Treating schistosomiasis among South African high school pupils in an endemic area, a qualitative study

Andrea Lothe, Nqobile Zulu, Arne Olav Øyhus, Eyrun Floerecke Kjetland, Myra Taylor

Schistosomiasis, a neglected tropical disease caused by parasites that infest open water sources such as rivers and dams may increase susceptibility to HIV. Mass-treatment with praziquantel tablets, recommended by the World Health Organization reduces the prevalence of schistosomiasis. The goal in endemic areas is 75% treatment participation in every treatment round (e.g. yearly). However, in rural Ugu district, KwaZulu-Natal, South-Africa there was low participation among pupils in a Department of Health Mass-Treatment Campaign for schistosomiasis. Nested in a large study on schistosomiasis the study was conducted in 2012 over 4 months using qualitative methods with the Health Belief Model as the conceptual framework. Purposive sampling was done. Focus Group Discussions were undertaken at six schools in grades 10-12. Individual in-depth interviews were held with one teacher and two pupils at each school. In addition three traditional healers and a community health worker were interviewed. The severity of schistosomiasis was not recognised and neither was the pupils' susceptibility. Barriers to treatment included confusing S, haematobium symptoms with sexually transmitted infections, teasing and stigma. Increased knowledge, health literacy for treatment, and correct understanding about the severity of schistosomiasis may provide cues to action. The study indicates that comprehensive information may increase pupil participation in mass-treatment and decrease schistosomiasis prevalence. This study was registered with clinicaltrials.gov registry database and the registration number is NCT01154907 30 June 2011.