Treating schistosomiasis among South African high school pupils in an endemic area, a qualitative study

Andrea Lothe, Nqobile Zulu, Arne Olav Øyhus, Eyrun Floerecke Kjetland, Myra Taylor, Andrea Lothe, Nqobile Zulu, Arne Olav Øyhus, Eyrun Floerecke Kjetland, Myra Taylor

Abstract

Background: Schistosomiasis, a neglected tropical disease caused by parasites that infest open water sources such as rivers and dams may increase susceptibility to HIV. Mass-treatment with praziquantel tablets, recommended by the World Health Organization reduces the prevalence of schistosomiasis. The goal in endemic areas is 75% treatment participation in every treatment round (e.g. yearly). However, in rural Ugu district, KwaZulu-Natal, South-Africa there was low participation among pupils in a Department of Health Mass-Treatment Campaign for schistosomiasis.

Methods: Nested in a large study on schistosomiasis the study was conducted in 2012 over 4 months using qualitative methods with the Health Belief Model as the conceptual framework. Purposive sampling was done. Focus Group Discussions were undertaken at six schools in grades 10-12. Individual in-depth interviews were held with one teacher and two pupils at each school. In addition three traditional healers and a community health worker were interviewed.

Results: The severity of schistosomiasis was not recognised and neither was the pupils' susceptibility. Barriers to treatment included confusing S, haematobium symptoms with sexually transmitted infections, teasing and stigma.

Conclusions: Increased knowledge, health literacy for treatment, and correct understanding about the severity of schistosomiasis may provide cues to action. The study indicates that comprehensive information may increase pupil participation in mass-treatment and decrease schistosomiasis prevalence.

Trial registration: This study was registered with clinicaltrials.gov registry database and the registration number is NCT01154907 30 June 2011.

Keywords: Health Belief Model; Mass-Treatment Campaign; Pupils; Schistosomiasis; South Africa.

Conflict of interest statement

Ethics approval and consent to participate

Four ethics’ committees had granted permission to conduct the research: the Biomedical Research Ethics Committee, University of KwaZulu-Natal, (Ref BF029/07), the KwaZulu-Natal Department of Health, Pietermaritzburg, (Ref HRKM010-08), the Norwegian ethics committee, Regional Etisk Komité Øst-Norge (REK-Øst), (Ref 469-07066a1. 2007. 535) and The European Group on Ethics in Science and New Technologies (Ref IRSES-2010:269245). Four main principles in research ethics were applied in this study; to cause no harm to the participants, to obtain informed consent, to protect participants, and not to deceive the participants.

Consent for publication

All participants signed individual consent forms with consent to publish.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Rosenstock’s Health Belief Model Adapted from Rosenstock [23]
Fig. 2
Fig. 2
Who would you tell if you had schistosomiasis

