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Table 1 Summary of studies that were used in the scoping Review

From: Knowledge, attitudes and practices on Schistosomiasis in sub-Saharan Africa: a systematic review

Author/Year Study objectives Type of study Population/study location Summary of main findings
Community based KAP studies (n = 18)
Adoka et al. [39] / 2014 To assess the community’s knowledge and perceptions of schistosomiasis prevalence, transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. Cross-sectional study using semi-structured questionnaires 243 community members/ Lake Victoria basin of Kenya. Sociodemographic variables: knowledge was associated with educational level, being male and occupation type
Knowledge: (i) 42% of respondents had no idea on how schistosomiasis is contracted, (ii) 22% rightly mentioned causes of schistosomiasis. (iii) Only 3% of the respondents were familiar with the life cycle of schistosomiasis and (iv) 38% had no idea how schistosomiasis is treated.
Misconceptions: 18% mentioned drinking/eating dirty water/food was the cause for schistosomiasis.
Practices: Risky water practices included, harvesting hippo grass, fishing, and washing clothes and utensils and bathing in rivers infested with intermediate host snails
Anguza et al. [28] / 2007 To elicit and understand peoples’ perceptions of intestinal schistosomiasis that is a prerequisite for designing appropriate control strategies. Mixed method study using 6 FGDs and 432 semi-structured interviews Community members (64 FGD participants and 432 respondents)/ Busia district of Uganda Sociodemographic variables: knowledge and practices were associated with being male, educated and employed
Knowledge: (i) 97% were aware of schistosomiasis, (ii) 14% were able to mention symptoms however early symptoms were poorly understood by all participants and (iii) only 45% knew about the existence of a schistosomiasis control program through peers and health workers
Misconceptions: 78% said schistosomiasis can be prevented by not drinking contaminated water.
Attitudes: Respondents perceived community involvement in schistosomiasis control to be very low, mainly due to fear of side effects
Practices: (i) Traditional medicine was preferred for schistosomiasis treatment.
(ii) About 70% of people practiced risky water practices whilst 88% admitted that people defecate in bushes and in the lake due to lack of latrines.
Adeneye et al. [17] / 2007 To describe sociocultural factors that influences the distribution process of praziquantel for the mass treatment of schistosomiasis infection. Qualitative study: FGDs and in-depth interviews were held with adolescents, children and Adults from six communities before and after MDA program implementation Adults, adolescents and children / Ogun State, Southwest Nigeria Knowledge: There was a high level of awareness on schistosomiasis; however causes of infection were poorly understood.
Misconceptions: Community members believed that schistosomiasis was caused by urinating at a T-junction on the road.
Attitudes: People thought treatment was expensive and doubted its efficacy prior to MDA Practices: (i) Participants became more receptive of treatment after program due to perceived efficacy of praziquantel against the disease and its availability.
(ii) Community based interventions had more successful treatment coverage compared to the Primary Health Care-centred or school based approaches
Dawaki et al. [29] / 2015 To evaluate the knowledge, attitude and practices (KAP) regarding schistosomiasis among rural Hausa communities in Kano State, Nigeria. Cross-sectional study using a structured questionnaire 551 individuals from rural communities in Kano State in Nigeria Sociodemographic variables: Males, those educated or employed and younger respondents were more knowledgeable compared to their counterparts.
Knowledge: (i) 74.5% were aware of urinary schistosomiasis; major sources of information were family and neighbours (ii) 38.6% of participants were ignorant of signs and symptoms, (iii) 67.0% had no knowledge on transmission and (iv) 63.8% were ignorant of all preventive measures.
Misconception: 18.9% of the respondents believed that schistosomiasis is caused by eating salty or sour food or that it can be spread by sharing a toilet with an infected person
Attitudes: Three-quarters of the respondents considered schistosomiasis a serious disease.
Practices: (i) Children and male adolescents were observed bathing/swimming in streams and ponds and human excreta was seen around water bodies and within farmlands.
(ii) Only 34.7% of the participants sought treatment from clinics/hospitals, almost 50% practiced self-medication and 15.3% either used traditional medicine or nothing.
