KNOWLEDGE, ATTITUDE AND PRACTICES TOWARDS THE PREVENTION AND CONTROL OF SCHISTOSOMIASIS AMONGST THE COMMUNITY AT BUTIABA LANDING SITE, BULIISA DISTRICT BY AFETI ALEX (BMS/0056/91/DU) A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS OF THE AWARD OF THE DEGREE OF BACHELLOR OF MEDICINE AND SURGERY OF KAMPALA INTERNATIONAL UNIVERSITY SUPERVISED BY: DR. KINTU MUGAGGA OCTOBER 2014 © DECLARATION I hereby declare that this research dissertation to the best of my knowledge has not been presented to any other institution before. Signature………………………………………..Date…………………………. AFETI ALEX (AUTHOR) Produced, supervised and submitted with the approval of: Signature………………………………………………Date……………………….. DR. KINTU MUGAGGA (SUPERVISOR) i DEDICATION This work is dedicated to my family members more especially my mother Semerita Zaru, brothers Musa Pariyo, Aaron Avutia, madam Harriet Kyamanywa and the children Opoa E, Ejoru N, and Ajedra; sisters Leah Apai and Fida Atibaru for their prayers and support in one way or the other during the study. ii ACKNOWLEDGEMENT I thank the Almighty God for giving me health, guidance, protection and strength up-to-date. More thanks goes to Belgian Embassy in Uganda for sponsoring me throughout the course. I acknowledge the efforts of my supervisor Dr. Kintu Mugagga for his guidance and supervision during the preparation of this work. Am also greatly indebted to my family members for their moral and financial support, and encouragement. To Dr. Jino Abiriga of Masindi General Hospital for his endless teaching and guidance during my clinical practice. All my fellow students, friends and colleagues for their cooperation and togetherness during the course. iii TABLE OF CONTENTS Page CHAPTER ONE: INTRODUCTION………………………………………1 1.1 Background.……………………………………………………………1 1.2 Statement of the problem……………………………………………2 1.3 Broad objective…………………………………………………………2 1.4 Study questions……………………….……………………………….3 1.5 Significance of the study….………………………………………….3 1.6 Conceptual frame work……………………………………………….3 CHAPTER TWO: REVIEW OF RELATED LITERATURE……………..5 2.1 Life history and transmission of Schistosomiasis………………5 2.2 Knowledge about preventive and control practices…………….7 2.3 Prevention and control measures…………………………………..9 CHAPTER THREE: METHODOLOGY………………………………..….25 3.1 Study design…………………………………………………………….25 3.2 Study area……………………………………………………………….25 3.3 Study population……………………………………………………….27 3.4Sample size………………………………………………………………..27 3.5 Sampling method……………………………………………………….28 3.6 Data collection…………………………………………………………..28 3.7 Data analysis and presentation…………………….………………28 3.8 Data quality control……………………………………………………28 3.9 Inclusion criteria……………………………………………………….28 3.10 Exclusion criteria…………………………………………………….29 3.11 Ethical consideration…………………………………………………29 3.12 Study limitations………………………………………………………29 3.13 Dissemination of results……………………………………….……29 CHAPTER FOUR: RESULT…………………………………………………30 CHAPTER FIVE: DISCUSSION OF RESULTS………………………….40 CAPTER SIX: CONCLUSION AND RECOMMENDATIONS…………..45 REFERENCES…………………………………………………………………46 iv LIST OF TABLES, FIGURES AND CHARTS. Flow chart 1.6.1 for conceptual frame work…….…………..……………4 Table 4.1: Demographic characteristics…………………………………..30 Figures 4.2: According to the knowledge ..……………………….…..…..32 Figures4.3: According to the attitude and practices ……...……………36 v LIST OF APPENDICES ………………………………………Page I. Letter of introduction………………………………………………49 II. Map of uganda showing buliisa district (study area)………50 III. Map of buliisa district showing butiaba landing site…..…51 vi LIST OF ABBREVIATIONS CDC: Center for Disease Control. DHO: District Health Officer. Dr: Doctor. PZQ: Praziquantel. S. mansoni/haematobium: Schistosomiasis mansoni/haematobium. WHO: World Health Organisation. %: Percentage. ≥: Greater than. <: Less than. vii ABSTRACT Schistosomiasis is an “emerging tragedy in our new global health decade” being endemic in 76 countries of the world affecting about 200 million people of the 700 million people living in the endemic areas. Even with readily available drugs, the pervasiveness of the intermediate host snails and the ease at which re-infection occurs; its control still presents an important challenge for public health services around the world. The objective of the study was to assess the knowledge, attitudes and practices amongst the residents of Piida B village, Butiaba landing site towards the prevention and control of Schistosomiasis. I conducted a cross sectional qualitative study where a population of 246 respondents were interviewed using pre-coded questionnaires. The demographic characteristics, knowledge, attitude and practices were then established and data generated and presented using tables, graphs and charts. I found out that over 87% of the respondents