References

    1. Schistosomiasis. . Accessed 16 Oct 2016.
    1. King CH. It's time to dispel the myth of "asymptomatic" schistosomiasis. PLoS Negl Trop Dis. 2015;9(2):e0003504. doi: 10.1371/journal.pntd.0003504.
    1. Downs JA, Dupnik KM, van Dam GJ, Urassa M, Lutonja P, Kornelis D, De Dood CJ, Hoekstra P, Kanjala C, Isingo R, et al. Effects of schistosomiasis on susceptibility to HIV-1 infection and HIV-1 viral load at HIV-1 seroconversion: a nested case-control study. PLoS Negl Trop Dis. 2017;11(9):1–15. doi: 10.1371/journal.pntd.0005968.
    1. Brodish PH, Singh K. Association between Schistosoma haematobium exposure and human immunodeficiency virus infection among females in Mozambique. Am J Trop Med Hyg. 2016;94(5):1040–1044. doi: 10.4269/ajtmh.15-0652.
    1. Kleppa E, Ramsuran V, Zulu S, Karlsen GH, Bere A, Passmore JA, Ndhlovu P, Lillebo K, Holmen SD, Onsrud M, et al. Effect of female genital schistosomiasis and anti-schistosomal treatment on monocytes, CD4+ T-cells and CCR5 expression in the female genital tract. PLoS One. 2014;9(6):e98593. doi: 10.1371/journal.pone.0098593.
    1. Mbabazi PS, Andan O, Fitzgerald DW, Chitsulo L, Engels D, Downs JA. Examining the relationship between urogenital schistosomiasis and HIV infection. PLoS Negl Trop Dis. 2011;5(12):e1396. doi: 10.1371/journal.pntd.0001396.
    1. Jourdan PM, Holmen SD, Gundersen SG, Roald B, Kjetland EF. HIV target cells in Schistosoma haematobium-infected female genital mucosa. Am J Trop Med Hyg. 2011;85(6):1060–1064. doi: 10.4269/ajtmh.2011.11-0135.
    1. Kjetland EF, Ndhlovu PD, Gomo E, Mduluza T, Midzi N, Gwanzura L, Mason PR, Sandvik L, Friis H, Gundersen SG. Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS. 2006;20(4):593–600. doi: 10.1097/01.aids.0000210614.45212.0a.
    1. Neglected Tropical Diseases. . Accessed 2 Jul 2015.
    1. King CH. Parasites and poverty: the case of schistosomiasis. Acta Trop. 2010;113(2):95–104. doi: 10.1016/j.actatropica.2009.11.012.
    1. Colley DG, Bustinduy AL, Secor WE, King CH. Human schistosomiasis. Lancet. 2014;383(9936):2253–2264. doi: 10.1016/S0140-6736(13)61949-2.
    1. Nour NM. Schistosomiasis: health effects on women. Rev Obstet Gynecol. 2010;3(1):28–32.
    1. Kjetland EF, Ndhlovu PD, Kurewa EN, Midzi N, Gomo E, Mduluza T, Friis H, Gundersen SG. Prevention of gynecologic contact bleeding and genital sandy patches by childhood anti-schistosomal treatment. AJTMH. 2008;79(1):79–83.
    1. Hotez PJ, Kamath A. Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden. PLoS Negl Trop Dis. 2009;3(8):e412. doi: 10.1371/journal.pntd.0000412.
    1. Appleton CC, Naidoo I. Why did schistosomiasis disappear from the southern part of the eastern cape? S Afr J Sci. 2012;108(1/2):1–11. doi: 10.4102/sajs.v108i1/2.411.
    1. Berge ST, Kabatereine NB, Gundersen SG, Taylor M, Kvalsvig JD, Mkhize-Kwitshana Z, Jinabhai CC, Kjetland EF. Generic praziquantel in South Africa: the necessity for policy change to avail cheap, safe and efficacious schistosomiasis drugs to the poor, rural population. S Afr J Epidemiol Infect. 2011;26(1):22–25.
    1. Chitsulo L, Engels D, Montresor A, Savioli L. The global status of schistosomiasis and its control. Acta Trop. 2000;77(1):41–51. doi: 10.1016/S0001-706X(00)00122-4.
    1. Fenwick A, Webster JP, Bosque-Oliva E, Blair L, Fleming FM, Zhang Y, Garba A, Stothard JR, Gabrielli AF, Clements AC, et al. The schistosomiasis control initiative (SCI): rationale, development and implementation from 2002-2008. Parasitology. 2009;136(13):1719–1730. doi: 10.1017/S0031182009990400.