Fleming et al. [40] / 2009 To describe the perceptions, attitudes, constraints and experiences of those implementing the programme and recipients of treatment. Qualitative study in 20 districts implementing the programme Community members/ L. Victoria islands in Uganda. Attitudes: MDA was perceived to be beneficial because it improved participants health conditions,
Practices: Poor health seeking behaviour was related to side-effects, smell and size of praziquantel (PZQ), together with shortage of Praziquantel in health facilities
Kabatereine et al. [16] / 2014 To assess community awareness on schistosomiasis KAP Cross sectional descriptive study using a semi structured questionnaire 908 household heads, 286 drug distributors, 181 pupils,104 teachers, 47 biomedical workers/ Lake Victoria, Uganda Socio-demographic variables: Males were 1.5 times more knowledgeable compared to females. Tertiary education, treatment history and staying longer in islands were also determinants of higher knowledge.
Knowledge: Biomedical staff (92.3%), pupils (84.3%), teachers (80.4%) and household heads (87.3%) knew about schistosomiasis. However knowledge on transmission was poor as shown by, 38% and 50% biomedical staff and household heads respectively.
Misconceptions: Fifteen percent of household heads believed schistosomiasis was caused by drinking dirty water and eating contaminated food
Practices: (i) Open defaecation was very common, only 33% house hold heads had latrines in their homes. (ii) An observation in schools showed that 15% of pit latrines were extremely filthy, 10.5% had no doors and 13.7% were unusable because they were either full or collapsed.
Mwai et al. [30] / 2016 To assess KAP on the control and prevention of schistosomiasis infection Cross sectional study utilizing a mixed method approach Community members aged 18 years and above (12 FGDs and 465 respondents) / Mwea Kirinyaga, Kenya Sociodemographic variables: Awareness on schistosomiasis was significantly associated with age, educational levels. Health workers were cited as the main source of information.
Knowledge: (i) Awareness was high (92.9%), (ii) only 30% had adequate knowledge on symptoms and 41% on transmission,(iii) 34.5% knew about prevention strategies
Misconception: (i) Schistosomiasis symptoms were associated with HIV and those infected were stigmatised.
(ii) Washing hands before eating and applying jelly oil before entering the rice paddies were also believed to be effective prevention strategies.
Attitudes: (i) 58.71 perceived schistosomiasis to be common in the area.
(ii) Treatment was perceived to be costly therefore some people preferred using herbs.
Practices: Respondents acknowledged risky practices such as open air defaecation and not washing hands. Most residents did not have proper pit latrines; they were often full and unusable. Only 49.25% knew about the existence of community intervention programmes.
Musuva et al. [31] / 2014 To evaluate intervention strategies, community knowledge, attitudes, and practices on schistosomiasis in an effort to improve intervention strategies Qualitative survey using 32 FGDs 237 Community members aged between 18 and 60 years/ Nyanza province in Kenya Knowledge: Respondents reported having heard of schistosomiasis mainly though schools but also posters, radio and community gatherings. However, many lacked comprehensive knowledge on schistosomiasis.
Misconception: Schistosomiasis was perceived as a sign of promiscuity. Respondents mistook it for STI’s (syphilis). Respondents also believed that schistosomiasis was contracted through drinking dirty water, eating uncooked or contaminated food.
Attitudes: Treatment was widely perceived as too expensive and therefore avoided.
Practices: Respondents felt health facilities were far, expensive, had long queues and sometimes no drugs thus they resorted to spiritual interventions, herbal treatments and medicine shops
Onyeneho et al. [32]/2010 To assess the knowledge, attitude/perception and practices of the people in Oshimili South and Ndokwa Northeast Local Government Areas of Delta State in Nigeria Cross-sectional study using a uniform set of structured interview schedule administered by trained field assistants. 400 randomly selected persons aged > or =15 years/Delta State in Nigeria Knowledge: One-third of the participants were aware of the schistosomiasis.
Misconceptions: A majority perceived schistosomiasis to be caused by witchcraft and sexual or body contact with infected persons. Infection was also considered a normal growing process.
Practices: (i) Treatment was often not sought because of the belief that there is no effective cure for schistosomiasis since it reoccurs after treatment. (ii) Swimming in rivers was a common activity among all participants, irrespective of sex and age.
Odhiambo et al. [48] / 2014 To assess community awareness on existence, signs and symptoms, causes, transmission, control and risk factors for contracting schistosomiasis as well as attitudes, health seeking behaviour and environmental antecedents that affect its control Cross-sectional, descriptive assessment that employed qualitative methods, including focus group discussions (FGDs) and key informant interviews (KIIs). Eight focus group discussions among adult community members and eight key informant interviews with opinion leaders/Kisumu City, Western Kenya Knowledge: Knowledge of signs and symptoms, prevention, transmission and control of schistosomiasis was poor at the beginning of MDA program. People reflected a poor understanding of preventive chemotherapy.
