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Background: Modifications of behavior can help reduce the risk of transmission by disrupting the parasite life cycle. Behavior intension is a necessary intermediate step in behavior change. This study aimed to explore protection motivation theory (PMT) in predicting likelihood of engagement in protective behavior against infection with Schistosoma., Methods: In China, a questionnaire for data collection was sent to users who followed the WeChat public account from June 2 to 6, 2023. Factors affecting intentional behavior of participants were analyzed using stepwise regression analysis and structural equation modeling., Results: A total of 2,243 valid questionnaires were collected, with a mean age of 30 ± 8.4 years. Approximately 1,395 (62.2%) participants reported that they had been exposed to wild waters in daily work and life. About 51.0 and 50.7% of respondents reported never having been exposed to wild water in the last 3 and 6 months, respectively. Results indicated that prior knowledge of schistosomiasis was associated with the 7 PMT subconstructs, which then influenced future preventative behaviors., Conclusion: Behavior intentionis a complicated and indispensable part of behavior change that is influenced by professional knowledge, socio-economic status, and personal characteristics. The effective dissemination of knowledge regards schistosomiasis should be strengthened to emphasize the effectiveness of protective measures against infection and severe disease., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wang, Li, Zhang, Mao and Li.)

Introduction: In Uganda, schistosomiasis (re)infections have continued to remain high despite the implementation of mass drug administration and sensitization campaigns aimed at controlling the disease. This could imply that there are some barriers to the implemented preventive measures. We conducted a mixed-methods study in Kagadi and Ntoroko districts around Lake Albert to assess knowledge, attitudes, and practices regarding schistosomiasis and to explore and understand perspectives regarding the disease., Materials and Methods: Semi-structured survey questionnaires were administered to 337 household adults selected through systematic random sampling. We also interviewed 12 participants and held 28 focus-group discussion sessions with 251 individuals respectively. Quantitative data was analysed using frequencies, percentages, and chi-square tests for associations, while themes and sub-themes were used to analyse qualitative data respectively., Findings: A total of 98.5%, 81.3%, and 78.5% had heard about schistosomiasis, and knew the main transmission modes and symptoms, respectively. The majority (75.8%) said avoiding contact with water was a preventative way, while 67.5% said observing signs and symptoms was a form of diagnosis. Furthermore, 98.4% and 73.4% said it was important to defecate in latrines and to avoid contact with contaminated water respectively. However, it is difficult to avoid contact with lake water because it is the only source of livelihood, especially for fisher communities. Open defecation is commonly practiced along the lake due to insufficient space and difficulties in the construction of latrines. Myths and misconceptions reported include; lake water is safe, gassing in water causes transmission, fetching water early in the morning and from deep water is safe, and feces in the lake water act as a bait for catching fish., Conclusions and Recommendations: Despite adequate knowledge of schistosomiasis and a positive attitude towards its prevention, existing myths and misconceptions, coupled with persistent risky water, sanitation, and hygiene practices still pose a challenge. A more robust community-based awareness intervention using bottom-up participatory approaches, accompanied by the provision of clean and safe water sources and increasing latrine coverage, could provide lasting solutions to these barriers., Competing Interests: The authors have declared that no competing interests exist.

Background: Control of schistosomiasis remains a priority in endemic areas. Local epidemiological data are necessary for a tailored control programme, including data on population behaviour in relation to the disease. The objective of this study was to assess schistosomiasis-related knowledge, attitudes and practices in the general population of Lambaréné, a small city in Gabon, in order to optimise the design and implementation of a local control programme that is tailored to need., Methods: The study was cross-sectional in nature. Eligible adults and children living in the study area who volunteered (with informed consent) to participate in the study were interviewed using standardised questionnaires, one of which was a simplified version of the primary questionnaire for participants aged 6-13 years. Data on the participants' knowledge, attitudes and practices that enhance the risk for contracting schistosomiasis were collected., Results: A total of 602 participants were included. The mean (± standard deviation) age was 21.2 (± 15.0) years, the female:male gender ratio was 1.6 and 289 (48%) participants completed the simplified version the questionnaire. Of the 602 participants, 554 (92%) reported past or current contact with freshwater, 218 (36%) reported a history of a diagnosis of schistosomiasis and 193 (32%) reported past intake of praziquantel medication. The overall levels of knowledge and adequate attitudes toward schistosomiasis among young adults and adults were 68 and 73%, respectively. The proportion of participants pursuing risk-enhancing practices (REP) was 60% among the whole study population. Location was significantly associated with differences in knowledge and REP levels. A history of confirmed schistosomiasis and larger family size were significantly associated with an increase in good knowledge and REP levels. However, the indication of freshwater-associated activities was only associated with a significant increase in the REP level., Conclusions: The results of this survey reveal a high level of population exposure to schistosomiasis, which is in line with known prevalence of schistosomiasis in Lambaréné and its surroundings. The local population has a reasonable level of knowledge of and adequate attitudes toward schistosomiasis but the level of REP is high, particularly in areas where piped water is absent. In terms of interventions, improving hygiene should have the highest priority, but in a context where provision of safe water is difficult to achieve, the effectiveness of praziquantel treatment and the education of at-risk populations on the need for protective behaviours should be a prominent feature of any local control programme., (© 2021. The Author(s).)

