Search

Primary prevention of schistosome infection has received little attention of late. We describe a novel water recreation area (WRA) to reduce Schistosoma haematobium infection rates in Adasawase, Ghana. Urogenital schistosomiasis is a water-based parasitic disease that affects over 100 million people worldwide, primarily children in the rural tropics. The disease is contracted via dermal contact with contaminated water. Widespread distribution of praziquantel is presently used to control morbidity, but chemotherapy does not confer immunity and reinfection can have severe health impacts. In 2008, an estimated 44% of school-aged children in Adasawase had S. haematobium eggs in their urine. Recreational contact with water was the primary transmission route. In collaboration with community members, a novel WRA was constructed. The WRA is groundwater and rainwater fed and serves more than 100 children at any given time. It was constructed from local materials and labor, designed to last more than 30 years, and minimizes exposure to S. haematobium. One year after construction, the annual incidence of S. haematobium infection dropped from 18.6% in 2009 to 4.6% in 2010, respectively (p < 0.001). Given the promising evidence, the data will be examined more rigorously to characterize factors that influence water contact and infection risk.

Background Urogenital schistosomiasis caused by Schistosoma haematobium was endemic in Adasawase, Ghana in 2007. Transmission was reported to be primarily through recreational water contact. Methods We designed a water recreation area (WRA) to prevent transmission to school-aged children. The WRA features a concrete pool supplied by a borehole well and a gravity-driven rainwater collection system; it is 30 m2 and is split into shallow and deep sections to accommodate a variety of age groups. The WRA opened in 2009 and children were encouraged to use it for recreation as opposed to the local river. We screened children annually for S. haematobium eggs in their urine in 2008, 2009, and 2010 and established differences in infection rates before (2008–09) and after (2009–10) installation of the WRA. After each annual screening, children were treated with praziquantel and rescreened to confirm parasite clearance. Principal Findings Initial baseline testing in 2008 established that 105 of 247 (42.5%) children were egg-positive. In 2009, with drug treatment alone, the pre-WRA annual cumulative incidence of infection was 29 of 216 (13.4%). In 2010, this incidence rate fell significantly (p, Author Summary Urogenital schistosomiasis is a disease caused by the parasite Schistosoma haematobium; it is often characterized by bloody urine and tends to disproportionately affect school-aged children in rural tropical regions. The parasite is transmitted via skin contact with surface water that is contaminated by human waste. The disease was endemic in Adasawase, a rural Ghanaian community, in 2007. Transmission occurred mainly through recreational water contact. We collaborated with community members to design a water recreation area (WRA) featuring a concrete pool supplied by a borehole well and a rainwater collection system. We opened the pool in 2009 and local officials encouraged children to use the WRA for recreation. We screened local children annually (2008, 2009, 2010) for S. haematobium infection. After each screening, children were treated with praziquantel and rescreened. Baseline testing in 2008 established that at least 105 of 247 (42.5%) children were infected. In 2009, 29 of 216 (13.4%) children were infected, reflecting annual cumulative incidence. In 2010, a significantly smaller percentage of children (9 of 245, 3.7%) were infected. We conclude that the WRA effectively reduced infection in Adasawase, and that it should be tested in other water-rich endemic areas.