Misconceptions: During MDA, Community Health Workers (CHW) were thought to be administering family planning pills thus some people rejected the drugs and chased CHW from their compounds
Attitudes: Schistosomiasis was not perceived as a serious disease due to poor knowledge of signs and symptoms. There was a general belief that transmission was unpreventable. Some doubted the efficacy of drugs.
Practices: (i) Poor sanitary conditions and practices were widely reported by CHW. (ii) There was poor reception of drugs due to fear of side effects and misconceptions however during the third year of MDA, there was notable improvement
Rassi et al. [33]/2016 To determine knowledge, attitudes and practices relating to schistosomiasis A representative cross-sectional household survey using a structured questionnaire Community members from 791 households/ Nampula Province, Mozambique Socio-demographics factors: Knowledge of schistosomiasis was associated with being male and educated.
Knowledge: (i) 91% were aware of schistosomiasis and such information was from relatives, neighbours or friends. (ii) 57% had no knowledge of causes; (iii) only 26% cited correct transmission routes and preventive practices 13%. (iv) 70% were able to mention at least two correct symptoms of the disease.
Misconceptions: (i) Most people 81%, believed schistosomiasis was transmitted through unprotected sex, (ii) 16% stated that it was hereditary or acquired during pregnancy or birth. (iii) Some believed it was acquired though drinking contaminated water.
Practice: Almost half stated that they did not protect themselves and their households from the disease.
Salawu and Odaibo [41]/2016 To assess the impact of knowledge, attitudes and sociodemographic factors on schistosomiasis burden in pregnant women of rural communities of Nigeria. A cross sectional field study using a semi-structured questionnaire 237 Pregnant women/ Ogun state Nigeria Socio-demographic factors: Schistosomiasis infection was associated with educational level, occupation type and religion.
Knowledge: Awareness on schistosomiasis was very low (34%) and less than 10% knew about the causes of schistosomiasis.
Misconceptions: 80% of participants believed schistosomiasis is contracted by urinating at junctions or where a dog once urinated
Practices: Multipurpose water usage pattern strongly predisposed the women to infection (OR 4.31, CI 2.17–8.57). Over 80% of the population visited the river either daily or weekly.
Tuhebwe et al. [42]/2015 To assess the uptake of MDA and associated factors Cross sectional study utilizing a mixed method approach Adults (615 respondents aged 18 years and above) in Koome Islands, Central Uganda Sociodemographic: Uptake of praziquantel was associated with age, occupational status and the level of education
Knowledge: There was inadequate knowledge about schistosomiasis transmission and prevention and these were associated with low MDA uptake.
Attitude: People felt the tablets were too big, had a bad taste and they feared the side effects
Practice: Long waiting time were reported barriers to MDA uptake however respondents who were knowledgeable about schistosomiasis transmission and prevention (adjusted odds ratio [AOR] 1.85, 95% CI 1.22–2.81) and reported to have received health education from the health personnel (AOR 5.95, 95% CI 3.67–9.65) were more receptive of drugs.
Yirenya-Tawiah et al. [49]/2011 To show the importance of schistosomiasis among adult populations in the Volta Basin of Ghana. Cross-sectional survey using a structured questionnaire A total of 3301 study subjects from 30 rural riparian communities on the Afram and Lower Volta Basin of Ghana. Knowledge: Knowledge was significantly associated with the male status and location.
(ii) 99.4% males and 88.7% females were aware of schistosomiasis as a waterborne disease, (ii) over 60% of the respondents correctly stated the cause of infection however, 36.5% of men and 22.2% of women did not know the source of infection; (iii) only 35.4% of males and 24.7% of females had knowledge on prevention.
Practice: (i) 38.5% of males and 39.5% of females showed symptoms during the study period reported to have done nothing about their health condition, (ii) 23.3% of males and 29.7% of females were taking self-medication and (iii) only 23.3% of males and 29.7% of females visited a health facility.
Yirenya-Tawiah et al. [51] / 2016 To determine urogenital schistosomiasis awareness in terms of its scope and signs and symptoms Mixed method study using a structured questionnaire; 24 focus group discussions (FGDs) were also conducted 2585 respondents aged 15–49 years from 30 riparian communities/ Endemic communities in Ghana Socio-demographic factors: Males were more knowledgeable than females, 14.5% and 7.2% (p = 0.001), respectively.
Knowledge: 99.4% of male respondents and 88.7% of female respondents were aware of schistosomiasis as a waterborne disease.
Only 207 out of 1096 subjects (18.9%) knew that schistosomiasis can have reproductive health implications and only 12.3% of respondents knew that urogenital schistosomiasis could facilitate the acquisition of HIV.