Background: Schistosomiasis is a parasitic neglected tropical disease that ranks second only to malaria in terms of human suffering in the tropics and subtropics. Biomedical disease control interventions need to be complemented with effective prevention and health education strategies, that address the social and environmental determinants of disease. Malaria Consortium conducted an implementation research study between May 2014 and February 2016, in four districts of Nampula province, Mozambique, to test a Community Dialogue (CD) intervention to enhance schistosomiasis prevention and control. The study aimed to evaluate the acceptability and feasibility of using CD to improve communities' level of knowledge, attitudes and practices, and engagement in wider schistosomiasis prevention and control efforts., Methods: The feasibility and acceptability of the CD intervention was evaluated using qualitative and process evaluation data collected throughout the development and implementation phases. Qualitative data sets included key informant interviews (N = 4) with health system personnel, focus group discussions (N = 22) with Community Dialogue facilitators and participants, field observation visits (N = 11), training reports (N = 7), feedback meeting reports (N = 5), CD monitoring sheets (N = 1,458) and CD planning sheets (N = 152)., Findings: The CD intervention was found highly acceptable and feasible, particularly well-suited to resource poor settings. Non-specialist community volunteers were able to deliver participatory CDs which resulted in increased knowledge among participants and triggered individual and communal actions for improved disease prevention and control. The visual flipchart was a key aid for learning; the use of participatory communication techniques allowed the correction of misconceptions and positioned correct prevention and control practices as the community recommendations, through consensus building., Conclusion: The Community Dialogue Approach should be embedded within neglected tropical disease control programmes and the health system to create long-lasting synergies between the community and health system for increased effectiveness. However, for behavioural change to be feasible, community engagement strategies need to be supported by improved access to treatment services, safer water and sanitation., Competing Interests: The authors have declared that no competing interests exist.

Objective: To examine the effect of rational emotive therapy on negative emotions among advanced schistosomiasis patients with repeated hospitalizations., Methods: A total of 97 advanced schistosomiasis patients with anxiety and depressive emotions that were hospitalized in Xiangyue Hospital of Hunan Institute of Schistosomiasis Control for three times or more were enrolled, and given rational emotive therapy for 4 weeks in addition to routine nursing care. The scores for anxiety, depression and quality of life were estimated in patients before and after the rational emotive therapy using the Self-Rating Anxiety Scale (SRS), the Self-Rating Depression Scale (SDS) and WHOQOL-BREF Form., Results: The SAS and SDS scores were significantly lower 4 weeks following rational emotive therapy than before the intervention (SAS score, 45.40 ± 7.77 vs. 59.25 ± 9.29, t = 14.021, P < 0.01; 51.48 ± 8.01 vs. 63.93 ± 9.59, t = 12.991, P < 0.01). The percentages of patients with moderate and severe anxiety and depression were significantly lower 4 weeks following rational emotive therapy than before the intervention ( P < 0.01), and the scores for each item in the quality of life were all significantly greater 4 weeks following rational emotive therapy than before the intervention ( P < 0.01)., Conclusions: Rational emotive therapy may improve the negative emotions and the quality of life of advanced schistosomiasis patients with repeated hospitalizations.

Background: Soil-transmitted helminthiasis (STH) and schistosomiasis are parasitic infections prevalent in tropical and subtropical countries, such as the Philippines. The prevalence of these infections remain high in certain Philippine provinces, despite established mass drug administration (MDA) programs in endemic communities. This study aimed to understand community knowledge and perceptions of these infections to determine their implications on the current control and elimination strategies, including possible barriers to MDA compliance., Methods: The study was conducted in Northern Samar and Sorsogon, two provinces with the highest STH and schistosomiasis prevalence in the country. Focus group discussions with separate parent and children groups were utilized to gather knowledge and perceptions on STH and schistosomiasis causes, symptoms, treatment, and prevention; and on the deworming drugs and overall program implementation. Data collection in Northern Samar were done in August 2017, while the sessions in Sorsogon took place in May 2018. A cultural construction of disease framework will show how several factors affect MDA participation., Results: Results showed that participants held mostly correct biomedical notions of the infections and expressed willingness to participate in MDA program. However, reservations remained due to a reported lack of information dissemination, lack of confidence in the drugs used, and widespread fear of adverse side effects., Conclusion: Addressing these concerns - improving the conduct of the deworming program, incorporating suggestions from the community, and managing potential adverse events - may help raise MDA participation and encourage better personal preventive practices, reducing STH and schistosomiasis prevalence., Trial Registration: N/A.

