INTRODUCTION
Urinary schistosomiasis, also known as urogenital schistosomiasis, is a
significant public health concern in sub-Saharan Africa, particularly in rural
areas with limited access to clean water and sanitation (Minjibir et al., 2020). This neglected tropical
disease (NTD) caused by the parasite Schistosoma
haematobium presents symptoms such as
haematuria (blood in urine), dysuria (painful urination), and bladder wall
damage, potentially leading to severe complications like hydronephrosis (kidney
swelling) and squamous cell carcinoma (Tamomh et al., 2018; Surakat et al, 2020)
Nigeria bears a substantial burden of schistosomiasis globally, with
approximately 29 million infected individuals, including 16 million children,
and an estimated 101 million people at risk due to factors such as widespread
snail hosts, inadequate sanitation, poverty, and limited healthcare access (Atalabi
et al., 2016; Kone, 2022; Saidu et
al., 2023). Despite efforts by the Federal Ministry of Health (FMOH) and
the National Schistosomiasis Control Program (NSCP) to reduce prevalence,
progress has been hindered by challenges such as the lack of baseline data on
disease distribution (Ekpo et al., 2008; Oluwole et al., 2022).
Studies have shown that educating at-risk populations can significantly
improve disease control, particularly in highly endemic areas. To propose
effective behavioural change strategies and implement tailored interventions,
it is essential to assess the knowledge, attitudes, and practices (KAP) of
local populations in endemic areas. KAP surveys serve as valuable tools for
understanding the local context, informing targeted intervention strategies (Sady
et al., 2015; Sacolo et al., 2018; Rassi et al., 2019; Feng et al., 2023).
This study aimed at assessing the KAP of residents of Otuoke and Otuaba,
identifying factors contributing to inadequate knowledge, negative attitudes,
and suboptimal practices regarding schistosomiasis. By addressing these gaps
and understanding cultural, social and behavioural determinants, the study
result provides baseline information for the design and implementation of interventions
that will enhance community awareness and practices, ultimately seeking to
reduce the prevalence and impact of urinary schistosomiasis within the study
area and potentially inform broader NTD control efforts.
MATERIALS AND METHODS:
Study area
The
study was conducted in Otuoke and Otuaba
communities in Ogbia Local Government Area of Bayelsa
State. They
are located 17 kilometres from Yenagoa, the Capital of the State. The
vegetations in the area are typical tropical rain forest. The Coordinates is
4°41′22.417″N 7°17′43.470″E. The
people speak the Ijaw and Ogbia
dialect. They are predominantly farmers and fishermen. Plantain, Banana, Palm
nuts and Cassava are produced in commercial quantities in these communities (Smith,
2010). Also, Fresh water fish and Snails are common
in the areas. There is also functional borehole in the communities. Some places
in the communities lack toilet facilities and bushes are used for toilet
purposes. There is a make-shift toilet created at the bank of the Otuoke River
with faeces directly flowing into the river. There is presence of a market and
two hospitals including the university clinic. There are State primary and
secondary schools in the boundary of Otuoke and Otuaba communities which serve
both communities. There is a traditional leader referred to as “king” that
serves both communities. He is being assisted by some elders in both
communities. The community Developmental Committee (CDC) oversees that peace
and development are maintained in both communities. The leadership is changed
continually by election. “Pidgin English” is used as a means of communication
with foreigners (Fig. 1).
DISCUSSION
Sustainable control
and prevention of Urinary schistosomiasis requires an understanding of the
communities’ knowledge, attitude and perception (KAP) of the disease in endemic
areas. Such information is useful in planning and implementation of control
strategies for schistosomiasis control and reducing its morbidity (WHO, 2022).
The result
of this study revealed that knowledge, attitude and the perception of the
respondents about the disease varied greatly. The males in the communities were
more responsive to the questions during the study, hence the reason they have
the highest percentage of respondents (129) than the females (98). This could
be due to the boldness of the males as they responded more freely to questions
than the females who were shy and sometimes run away from interviews. Most
female in the communities also withdrew from answering certain questions about
the infection, most especially when asked if they have had the disease or seen
“blood in their urine” recently. This corresponds with the findings of Awi-waadu
and Ezenwaka (2009) in Abua/Odual Local Government Area of Rivers State that
males (55.5%) responded more than females (44.5%).