Omedo et al. [47]/2012 To determine the Community Health Workers’ Experiences and Perspectives on Mass Drug Administration for Schistosomiasis Control in Western Kenya: The SCORE Project Qualitative study using unstructured open-ended group discussions 65 CHWs were interviewed from the eight districts/ Western Kenya Attitude: Community Health Workers (CHWs) reported that people had negative attitudes towards the MDA due to lack of media awareness of such an intervention and some were not comfortable with being treated by non-professionals.
Misconception: CHWs reported that some residents rejected the drugs due to a belief that they could cause cancer, some believed they were for HIV treatment and some thought the drugs were meant to kill them.
Practice: Some people refused praziquantel because they preferred taking the drug for treatment and not for prevention. The lack of food negatively affected residents’ reception of the drug.
Omedo et al. [34]/2014 To evaluate the impact of a health communication campaign for schistosomiasis in Kisumu West, Kenya: the SCORE Project Qualitative study using FGDs 53 community health care workers/ Kisumu West, Kenya Knowledge: Media awareness before MDA increased knowledge on schistosomiasis control and side effects which stimulated increased acceptance and demand for the drug.
Misconception: Community Health Workers reported that some people thought praziquantel tablets were family planning pills
Practice: (i) Community Health Workers reported improved work output and compliance compared to baseline.(ii) Community Health Workers perceived radios and as more effective than community gatherings as means for sensitising the community.
(iii) The involvement of stakeholders in mass media campaign process was also said have been beneficial.
Mwanga and Lwambo [43] / 2013 To determine the pre- and post-intervention perceptions and water contact behaviour related to schistosomiasis in north-western Tanzania Data was from post-intervention knowledge, attitudes and practices (KAP) questionnaire surveys conducted between 2008 and 2010 157 community members aged 15 years and above in north-western Tanzania. Knowledge: There was a significant increase in respondents’ knowledge of the cause, transmission, symptoms and health consequences of schistosomiasis after the intervention.
Practice: The frequency, duration and timing of water contacts also decreased significantly after the intervention. Reported behaviour was found to be congruous with the actual (observed) behaviour.
Studies on care givers KAP n = (4)
Ng’weng’weta and Tarimo [35]/2016 To determine the magnitude of S. haematobium and factors associated with exposure of preschool children in Kigogo ward, Kindoni district, Dar es Salaam Quantitative cross sectional study A total of 408 caregivers and 424 pupils/ Kinondoni municipality, Dar es Salam, Tanzania 2016 Socio-demographic factors: Marital status was the only demographic variable significantly associated with knowledge on schistosomiasis.
Knowledge: Awareness was 91.7% among care givers. The level of comprehensive knowledge was 83.6% on the mode of transmission, symptoms, treatment and preventive measures, all encompassing.
Attitudes: 76% did not consider schistosomiasis a health problem yet above 90% perceived their water practices to be risky and predisposing their children to infection
Practice: The high level of knowledge (83.6%) in this study was said to be a reflection of ongoing preventive chemotherapy campaigns
Ekpo et al. [36]/2010 To determine the prevalence and intensity of urinary schistosomiasis in pre-school children between the ages of 1–6 years Qualitative survey, using 3 FGDs among adult males, adult females and pre-school children aged 4–6 years. Care givers and Preschool children aged 1–6 / Ilewo-Orile Nigeria. Knowledge: knowledge on transmission and treatment was poor
Attitudes: Schistosomiasis was not perceived as a serious disease.
Misconceptions: Schistosomiasis was considered a sign of virility and maturity
Practices: (i) Care givers were seen during the study exposing preschool children to infection by taking them along to rivers for bathing and washing.
(ii) Older children were visiting streams on their own for washing clothes, fetching water, bathing and swimming.
Ekpo et al. [46]/2012 To determine the prevalence and intensity of Schistosoma haematobium infection in preschool children aged below 6 years in two rural communities Qualitative study using FGDs among community members Care givers and Preschool children aged 1–6/ Ijebu East, South-western Nigeria. Knowledge: Care givers were aware that fresh water bodies could cause schistosomiasis but did not know the mode of transmission
Misconceptions: Most respondents’ believed drinking unclean water was the cause for schistosomiasis.
Practice: (i) Community members revealed that streams were their only source of water for washing, bathing and cooking.
(ii) Preschool children aged 3–6 years were observed bathing and washing in streams whereas younger preschool children were seen accompanying their mothers to streams.