    1. WHO: Helminth control in school-age children. A guide for managers of control programmes: preventive chemotherapy and transmission control (PCT), 2nd edn. Geneva: World Health Organization; 2011.
    1. WHO urges increased access to praziquantel as schistosomiasis treatment coverage improves. . Accessed 16 Sept 2016.
    1. Schistosomiasis: Strategy. . Accessed 2 Jul 2015.
    1. Randjelovic A, Frønæs SG, Munsami M, Kvalsvig JD, Zulu SG, Gagai S, Maphumulo A, Sandvik L, Gundersen SG, Kjetland EF, et al. A study of hurdles in mass treatment of schistosomiasis in KwaZulu-Natal, South Africa. S Afr Fam Pract. 2015;57(2):57–61.
    1. Rosenstock IM. The health belief model: explaining health behaviour through expectancies. In: Glanz K, Rimer BK, Viswanath K, editors. Health behaviour and health education: theory, research and practice volume XXXI. San francisco: The Jossey Bass Health Series; 1990. pp. 439–462.
    1. Jacobs A. Life orientation as experienced by learners: a qualitative study in north-West Province. J Educ. 2011;31(2):212–23.
    1. Tuhebwe D, Bagonza J, Kiracho EE, Yeka A, Elliott AM, Nuwaha F. Uptake of mass drug administration programme for schistosomiasis control in Koome Islands, Central Uganda. PLoS One. 2015;10(4):e0123673. doi: 10.1371/journal.pone.0123673.
    1. O'Farrell N. Genital ulcers, stigma, HIV, and STI control in sub-Saharan Africa. Sex Transm Infect. 2002;78(2):143–146. doi: 10.1136/sti.78.2.143.
    1. Weiss MG, Ramakrishna J, Somma D. Health-related stigma: rethinking concepts and interventions 1. Psychol Health Med. 2006;11(3):277–287. doi: 10.1080/13548500600595053.
    1. Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Lancet. 2006;367(9509):536–538. doi: 10.1016/S0140-6736(06)68189-0.
    1. Sen A. Social exclusion: concept, application, and scrutiny. Manila: Office of Environment and Social Development, Asian Development Bank; 2000.
    1. Ribera JM, Grietens KP, Toomer E, Hausmann-Muela S. A word of caution against the stigma trend in neglected tropical disease research and control. PLoS Negl Trop Dis. 2009;3(10):e445. doi: 10.1371/journal.pntd.0000445.
    1. Hotez P, Ottesen E, Fenwick A, Molyneux D. The neglected tropical diseases: the ancient afflictions of stigma and poverty and the prospects for their control and elimination. Adv Exp Med Biol. 2006;582:23–33. doi: 10.1007/0-387-33026-7_3.
    1. Takougang I, Meli J, Fotso S, Angwafo F, Kamajeu R, Ndumbe PM. Some social determinants of urinary schistosomiasis in northern Cameroon: implications for schistosomiasis control. Afr J Health Sci. 2004;11(3–4):111–120.
    1. Ugu District Municipality . 2008/09 IDP review: executive summary. Ugu: Ugu District Municipality; 2009.
    1. Ugu District Municipality. Geneva: 2011/12 IDP Review: Ugu District Municipality; 2012.
    1. Craig AP, Richter-Strydom LM. Unplanned pregnancies among urban Zulu schoolgirls. Community research as preparation for intervention. S Afr Med J. 1983;63(12):452–455.
    1. Kjetland EF, Kurewa EN, Ndhlovu PD, Gwanzura L, Mduluza T, Gomo E, Midzi N, Mason PR, Friis H, Gundersen SG. Female genital schistosomiasis - a differential diagnosis to sexually transmitted disease: genital itch and vaginal discharge as indicators of genital S. Haematobium morbidity in a cross-sectional study in endemic rural Zimbabwe. Trop Med Int Health. 2008;13(12):1509–1517. doi: 10.1111/j.1365-3156.2008.02161.x.
