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Process evaluation of schistosomiasis control in Uganda, 2003 to 2006: perceptions, attitudes and constraints of a national programme

Published online by Cambridge University Press:  21 August 2009

F. M. FLEMING ,
A. FENWICK ,
E. M. TUKAHEBWA ,
R. G. N. LUBANGA ,
H. NAMWANGYE ,
S. ZARAMBA  and
N. B. KABATEREINE
F. M. FLEMING*
Affiliation:
Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK
A. FENWICK
Affiliation:
Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK
E. M. TUKAHEBWA
Affiliation:
Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda
R. G. N. LUBANGA
Affiliation:
Department of Social Work and Social Administration, Makerere University, P.O. Box 7062, Kampala, Uganda
H. NAMWANGYE
Affiliation:
Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda
S. ZARAMBA
Affiliation:
Ministry of Health, Headquarters, P.O. Box 7272, Kampala, Uganda
N. B. KABATEREINE
Affiliation:
Vector Control Division, Ministry of Health, P.O. Box 1661, Kampala, Uganda
*
*Corresponding author: Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK. Tel: +44 (0)20 7594 3626; Fax: +44 (0)20 7262 8140. E-mail: [email protected]
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Summary

Schistosomiasis is widespread in Uganda along large lakes and rivers with approximately 4 million people infected. Hookworm infections also prevalent throughout the country, while infections with Ascaris lumbricoides and Trichuris trichiura are mainly found in south-western Uganda. A national programme aimed at controlling morbidity due to these infections was launched in 2003. This article describes the perceptions, attitudes, constraints and experiences of those implementing the programme and those receiving the treatment. The study used qualitative data collected largely in two districts but also from 18 other districts implementing the programme. Results showed that mass treatment was perceived to be beneficial because the drugs make people feel better. However, side-effects of praziquantel (PZQ), the smell and size of the tablets and the use of height, not weight, to determine dose were raised as major factors discouraging people from taking the drug. Generally, most of the end-users were appreciative of the programme and were beginning to demand regular treatment. Nevertheless, intensive and sustained health education is still vital for improvement of treatment coverage, especially among the non-compliers. It was repeatedly highlighted that there is a need to stock PZQ in all health facilities in endemic areas. Provision of incentives to drug distributors and to involve as many stakeholders as possible in the planning phase were also raised by respondents. Lessons learned for the development and success of a helminth control programme at a national scale are discussed.

Keywords

SchistosomiasisSchistosoma mansonisoil-transmitted helminthiasiscontrolprocess evaluationperceptionsattitudepraziquantelUganda
Type
SECTION 3 PROGRAMMATIC OPTIMISATION OF DRUG DELIVERY
Information
Parasitology , Volume 136 , Special Issue 13: Control of schistosomiasis in sub-Saharan Africa , November 2009 , pp. 1759 - 1769
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

