Department of Community Health, Faculty of Public Health, Lira University, Lira, Uganda.
Department of Human Development and Relational Sciences, Faculty of Interdisciplinary Sciences, Mbarara University of Science and Technology, Mbarara, Uganda.
BMC Public Health. 2023 Jun 5;23(1):1072. doi: 10.1186/s12889-023-16020-z.
Schistosomiasis poses a serious public health problem and a social challenge affecting over 240 million people, the majority of whom live in sub-Saharan Africa. The World Health Organization (WHO) recommends praziquantel (PZQ) drug treatment through regular mass drug administration (MDA) accompanied by social mobilisation and health education and sensitisation. With social mobilisation and health education and sensitisation, there is bound to be increased demand for the PZQ, especially in the case of endemic communities. However, it is not clear where communities go for PZQ treatment in the absence of PZQ MDA. We explored the health-seeking behaviours regarding schistosomiasis treatment among communities along Lake Albert in Western Uganda when MDA had delayed, to inform a review of the implementation policy for the achievement of the WHO's 2030 target of 75% coverage and uptake.
We conducted a community-based qualitative study in Kagadi and Ntoroko, an endemic community in January and February 2020. We interviewed 12 individuals: local leaders, village health teams, and health workers, and conducted 28 focus group discussion sessions with 251 purposively selected community members. The audio recordings of the data were transcribed and analyzed using a thematic analysis model.
Generally, participants seldom seek medication for schistosomiasis-related signs and symptoms from government hospitals and health centres II, III and IV. Instead, they rely on community volunteers such as VHTs, private facilities, such as clinics and drug shops nearby, or traditional sources (e.g. witch doctors and herbalists). Results show that factors influencing people to seek treatment from sources other than the government are: the absence of PZQ drugs in the government health facility; health workers' negative attitude towards patients; long distances to the government hospitals and health facilities; poor and inaccessible roads; medication-related costs; and negative perceptions of the PZQ drug.
Availability and accessibility of PZQ seem to be a big challenge. PZQ uptake is further hampered by health systems and community-related and socio-cultural factors. Thus there is a need to bring schistosomiasis drug treatment and services closer to endemic communities, stock nearby facilities with PZQ and encourage endemic communities to take the drug. Contextualised awareness-raising campaigns are needed to debunk myths and misconceptions surrounding the drug.
血吸虫病是一个严重的公共卫生问题，也是一个影响超过 2.4 亿人的社会挑战，其中大多数人生活在撒哈拉以南非洲地区。世界卫生组织（WHO）建议通过定期大规模药物治疗（MDA），同时进行社会动员、健康教育和宣传，来治疗血吸虫病。随着社会动员、健康教育和宣传，对吡喹酮（PZQ）的需求必然会增加，特别是在流行地区社区。然而，在没有 MDA 的情况下，社区在哪里可以获得 PZQ 治疗尚不清楚。我们探讨了乌干达西部阿尔伯特湖沿岸社区在 MDA 延迟时治疗血吸虫病的寻医行为，以了解对实现世卫组织 2030 年 75%覆盖率和接受率目标的实施政策的审查。
我们于 2020 年 1 月和 2 月在卡加迪和恩托罗科（一个流行区社区）进行了一项基于社区的定性研究。我们采访了 12 个人：地方领导、村卫生工作队和卫生工作者，并与 251 名有目的地选择的社区成员进行了 28 次焦点小组讨论。对数据的音频记录进行了转录，并使用主题分析模型进行了分析。
一般来说，参与者很少因血吸虫病相关症状和体征而从政府医院和卫生中心 II、III 和 IV 求医。相反，他们依赖社区志愿者（如村卫生工作队）、附近的私人诊所和药店，或传统的医疗来源（如巫医和草药医生）。研究结果表明，影响人们从政府以外的来源寻求治疗的因素有：政府卫生机构缺乏 PZQ 药物；卫生工作者对患者的消极态度；前往政府医院和卫生机构的距离远；道路状况差且难以到达；药物相关费用；以及对 PZQ 药物的负面看法。
PZQ 的供应和可及性似乎是一个巨大的挑战。获得 PZQ 的机会进一步受到卫生系统以及社区相关和社会文化因素的阻碍。因此，需要将血吸虫病药物治疗和服务带到流行社区，在附近的设施储备 PZQ，并鼓励流行社区服用该药物。需要开展有针对性的宣传活动，以消除围绕该药物的神话和误解。