    1. Poggensee G, Feldmeier H, Krantz I. Schistosomiasis of the female genital tract: public health aspects. Parasitol Today. 1999;15(9):378–381. doi: 10.1016/S0169-4758(99)01497-0.
    1. Galappaththi-Arachchige HN, Amlie Hegertun IE, Holmen S, Qvigstad E, Kleppa E, Sebitloane M, Ndhlovu PD, Vennervald BJ, Gundersen SG, Taylor M, et al. Association of Urogenital Symptoms with history of water contact in young women in areas endemic for S. Haematobium. A cross-sectional study in rural South Africa. Int J Environ Res Public Health. 2016;13(11):1–12. doi: 10.3390/ijerph13111135.
    1. Hegertun IEA, Sulheim Gundersen KM, Kleppa E, Zulu SG, Gundersen SG, Taylor M, Kvalsvig JD, Kjetland EF. S. Haematobium as a common cause of genital morbidity in girls: a cross-sectional study of children in South Africa. PLoS Negl Trop Dis. 2013;7(3):e2104. doi: 10.1371/journal.pntd.0002104.
    1. Kjetland EF, Leutscher PD, Ndhlovu PD. A review of female genital schistosomiasis. Trends Parasitol. 2012;28(2):58–65. doi: 10.1016/j.pt.2011.10.008.
    1. Leutscher PD, Ramarokoto CE, Reimert C, Feldmeier H, Esterre P, Vennervald BJ. Community-based study of genital schistosomiasis in men from Madagascar [letter] Lancet. 2000;355(9198):117–118. doi: 10.1016/S0140-6736(99)04856-4.
    1. Leutscher PD, Ramarokoto CE, Hoffmann S, Jensen JS, Ramaniraka V, Randrianasolo B, Raharisolo C, Migliani R, Christensen N. Coexistence of urogenital schistosomiasis and sexually transmitted infection in women and men living in an area where Schistosoma haematobium is endemic. Clin Infect Dis. 2008;47:775–82. doi: 10.1086/591127.
    1. Stecher CW, Kallestrup P, Kjetland EF, Vennervald B, Petersen E. Considering treatment of male genital schistosomiasis as a tool for future HIV prevention: a systematic review. Int J Public Health. 2015;60(7):839–848. doi: 10.1007/s00038-015-0714-7.
    1. Crawford TA. Seeking help for psychological distress: the interface of Zulu traditional healing and western biomedicine. Ment Health Relig Cult. 2004;7:131–148. doi: 10.1080/13674670310001602463.
    1. Ngubane H. Body and mind in Zulu medicine. An ethnography of health and disease in Nyuswa-Zulu thought and practice. 2008.
    1. Scholtz HJ, Phillips VM, Knobel GJ. Muti or ritual murder. Forensic Sci Int. 1997;87(2):117–123. doi: 10.1016/S0379-0738(97)02132-4.
    1. Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J. Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis. 2006;6(7):411–425. doi: 10.1016/S1473-3099(06)70521-7.
    1. Richter LM, Desmond C. Targeting AIDS orphans and child-headed households? A perspective from national surveys in South Africa, 1995-2005. AIDS Care. 2008;20(9):1019–1028. doi: 10.1080/09540120701842738.
    1. King CH. Toward the elimination of schistosomiasis. N Engl J Med. 2009;360(2):106–109. doi: 10.1056/NEJMp0808041.
    1. Gurarie D, Yoon N, Li E, Ndeffo-Mbah M, Durham D, Phillips AE, Aurelio HO, Ferro J, Galvani AP, King CH. Modelling control of Schistosoma haematobium infection: predictions of the long-term impact of mass drug administration in Africa. Parasit Vectors. 2015;8:529. doi: 10.1186/s13071-015-1144-3.
    1. Knopp S, Mohammed KA, Ali SM, Khamis IS, Ame SM, Albonico M, Gouvras A, Fenwick A, Savioli L, Colley DG, et al. Study and implementation of urogenital schistosomiasis elimination in Zanzibar (Unguja and Pemba islands) using an integrated multidisciplinary approach. BMC Public Health. 2012;12:930. doi: 10.1186/1471-2458-12-930.

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