Only a
handful (1.76%) of children aged 5-9 years were able to respond to questions
and they indicated that they reported to their parents when they saw a “reddish
substance” in their urine. Respondents aged 20-25 years responded more freely,
indicating more willingness to answer questions about the disease. This could
be due to their knowledge of the disease and the ability to be vocal about the
symptoms and manifestations, and also the general conception that any infection
that involves blood coming out of the body is very serious (Yohana
et al., 2022).
The
knowledge about the cause of the disease was widely distributed as most
respondents claimed not to have any idea about the cause of the disease. This
was in sync with a similar study by Yohana et
al. (2022) where a general lack of knowledge about the disease was
reported. This could be due to the fact that they believed the infection will
heal on its own or that it is caused by various fetish means. Some respondents
reported that the disease was caused by witchcraft with some making reference
to disobeying certain traditional rules and regulations in the study area.
The
admittance of blood in the urine which is the characteristic symptom of the
infection (Tamomh
et al., 2018; Surakat et al., 2020) by a good number of
respondents suggests that the disease is likely present in the communities.
This calls for concern and shows that appropriate measures has not been ideally
implemented to prevent the occurrence of the disease in both communities.
The
knowledge about the proper way of diagnosing the infection was poor as also reported
by Noriode et al. (2018). This could
be because of other complications that may arise from the disease progression.
The admittance of examination of blood samples could be influenced as being a
popular choice due to the fact that most diseases occurring in the study area
are diagnosed through blood examination including the disease.
The choice
of various avenues for treatment by the respondents could mostly be due to
financial reasons as they perceived that it is more cost-friendly to go to the local
drug stores than going to the hospital. Churches and mosques were the least
places recognized for attaining treatment. Some respondents preferred going to
local traditional healers for treatment and these were mostly traditionalists,
elderly people and also those with the least educational background. In
general, the result revealed that the proportion of the level of knowledge
about Urinary schistosomiasis did not differ between Otuoke and Otuaba
communities. This may be possible since both communities are located in Bayelsa
and do share similar cultural and belief system.
The
attitude towards individuals with the disease was positive as most respondents
indicated that a concerning attitude was shown towards those with the
disease. This could be due to the
general belief that a disease or infection that includes blood coming out of
the body is termed serious. While there was a
level of concern among certain individuals regarding the disease, a proportion
exhibited neutral or indifferent attitudes. Addressing these attitudes is
crucial to foster a community-wide understanding of the importance of
supportive attitudes towards affected individuals and the significance of
disease prevention (Hambury et al.,
2021).
The
respondents that indicated their source of water to be from borehole (tap
water) were found to have attained a certain level of education and understand
the effect of unclean water. Some respondents reported using freshwater from
streams for various domestic activities and took actions to protect themselves
from various contamination, such as ‘’the addition of a little quantity of soda
ash” as indicated by one respondent. Although these methods are rudial, they
prove that implementation of recommended preventive measures and educational awareness
about the disease will go a long way in fighting against the disease (Folefac et al., 2018; Alo et al., 2021).
The type
of toilet facility in a community plays an important role in the prevention of
so many infectious diseases. It was observed that majority of the respondents
made use of a water closet although there is presence of make-shift toilets
close to the Otuoke River. It was also noticed that the sewage from this toilet
drains directly into the river. This could be the means of toilet used by those
who indicated the use of other facilities. This behavioural practice could be
one of the factors contributing to the spread of the disease in the study area (Shabani
et al., 2022).
Those who
engaged in activities that involve fresh water wore little or no footwear and
were scantily dressed. The lack of proper protective measures may contribute to
the penetration of the Schistosoma larvae into the body (Kulinkina et al., 2023; Tadele et al., 2023).
