Barriers and Misconceptions Hindering Reduction of Intestinal Schistosomiasis in Mbita Sub-County, Western Kenya

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Abstract Background Community and individual participation are crucial for the success of schistosomiasis control. The World Health Organization (WHO) has highlighted the importance of enhanced sanitation, health education, and mass treatment in the fight against schistosomiasis. These approaches rely on the knowledge and practices of the community to be successful; however, where the community knowledge is low and inappropriate, it hinders intervention efforts. Hence, it is essential to identify barriers and misconceptions related to awareness of schistosomiasis, sources of infection, mode of transmission, symptoms, and control measures. Methods This was a mixed-method cross-sectional study involving 1,200 pre-school aged children randomly selected and examined for Schistosoma mansoni infection using the Kato-Katz technique. All parents/guardians of selected children were enrolled for a pre-tested questionnaire survey, while 42 were engaged in focus group discussions (FGDs). Results The majority of the respondents (85.5%) had heard about schistosomiasis, and its awareness was associated with the participant’s level of education (OR = 0.16, 95% CI = 0.08, 0.34). A positive association was observed between higher educational attainment and knowledge of the causative agent (OR = 0.69, 95% CI = 0.49, 0.96). Low education level was significantly associated with limited knowledge of transmission through lake water contact (OR = 0.71, 95% CI = 0.52, 0.97) and infection from the lake (OR = 0.33, 95% CI = 0.19, 0.57). Notably, parents/guardians who have heard of schistosomiasis could not recognize symptoms of S. mansoni infection, such as abdominal pain (91.8%, 815/888) and blood in the stool (85.1%, 756/888). Surprisingly, 49.8% (442/888) incorrectly identified hematuria (blood in urine), a key sign of S. haematobiumbut not S. mansoni, in an endemic area for S. mansoni infection. The majority (82.6%, 734/888) of parents/guardians were unaware that dams are potential infection sites, despite 53.9% (479/888) of their pre-school aged children testing positive for schistosome infection. Conclusion The study revealed a low level of knowledge on intestinal schistosomiasis causes, mode of transmission, signs and symptoms and potential infection sites within the community, all of which contributes to misconceptions and may hinder control efforts.

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