Is there a gap between health education content and practice toward schistosomiasis prevention among schoolchildren along the shores of Lake Victoria in Kenya?

Abstract

Despite provision of preventive measures against schistosomiasis such as mass drug administration (MDA), the prevalence of Schistosoma mansoni remains high in communities living near Lake Victoria. This study aimed to analyse the status of schistosomiasis, including its prevalence, health education, knowledge, attitudes, and practices (KAP) among pupils, and water use in schools in Mbita situated along the shores of Lake Victoria. Four primary schools were selected as target schools and pupils in classes six and seven were recruited as study participants. The prevalence of S. mansoni was examined by Kato-Katz method. Simultaneously, a KAP survey toward schistosomiasis was conducted among the pupils. Health education contents were extracted from textbooks. All primary schools in the study site were surveyed regarding how each secured water used for daily school life. The prevalence of S. mansoni was 56% and 36% in 2015 and 2016, respectively. 60-70% of pupils chose a correct answer for the mode of transmission. More than 70% of pupils answered that bathing in Lake Victoria causes Schistosoma infection; however, more than 70% of pupils bathed in Lake Victoria sometimes or every day. According to the science textbook, "avoiding contact with contaminated water" is the way to prevent schistosomiasis; however, 66% of schools asked pupils to bring water from Lake Victoria. The prevalence of S. mansoni among pupils remains high. Schoolchildren are taught to avoid contact with contaminated water but are often asked to fetch water from the lake. From the school health viewpoint, health education that reflects the social and cultural context of the community in the contents and teaching methods are needed. In addition to this, provision of sanitation infrastructure is needed. A comprehensive and innovative approach which harmonises central and local governments and other stakeholders, as well as community is important to prevent schistosomiasis.

Fig 1. Study site and target schools.

A green rectangle in the national map indicates the position of the area shown in the main map frame. Red stars in the main frame indicate target schools. Blue rhombuses indicate boreholes. Brown small dots indicate households that do not have piped water. Cream small dots indicate households that have piped water. Base map data was downloaded from USGS LandsatLook https://landsatlook.usgs.gov/viewer.html Kenya map image was downloaded from CIA World Factbook https://www.cia.gov/library/publications/the-worldfactbook/graphics/maps/large/ke-map.gif.

Fig 2. Water source of schools (Multiple answers, N = 93).

Fig 3. Proportion of schools using water fetched by pupils and fetching points (N = 93).