had some general knowledge about Schistosomiasis although 206 (84%) had no or very low level (primary school dropout) of formal Education and fishing was the main occupation 101 (41%). There was also continuous contamination of the lake with faecal matter with 83 (74%) reported defaecating either in the lake or nearby bush at lakeshore while in water, as well as contact with lake water amongst 235 (96%) without the use of any protective gadgets amongst 190 (90%) with 197 (93%) accepted uptake of PZQ tablets during mass deworming. In conclusion in spite of the good general knowledge about Schistosomiasis, its prevention and control still possess a big challenge. I recommend continuous Health Education on proper disposal of human faeces and urine; avoid contact with lake water or use of protective gadgets as well as annual mass deworming. viii CHAPTER ONE: INTRODUCTION 1.1 BACKGROUND Schistosomiasis has been described as an “emerging tragedy in our new global health decade” with its control still presenting an important challenge for public health services around the world (Baker John, et al., 2007; Hotez and Fenwick, 2009; Standly et al, 2009; king, 2009; and WHO, 2010). It is endemic in 76 countries of the world, affecting about 200 million people of the 700 million people living in the endemic areas with about 120 million people having symptomatic infection, 20 million develop severe disease and between 150,000-280,000 die as a consequence of the disease per year (Van der werf et al, 2003; WHO, 2010). About 7.1 million people are infected with S. mansoni in the Americas, 95% of which is in Brazil (WHO, 2010). Sub-Saharan Africa accounts for approximately 80-85% of the 200 million infected people worldwide with the overwhelming majority of human infections caused by S. mansoni or the S. haematobium group (Hotez et al., 2009; Steinmann et al, 2006; WHO, 2002). In Uganda, an estimated 2 million people are infected, 13% of the population is at risk of infection commonly caused by S. mansoni found in 63 out of the 112 districts with the countrywide prevalence is just over 10%, but in selected foci there is almost 100% severe infection with the highest prevalence and intensity of Schistosomiasis in areas along the main water bodies especially in lakes Victoria, Albert, Kyoga, and Albert Nile (along River Nile) but it is focal There is no clear data on it’s the prevalence at Buliisa but is said to be endemic along Lake Albert ((Kabatereine et al., 2003, 2004; Tukahebwa, et al, 2013). 1 1.2 STATEMENT OF THE PROBLEM Since the official launch of the Uganda National Programme for the control of Bilharzia and Intestinal Worms at Pakwach, Nebbi District in March 2003 with mass drug treatment using Praziquantel (PZQ) (Kabatereine et al 2003), the intensity of Schistosomiasis was reduced by 70% and 98.2 in the first and the second year respectively. People later developed reinfections because of the continued contact with infected water suggesting that knowledge about prevention and control were not fully used in Uganda thus lead to raising an issue of health education by the Community Drug Distributors as a way forward (Kabatereine, et al, 2006). It was noted that infection and re-infection with Schistosomiasis can only be avoided if communities or individuals have good knowledge about the life cycle and control methods (Koukounari et al, 2007; Simonga 2009). The study therefore, intended to investigate the knowledge, attitudes and practices on prevention and control of Schistosomiasis amongst the community of Piida B village which findings shall tell how much Health Education has been implemented as an additional strategy. 1.3 OBJECTIVES 1.3.1 BROAD OBJECTIVES To assess the knowledge, attitudes and practices of the residents of Piida B village, Butiaba landing site towards the control and prevention of Schistosomiasis. 1.3.2 SPECIFIC OBJECTIVES a. To find out how much the people know about Schistosomiasis. b. To find out what prevention and control measures the community undertakes. c. To find the impact of the community practice on Schistosomiasis. 2 1.4 STUDY QUESTIONS 1. What do the residents of Piida B know about Schistosomiasis prevention and control? 2. Do these residents have any precautionary measures towards the prevention and control Schistosomiasis? 3. What might be the impact of people’s practices on the prevention and control Schistosomiasis? 1.5 SIGNIFICANCE OF THE STUDY This study was intended to identify the gaps, misconceptions, lack of knowledge, good and bad attitudes and practices towards the prevention and control of Schistosomiasis and help and guide the policy makers and implementers in formulation and incorporation of health education strategies specific to that community. In addition, the