Generally
on attitude of the respondents on the disease, both communities shared similar
attitude towards the disease but when it comes to “contact with freshwater
sources” and “activities with freshwater”, both communities had varying view,
with residents in Otuoke having less contact with freshwater and reduced
freshwater activities than residents Otuaba. Owing to the fact that a former
president of Nigeria was from Otuoke, the community must have enjoyed some
level of development, awareness and education that kept them away from exposures
that can make them vulnerable to Urinary schistosomiasis.
CONCLUSION
The knowledge,
attitude and perception (KAP) study conducted in Otuoke and Otuaba communities
indicated poor knowledge regarding urinary schistosomiasis. This knowledge
deficit poses a significant challenge to disease prevention and control efforts
within the community. The KAP between both communities are majorly similar
although Otuoke residents had lower contact and activities with freshwater than
Otuaba residents.
Competing
interests: No conflict of
interest exists.
Authors'
contributions: ECO designed the study protocol. OSC
performed the field data collection. Both authors analyzed and interpreted the
data. OSC wrote the initial manuscript. All authors read and approved the final
manuscript.
Acknowledgements:
The
authors acknowledge the residents of Otuoke and Otuaba communities for their
consent to this study. Mr. Amadi, Fyneface of PAMO University, Port Harcourt,
Rivers State, is greatly appreciated for his technical support.
REFERENCES
Alo C, Akamike I, Agbo
U, Eze I, Madudueze U, Okedo-Alex I, Azuogu B, Una A, Elum P, Ugochukwu C, Nwonwu E and Ogbonnaya L (2021). Prevalence,
knowledge, attitude and preventive practices regarding intestinal and urinary
parasites among primary school children in a rural community in Ebonyi State, Nigeria. J. Epidemiol
Soc. Niger. 4 (1):
39-50.
Atalabi TE, Lawal
U and Ipinlaye SJ (2016). Prevalence and intensity of
genito-urinary schistosomiasis
and associated risk factors among junior high school students in two local
government areas around Zobe Dam in Katsina State, Nigeria. Parasit
Vectors 9: 388.
Awi-Waadu G and Ezenwaka CO (2009). Urinary schistosomiasis in Abua/Odual
Local Government Area, Rivers State, Nigeria. Afr. J. Appl
Zool Env. Biol. 11: 116-123.
Ekpo UF, Mafiana
CF, Adeofun CO, Solarin ART and Idowu AB (2008). Geographical information system and predictive risk maps of
urinary schistosomiasis in Ogun
State, Nigeria. BMC Infect. Dis. 8: 74. https://doi.org/10.1186/1471-2334-8-74.
Feng J, Wang
X, Zhang X, Hu H, Xue J, Cao C, Xu
J, Yang P and Li S (2023). Effect of Health
Education on Schistosomiasis Control Knowledge, Attitude, and Practice after
Schistosomiasis Blocking: Results of a Longitudinal Observational Study in the
Field. Trop Med. Infect. Dis. 8 (5): 267.
Folefac LN, Nde-Fon
P, Verla VS, Tangye MN, Njunda AL and Luma HN (2018).
Knowledge, attitudes and practices regarding urinary schistosomiasis among
adults in the Ekombe Bonji
Health Area, Cameroon. Pan Afr Med J. 29: 161.
Hambury SD, Grobler
AD and Melariri PE (2021). Knowledge, attitudes, and
practices on urinary schistosomiasis among primary schoolchildren in Nelson
Mandela Bay, South Africa. J. Parasitol Res. 2021,
6774434.
Kone KJ, Onifade
AK and Dada EO (2022). Occurrence of urinary schistosomiasis and associated
bacteria in parts of Ondo State, Nigeria. PLOS Glob
Public Health 2 (10): e0001119.
Kulinkina AV, Farnham A, Biritwum NK, Utzinger J and Walz Y (2023). How do disease-control measures impact
spatial predictions of schistosomiasis and hookworm? The example of predicting
school-based prevalence before and after preventive chemotherapy in Ghana. PLoS Negl Trop Dis. 17 (6): e0011424.
Minjibir AA, Mu’azu L, Tinuoye and Ali M
(2020). Prevalence of Schistosomiasis among Primary Pupils in Dawakin-Kudu
Local Government Area Kano State, Nigeria. ARC J Urol. 5 (1): 15-20.