Moyo et al. [50]/2016 To determine the prevalence of and risk factors for schistosomiasis among a group of preschool children in Malawi. Cross-sectional study using a structured questionnaire Pre-school children, aged between 6 and 60 months and caregivers/ Malengachanzi, Nkhotakota District, Malawi Knowledge: The levels of knowledge on causation, prevention and treatment were 71%, 88%, and 80%, respectively.
Practice: (i) Caregivers reported that their children accompany them to rivers/streams when conducting domestic chores.
(ii) Male preschool children were said to independently play in streams along with their older peers.
School based KAP studies (n = 5)
Wolmarans and De Kock [44] / 2009 To determine the influence of health education on the prevalence, intensity and morbidity of Schistosoma haematobium infections in children over a two-year period in the Limpopo Province, South Africa Experimental study over a 2 year period, 67children in the experimental group and 179 in control groups Schoolchildren between the ages of 4 and 14 in Mamitwa Village Limpopo Province Knowledge: (i) 30% indicated that they had no knowledge of schistosomiasis and 43% regarded their families as main sources of information. (ii) 0% could associate the transmission of schistosomiasis with the indiscriminate passage of contaminate excreta in natural water bodies.
Practice: (i) 98% indicated that they did not make use of house taps.
(ii) 76% paid visits to the local river or dam as the main source of recreation, bathing and washing of clothes.
(iii) Only 33% of the school children indicated that their houses were equipped with toilets.
Maseko et al. [37] / 2016 The study aimed to assess the KAPs of schoolchildren on schistosomiasis, and to identify practices that support or hinder the progress of schistosomiasis control A descriptive quantitative cross-sectional survey using a structured questionnaire 146 Primary school children in Siphofaneni Swaziland Sociodemographic variables: Knowledge was correlated with predictors such as male sex, always urinating in water, and always using river water for domestic practices.
Knowledge: (i) 97.3% had heard about schistosomiasis. (ii) 74% knew the signs and symptoms of urinary schistosomiasis however, (iii) only 0.7% knew signs and symptoms of intestinal schistosomiasis. (iv) 52.7% participants had knowledge of preventive measures
Misconceptions: Misconceptions noted were said to be related to prevention and treatment
Attitudes: The mean score of schistosomiasis attitudes was 86.8%.
Practice: 78.8% reported being engaged in risky water practices and 65.1% was the mean score for practices.
Chaula and Tarimo [45] / 2014 To assess the impact of the two rounds of MDA on prevalence and intensity of Schistosoma haemamtobium and the impact of MDA campaigns on knowledge of urinary schistosomiasis, safe water use and contact with potentially unsafe water bodies. A quantitative cross-sectional study. A structured questionnaire was used to collect data 488 schoolchildren, Bahi district in central Tanzania. Practice: Uptake of MDA was 39.5% in 2011 and 43.6% in 2012.
MDA campaigns had significant impact on knowledge of the disease (p = 0.02) and borderline impact on safe water use (p = 0.04) but had no impact on avoidance of contact with unsafe water bodies (p = 0.06)
Mazigo et al. [38] / 2010 To determine the prevalence of Schistosoma mansoni, knowledge, perceptions and preventative practices of school children towards Cross sectional study using a structured questionnaire 200 randomly selected school children/ Sengerema district, Tanzania. Sociodemographic variables: Knowledge significantly increased with age
Knowledge: (i) About 87.5% of the respondents reported to have heard about schistosomiasis and the main source of information were schools. (ii) Only 40.5% of the respondents associated schistosomiasis with water contact and (iii) 39.5% accurately quoted symptoms. (iv) 34.5% respondents mentioned correct control strategies against schistosomiasis.
Practice: (i) 84% of the children reported going to the lake and 68% reported to participate in paddy cultivation.
(ii) Most of respondents (96.5%) reported the use of toilets.
(iii) A majority (82%) of the respondents reported that they had participated in previous MDA.
Person et al. [56] / 2016 To better understand community knowledge, perceptions, and practices associated with schistosomiasis among school-aged children on Unguja and Pemba islands Qualitative study involving 35 children’s discussion groups, 41 in-depth interviews with parents and teachers, and 5 focus group discussions with community members School children, parents, teachers and community leaders /Zanzibar, United Republic of Tanzania Knowledge: (i) there was poor knowledge on disease transmission, (ii) lack of understanding on severity of disease-associated consequences, (iii) and lack of alternative options for water related activities of daily living and recreational play
Practices: School-aged children were regularly exposed to contaminated natural, open freshwater bodies through practicing daily recreational and domestic activities