Ali, M. I., Byskov, J., Mokgweetsinyana, S. S., Sibiya, J. and Mott, K. E. (1989). Integration of control of schistosomiasis due to S. mansoni within primary health care in Ngamiland, Botswana. Tropical Medicine and Parasitology 4, 195–200.Google Scholar
Anguzu, J., Oryema-Lalobo, M., Oundo, G. B. and Nuwaha, F. (2007). Community perception of intestinal schistosomiasis in Busia district in Uganda. East African Medical Journal 84, 56–66.Google ScholarPubMed
Asaolu, S. O. and Ofoezie, I. E. (2003). The role of health educations and sanitation in the control of helminth infections. Acta Tropica 86, 283–294.Google Scholar
Brooker, S., Kabatereine, N. B., Fleming, F. and Devlin, N. (2008). Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up. Health Policy and Planning 23, 24–35.CrossRefGoogle ScholarPubMed
Brooker, S., Marriot, H., Hall, A., Adjei, S., Allan, E., Maier, C., Bundy, D. A. P., Drake, L. J., Coombes, M. D., Azene, G., Lansdown, R. G., Wen, S. T., Dzodemenyo, M., Cobbinah, J., Obro, N., Kihamia, C. M., Issae, W., Mwanri, L., Mweta, M. R., Mwaikemwa, A., Salimu, M., Ntimbwa, P., Kiwelu, V. M., Turuka, A., Nkungu, D. R. and Magingo, J. (2001). Community perception of school-based delivery of anthelmintics in Ghana and Tanzania. Tropical Medicine and International Health 6, 1075–1083.CrossRefGoogle ScholarPubMed
Cioli, D. and Pica-Mattoccia, L. (2003) Praziquantel. Parasitology Research 90, S3–S9.Google Scholar
Danso-Appiah, A., de Vlas, S. J., Bosompem, K. M. and Habbema, J. D. F. (2004). Determinants of health-seeking behaviour for schistosomiasis-related symptoms in the context of integrating schistosomiasis control within the regular health services in Ghana. Tropical Medicine and International Health 9, 784–794.CrossRefGoogle ScholarPubMed
Ekeh, H. E. and Adeniyi, J. D. (1988). Health education strategies for tropical disease control in schoolchildren. Journal of Tropical Medicine and Hygiene 91, 55–59.Google Scholar
Gryseels, B., Polman, K., Clerinx, J. and Kestens, L. (2006). Human schistosomiasis. Lancet 368, 1106–1118.CrossRefGoogle ScholarPubMed
Jarallah, J. S., Al Shammari, S. A., Khoja, T. A. and Al Sheikh, M. (1993). Role of primary health care in the control of schistosomiasis: the experience in Riyadh, Saudi Arabia. Tropical and Geographical Medicine 45, 297–300.Google ScholarPubMed
Kabatereine, N. B., Brooker, S., Koukounari, A., Kazibwe, F., Tukahebwa, E. M., Fleming, F. M., Zhang, Y., Webster, J. P., Stothard, J. R. and Fenwick, A. (2007). Impact of a national helminth control programme on infection and morbidity in Ugandan schoolchildren. Bulletin of the World Health Organization 85, 91–99.Google Scholar
Kabatereine, N. B., Brooker, S., Tukahebwa, E. M., Kazibwe, F. and Onapa, A. W. (2004). Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control. Tropical Medicine and International Health 9, 372–380.CrossRefGoogle ScholarPubMed
Kabatereine, N. K., Fleming, F. M., Nyandindi, U., Mwanza, J. C. L. and Blair, L. (2006 b). The control of schistosomiasis and soil-transmitted helminths in East Africa. Trends in Parasitology 22, 332–339.CrossRefGoogle ScholarPubMed
Kabatereine, N. B., Kemijumba, J., Ouma, J. H., Sturrock, R. F., Butterworth, A. E., Madsen, H., Ørnbjerg, N., Dunne, D. W. and Vennervald, B. J. (2003). Efficacy and side-effects of praziquantel treatment in a highly endemic Schistosoma mansoni focus at Lake Albert, Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 97, 599–603.Google Scholar
Kabatereine, N. B., Tukahebwa, E., Kazibwe, F., Namwangye, H., Zaramba, S., Brooker, S., Stothard, J. R., Kamenka, C., Whawell, S., Webster, J. P. and Fenwick, A. (2006 a). Progress towards countrywide control of schistosomiasis and soil-transmitted helminthiasis in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 100, 208–215.CrossRefGoogle ScholarPubMed
Kabatereine, N. B., Tukahebwa, E. M., Kazibwe, F., Twa-Twa, J. M., Barenzi, J. F., Zaramba, S., Stothard, J. R., Fenwick, A. and Brooker, S. (2005). Soil-transmitted helminthiasis in Uganda: epidemiology and cost of control. Tropical Medicine and International Health 10, 1187–1189.CrossRefGoogle ScholarPubMed
Katabarwa, M. N, Mutabazi, D. and Richards, F. O. Jr. (1999). The community-directed, ivermectin-treatment programme for onchocerciasis control in Uganda–an evaluative study (1993–1997). Annals of Tropical Medicine and Parasitology 93, 727–735.CrossRefGoogle ScholarPubMed