Noriode RM, Idowu ET, Otubanjo OA and Mafe MA. (2018). Urinary
schistosomiasis in school aged children of two rural endemic communities in Edo
State, Nigeria. J Infect Public Health 11 (3): 384-388.
Tamomh AG, Abakr AD and Nour BYM (2018). Urinary schistosomiasis among basic school children in a new
irrigated sugar scheme area, White Nile State, Sudan. J Microbiol
Exp. 6 (2): 93-96.
Oborie, E and Nwankwoala,
H (2012). Relationships between Geoelectrical and Groundwater Parameters in Parts of Ogbia,
Bayelsa Sate, Central Niger Delta. Cont J. Earth Sci.
7: 29-39.
Oluwole AS, Ekpo
UF, Nebe OJ, Akpan NM , Jacob SM, Amazigo UV and Stothard JR (2022). The new WHO guideline for control and elimination of human
schistosomiasis: implications for the Schistosomiasis Elimination Programme in Nigeria.
Infect Dis Poverty. 11, 111. https://doi.org/10.1186/s40249-022-01034-3.
Rassi C, Martin S,
Graham K, de Cola MA, Christiansen-Jucht C, Smith LE,
Jive E, Phillips AE, Newell JN and Massangaie M (2019). Knowledge, attitudes and practices with regard to
schistosomiasis prevention and control: Two cross-sectional household surveys
before and after a Community Dialogue intervention in Nampula
province, Mozambique. PLoS Negl
Trop Dis. 13 (2): e0007138.
Sacolo H, Chimbari
M and Kalinda C (2018). Knowledge, attitudes and
practices on Schistosomiasis in sub-Saharan Africa: a systematic review. BMC
Infect. Dis. 18 (1): 46. https://doi.org/10.1186/s12879-017-2923-6.
Sady H, Al-Mekhlafi
HM, Atroosh WM, Al-Delaimy AK, Nasr NA, Dawaki S, Al-Areeqi MA, Ithoi I, Abdulsalam
AM, Chua KH and Surin J (2015). Knowledge, attitude, and practices towards schistosomiasis among
rural population in Yemen. Parasit Vectors 8, 436.
https://doi.org/10.1186/s13071-015-1050-8.
Saidu U, Ibrahim MA, de Koning HP, McKerrow JH, Caffrey CR and Balogun EO (2023).
Human schistosomiasis in Nigeria: present status, diagnosis, chemotherapy, and
herbal medicines. Parasitol Res. 122: 2751-2772.
Shabani M, Zacharia
A, Mushi V, Joseph M, Kinabo
C and Makene T. (2022). Prevalence and predictors of
intestinal schistosomiasis among the adult population, and water and sanitation
conditions - A community-based cross-section study at Muleba
District, Tanzania. Rwanda Med. J. 79 (1): 36-43.
Smith J (2010). Geography of Bayelsa State.
Lagos publishers, 76.
Surakat OA, Alabi
OR, Ogundana TE, Rufai M, Adeleke MA, Sam-Wobo SO and Mafiana CF (2020).
Evaluation of Water Sanitation and Hygiene (WASH) Facilities and Its
Association with Urinary Schistosomiasis in Selected Settlements of Osun State,
Nigeria. Pan Afr J. Life Sci. 4(2): 51-58.
Tadele T, Astatkie
A, Tadesse BT, Makonnen E, Aklillu E and Mequanente A.
(2023). Efficacy and safety of praziquantel treatment
against Schistosoma mansoni
infection among pre-school age children in southern Ethiopia. Trop Med Health
51, 72. doi:
10.1186/s41182-023-00562-4. PMID: 38124206; PMCID: PMC10731898.
World Health
Organization (WHO) (2022). WHO launches new guideline for the control and elimination of human schistosomiasis. 14 February 2022; 142 Pages. https://www.who.int/publications/i/item/9789240041608.
Yohana C, Kinung’hi
SM, Nyundo BA, Rambau PF
and Bakuza JS (2022). Knowledge, attitudes and
practices on urinary schistosomiasis-related morbidity among communities in
Itilima District, Tanzania. Tanz. J. Sci. 48 (4): 875-885.
