Eradication of schistosomiasis in Guangxi, China. Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future

Abstract

Reported are the results of a community-based assessment of maintenance of schistosomiasis eradication in Guangxi, a large autonomous region of China with a population of 44 million. Eradication of the disease was achieved in 1989 in Guangxi but maintenance costs are rising. We focused on three counties that had the most intense transmission in the past: Binyang, Jingxi, and Yishan. Four instruments were used: in-depth interviews, focus group discussions, a knowledge, attitudes and practices survey, and subsequent community feedback. In the past, schistosomiasis had serious consequences in Guangxi, decreasing work capacity and restricting marriage and occupational mobility. Since its eradication there have been clear benefits in terms of increased agricultural output and improved farming conditions. Personal habits and traditional manual farming activities in Guangxi would continue to expose a large proportion of the population to environmental risk if the disease were to return. Ignorance about control programme achievements is increasing and is related to youth and inexperience. There was a universal desire in the study counties for more local education about the history of the programme and about the risk of schistosomiasis returning. Snail surveillance is considered important, but people are not willing to volunteer for such work. Our study methods were novel for Guangxi and community feedback was helpful. Snail checking procedures have been modified to make them more efficient and no snails have been found since 1992. The animal and human stool examinations have ceased and vigilance now concentrates on snails and children (skin tests). The long-term strategy is to make the population invulnerable to future schistosomiasis transmission if the snail vectors return. This means continuing education and making the former endemic counties a high priority for water and sanitation improvements.

PIP: Schistosomiasis was successfully eradicated from Guangxi, an autonomous region of China with 44 million inhabitants, in 1989, but maintenance costs are rising. Findings are reported from a community-based assessment of the maintenance of schistosomiasis eradication in Binyang, Jingxi, and Yishan counties, where transmission used to be the most intense. Findings are based upon interviews; focus group discussions; a knowledge, attitude, and practices survey; and community feedback. In Guangxi, schistosomiasis used to decrease work capacity and restrict marriage and occupational mobility. However, since its eradication, agricultural output has increased and family conditions have improved. Certain personal habits and traditional manual farming activities in Guangxi would nonetheless still expose much of the population to environmental risk if the disease were to return. The increasing ignorance about control program achievements is related to youth and inexperience. There was a universal desire in the counties for more local education about the history of the program and the risk of schistosomiasis returning. Snail checking procedures have been modified to make them more efficient, and no snails have been found since 1992. The long-term strategy is to make the population invulnerable to future schistosomiasis transmission if the snail vectors return.