Evaluation of a Novel Primary Prevention Technique for the Control of Urogenital Schistosomiasis: A Pilot Intervention in Adasawase, Ghana.
Adasawase, a rural Ghanaian town, 36% of girls (n=43/119) and 51% of boys (n=69/134) who
were screened three times were infected with S. haematobium as of 2008. Praziquantel was
administered by Ghana Health Services. In 2009, schoolchildren were screened three or
more times and prevalence was estimated to be 13% (n=13/98) among girls and 24%
(n=29/122) among boys, indicating ongo... read moreing transmission of S. haematobium. In 2009,
children again received praziquantel. Children in Adasawase contract schistosomiasis in
the Tini River where they play, bathe, and collect water. An intervention in the form of
a novel water recreation area (WRA) was designed and implemented to function as an
effective, sustainable form of primary prevention. It consists of a concrete pool
supplied by two hand-pumped boreholes and a rainwater collection system. Adasawase was
selected for the study based on the relatively high prevalence of urogenital
schistosomiasis, strong support of the project by community leaders, and water
availability. Concrete structural elements were constructed in 2008 and waterproofing
and aesthetic touches were completed in 2009. The WRA was opened for public use after
praziquantel treatment in 2009. Community members operate and maintain the WRA. Local
children were encouraged by community leaders to use the WRA instead of the Tini River
for recreation. In 2010, one year after opening the WRA, children were screened at least
three times for S. haematobium eggs; only 2% of girls (n=2/105) and 5% of boys (n=7/141)
were positive, reflecting annual incidence after WRA construction. Risk factors
associated with infection also changed significantly during the course of the study.
Age, sex, and observed river use in 2009 correlated with 2008 infection status. Observed
river use and previous infection status were the only significant risk factors in 2009.
Statistical analysis of positive children in 2010 was not possible due to the small
number of positive children. The WRA should be evaluated in other water-rich regions to
determine whether it is effective and sustainable in other settings. Continued
praziquantel administration is still necessary for morbidity control and should be
promoted in conjunction with WRAs.
Thesis (Ph.D.)--Tufts University, 2011.
Submitted to the Dept. of Civil Engineering.
Advisor: David Gute.
Committee: Kwabena Bosompem, John Durant, Jeanine Plummer, and Miguel Stadecker.
Keywords: Public health, Environmental health, and Civil engineering.read less