Schistosomiasis in School Aged Children: Community Perceptions and Experiences with Praziquantel Treatment – A Qualitative Study from Uganda

Abstract

Aim: The aim of this master’s thesis was to explore experiences and perceptions with praziquantel (PZQ) treatment in Ugandan school children, and to explore how the treatment is conducted. Furthermore the aim was to explore how information is communicated between children, teachers and parents/ caregivers.

Background: Schistsomiasis is a major problem in Uganda and is prevalent in coastal regions. A mass drug administration program with PZQ was initiated in 2003 by the government, to treat and limit the spread of the disease. As part of this MDA program, children are treated with PZQ in schools. A systematic literature search was conducted in 3 different databases. The amount of literature on this subject was found to be very limited, thus this study contributes with new knowledge.

Theoretical perspectives: The user perspective and phenomenology were used as theoretical frames of reference.

Method and design: The study was conducted using semi structured qualitative interviews as research method. Data were collected during a fieldwork in Uganda. 16 interviews were conducted in Jinja and 14 on Buvuma, comprising interviews with children, teachers and parents/ caregivers. When necessary, a translator was used during interviews and in the process of transcribing.

Results: The structure of the treatment was different on the 2 study sites. Teachers in Jinja were more independent in the treatment program. Different perceptions of the treatment exist. Children do not have an understanding of the need for preventive treatment. Children and preschool children are perceived to be at risk of infection, as they spent time in, and at the lake, and drink dirty water. Dose poles have been confused, with overdosing of the children as a consequence. Children less than 94 cm have been treated with PZQ. Several methods of PZQ administration are used: dividing, chewing, grinding and swallowing. Several ways of communicating between the informants are used.

Discussion: The theoretical frames of reference were useful in understanding the informant’s experiences and perceptions. Problems with translators and the fact that most interviews ended up being more structured than intended limited the validity of the data.

Conclusion and perspectives: The study provided a glimpse into the informant’s experiences and perceptions. A syrup formulation of PZQ should be present to ease administration, particular as preschool children might be included in the mass drug administration program in the future. A cartoon, already developed, for teaching about schistosomiasis would be ideal to implement in the schools.