Katabarwa, M. N., Mutabazi, D. and Richards, F. O. Jr. (2000). Controlling onchocerciasis by community-directed, ivermectin-treatment programmes in Uganda: why do some communities succeed and others fail? Annals of Tropical Medicine and Parasitology 94, 343–352.Google Scholar
Landouré, A., van der Werf, M. J., Traoré, M. and de Vlas, S. J. (2003). Evaluation of case management in the integrated schistosomiasis-control programme in Mali. Annals of Tropical Medicine and Parasitology 97, 723–736.CrossRefGoogle ScholarPubMed
Lansdown, R., Ledward, A., Hall, A., Issae, W., Yona, E., Matulu, J., Mweta, M., Kihamia, C., Nyandindi, U. and Bundy, D. (2002). Schistosomiasis, helminth infection and health education in Tanzania: achieving behaviour change in primary schools. Health Education Research 17, 425–433.CrossRefGoogle ScholarPubMed
Lwambo, N. J., Siza, J. E. and Mwenda, G. C. (2005). Community's willingness to pay for a school-based chemotherapy programme to control morbidity due to schistosomiasis and soil-transmitted helminthiasis in children in rural Tanzania. Tanzania Health Research Bulletin 7, 149–153.Google ScholarPubMed
Massa, K., Magnussen, P., Sheshe, A., Ntakamulenga, R., Ndawi, B. and Olsen, A. (2009). Community perceptions on the community-directed treatment and school-based approaches for the control of schistosomiasis and soil-transmitted helminthiasis among school-age children in Lushoto, Tanzania. Journal of Biosocial Science 41, 89–105.CrossRefGoogle Scholar
Montresor, A., Engels, D., Chitsulo, L., Bundy, D. A. P., Brooker, S. and Savioli, L. (2001). Development and validation of a ‘tablet pole’ for the administration of praziquantel in sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene 95, 542–544.CrossRefGoogle ScholarPubMed
Mwanga, J. R., Magnussen, P., Mugashe, C. L., Gabone, R. M. and Aagaard-Hansen, J. (2004). Schistosomiasis-related perceptions, attitudes and treatment-seeking practices in Magu district, Tanzania: public health implications. Journal of Biosocial Science 36, 63–81.CrossRefGoogle ScholarPubMed
Nuwaha, F., Okware, J. and Ndyomugyenyi, R. (2005). Predictors of compliance with community-directed ivermectin treatment in Uganda: quantitative results. Tropical Medicine and International Health 10, 659–667.CrossRefGoogle ScholarPubMed
Nwaorgu, O. C., Okeibunor, J., Madu, E., Amazigo, U., Onyegegbu, N. and Evans, D. (1998). A school-based schistosomiasis and intestinal helminthiasis control programme in Nigeria: acceptability to community members. Tropical Medicine and International Health 3, 842–849.Google Scholar
Parker, M., Allen, T. and Hastings, J. (2008). Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda. Journal of Biosocial Science 40, 161–181.Google Scholar
Poggensee, G., Krantz, I., Nordin, P., Mtweve, S., Ahlberg, B., Mosha, G. and Freudenthal, S. (2005). A six-year follow-up of schoolchildren for urinary and intestinal schistosomiasis and soil-transmitted helminthiasis in Northern Tanzania. Acta Tropica 93, 131–140.Google Scholar
Raso, G., N'Goran, E. K., Toty, A., Luginbühl, A., Adjoua, C. A., Tian-Bi, N. T., Bogoch, I. I., Vounatsou, P., Tanner, M. and Utzinger, J. (2004). Efficacy and side-effects of praziquantel against Schistosoma mansoni in a community of western Côte d'Ivoire. Transactions of the Royal Society of Tropical Medicine and Hygiene 98, 18–24.CrossRefGoogle Scholar
Utzinger, J., Bergquist, R., Xiao, S. H., Singer, B. H. and Tanner, M. (2003). Schistosomiasis control – the way forward. Lancet 362, 1932–1934.CrossRefGoogle ScholarPubMed
van der Werf, M. J., de Vlas, S. J., Landouré, A., Bosompem, K. M. and Habbema, J. D. F. (2004). Measuring schistosomiasis case management of the health services in Ghana and Mali. Tropical Medicine and International Health 9, 149–157.Google Scholar
Wang, L., Utzinger, J. and Zhou, X. N. (2008). Schistosomiasis control – experience and lessons from China. Lancet 372, 1793–1795.CrossRefGoogle ScholarPubMed
Webster, J., Worrall, E., Hill, J., Hanson, K. and Lines, J. (2004). Strengthening the potential of health systems in rural Africa. British Medical Journal 328, http://www.bmj.com/cgi/eletters/328/7448/1129Google Scholar
Zhou, X. N., Wang, L. Y., Chen, M. G., Wu, X. H., Jiang, Q. W., Chen, X. Y., Zheng, J. and Utzinger, J. (2005). The public health significance and control of schistosomiasis in China–then and now. Acta Tropica 96, 97–105.Google Scholar