We found a shadow wage rate of labour that is between 15 and 55% of the market wage rate.