Isaiah Phyllis Munyiva, Afriyie Doris Osei, Maghanga Mary, Ogeto Donna Obare, Nyamongo Mary Amuyunzu, Steinmann Peter
Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
University of Basel, Basel, Switzerland.
PLOS Glob Public Health. 2024 Dec 19;4(12):e0004035. doi: 10.1371/journal.pgph.0004035. eCollection 2024.
A new formulation of praziquantel, arpraziquantel (arPZQ), has been developed for preschool-aged children (PSAC) to fill the treatment gap for this age group in schistosomiasis control and elimination programs. There is now a priority to ensure that the drug reaches all at-risk PSAC in endemic areas, including hard-to-reach areas and populations. This study aimed to determine schistosomiasis treatment-related contextual factors among fishermen and island populations in Homa Bay County, Kenya, and to identify a suitable platform to deliver arPZQ. We conducted a generic qualitative study using two case study interviews with parents/caregivers living with disability caring for children ≤5 years,18 focus group discussions (FGDs) with parents/caregivers of children ≤5 years (each with 8-10 participants), 14 key informant interviews (KIIs) with various government agencies, and unstructured observations. The data were analyzed using thematic analysis. The case study interviews and FGDs revealed awareness of schistosomiasis among community members but limited knowledge of transmission risk factors. Lake water and open defecation were the main predisposing factors to infection. We observed poor health-seeking behavior in the community due to inaccessibility of quality healthcare services, resulting from health system level, population level, and geographic barriers. Despite these barriers, community members reported positive experiences with previous PZQ mass drug administration (MDAs) and other innovative healthcare programs, and expressed willingness to participate in future MDAs, including with arPZQ. Based on the reported barriers, the door-to-door distribution approach by community health promoters was proposed by parents and key informants as the most feasible platform for community sensitization, mobilization, and arPZQ delivery. To achieve high arPZQ treatment coverage for all at-risk PSAC, and promote ownership and sustainability of the program, the door-to-door approach is the most promising platform to deliver treatment and public health promotion in marginalized hard-to-reach island populations of Lake Victoria, Kenya.
吡喹酮的一种新制剂，即蒿甲吡喹酮（arPZQ），已被开发用于学龄前儿童（PSAC），以填补血吸虫病控制和消除计划中该年龄组的治疗缺口。目前的一个优先事项是确保该药物能够送达流行地区所有面临风险的学龄前儿童，包括难以到达的地区和人群。本研究旨在确定肯尼亚霍马湾县渔民和岛屿居民中与血吸虫病治疗相关的背景因素，并确定一个合适的平台来提供蒿甲吡喹酮。我们进行了一项一般性定性研究，对照顾≤5岁残疾儿童的父母/照料者进行了两次案例研究访谈，与≤5岁儿童的父母/照料者进行了18次焦点小组讨论（每个小组有8 - 10名参与者），与各政府机构进行了14次关键信息提供者访谈（KIIs），并进行了非结构化观察。使用主题分析法对数据进行了分析。案例研究访谈和焦点小组讨论揭示了社区成员对血吸虫病的认识，但对传播风险因素的了解有限。湖水和露天排便为感染的主要诱发因素。由于卫生系统层面、人群层面和地理障碍导致难以获得优质医疗服务，我们观察到社区中存在不良的就医行为。尽管存在这些障碍，社区成员报告了以往吡喹酮大规模药物治疗（MDA）和其他创新医疗保健项目的积极经历，并表示愿意参与未来的MDA，包括使用蒿甲吡喹酮。基于所报告的障碍，父母和关键信息提供者提议由社区健康促进者采用挨家挨户分发的方式，作为社区宣传、动员和提供蒿甲吡喹酮的最可行平台。为了实现对所有面临风险的学龄前儿童的高蒿甲吡喹酮治疗覆盖率，并促进该项目的自主性和可持续性，挨家挨户的方式是在肯尼亚维多利亚湖边缘化且难以到达的岛屿人群中提供治疗和促进公共卫生的最有前景的平台。