Schistosomiasis is a chronic but preventable disease that affects 260 million people worldwide. In the Philippines, 860,000 people are afflicted with Schistosoma japonicum annually, and another 6.7 million live in endemic areas. The disease's complex epidemiology as well as the influence of poverty in endemic areas demand an integrated, multi-sectoral approach to disease control. Results from behavioral or sociocultural studies on schistosomiasis could improve the content and impact of schistosomiasis control in rural villages in the Philippines. We investigated knowledge, attitudes and practices related to schistosomiasis transmission and control in an endemic village in Leyte Province, Philippines. We administered a questionnaire to 219 participants covering 1) knowledge and attitudes related to schistosomiasis, its symptoms, and its transmission; 2) attitudes and practices in relation to schistosomiasis prevention; 3) willingness to comply with public health control programs; and 4) whether the respondent had previously contracted schistosomiasis. Responses revealed fairly high measures of schistosomiasis knowledge (mean 17.0 out of 23 questions, range 6-23), but also inconsistent disease prevention behavior. A high proportion of participants (72.6%, n = 159) reported previous disease. Participant belief in the preventability of schistosomiasis was revealed to be a key attitude, as carabao owners who believed in prevention were over five times more likely to be willing to vaccinate their carabaos (OR = 5.24, 95% CI 1.20-27.68, P = 0.04). Additionally, participants who did not believe in prevention were about twice as likely to report previous disease (OR = 2.31, 95% CI 1.02-5.63, P = 0.05). Our results suggest that future public health interventions should address barriers to disease-preventing behavior, as well as maintaining community belief in disease prevention. Comprehensive disease control programs should be supplemented by sociocultural and behavioral context in order to improve their impact in endemic communities., Competing Interests: The authors have declared that no competing interests exist.

Background: The Community Dialogue Approach is a promising social and behaviour change intervention, which has shown potential for improving health seeking behaviour. To test if this approach can strengthen prevention and control of schistosomiasis at community level, Malaria Consortium implemented a Community Dialogue intervention in four districts of Nampula province, Mozambique, between August 2014 and September 2015., Methodology/principal Findings: Cross-sectional household surveys were conducted before (N = 791) and after (N = 792) implementation of the intervention to assess its impact on knowledge, attitudes and practices at population level. At both baseline and endline, awareness of schistosomiasis was high at over 90%. After the intervention, respondents were almost twice as likely to correctly name a risk behaviour associated with schistosomiasis (baseline: 18.02%; endline: 30.11%; adjusted odds ratio: 1.91; 95% confidence interval: 1.14-2.58). Increases were also seen in the proportion of people who knew that schistosomiasis can be spread by infected persons and who could name at least one correct transmission route (baseline: 25.74%; endline: 32.20%; adjusted odds ratio: 1.36; 95% confidence interval: 1.01-1.84), those who knew that there is a drug that treats the disease (baseline: 29.20%, endline: 47.55%; adjusted odds ratio: 2.19; 95% confidence interval: 1.67-2.87) and those who stated that they actively protect themselves from the disease and cited an effective behaviour (baseline: 40.09%, endline: 59.30%; adjusted odds ratio: 2.14; 95% confidence interval: 1.40-3.28). The intervention did not appear to lead to a reduction in misconceptions. In particular, the belief that the disease is sexually transmitted continued to be widespread., Conclusions/significance: Given its overall positive impact on knowledge and behaviour at population level, Community Dialogue can play an important role in schistosomiasis prevention and control. The intervention could be further strengthened by better enabling communities to take suitable action and linking more closely with community governance structures and health system programmes., Competing Interests: The authors have declared that no competing interests exist.

Background: Among parasitic infections, schistosomiasis ranks second after malaria in terms of worldwide morbidity. Despite efforts to contain transmission, more than 230 million people are infected, of which 85% live in Sub-Saharan Africa. While the epidemiologic characteristics of schistosomiasis have been extensively studied across endemic settings, social factors have been paid less attention. The current study assesses community knowledge of schistosomiasis causes, transmission, signs, symptoms and prevention, as well as healthcare-seeking behaviours in two West African settings, with the aim of strengthening schistosomiasis control interventions., Methods: From August 2014 to June 2015, we conducted two cross-sectional surveys in Korhogo, Côte d'Ivoire and Kaédi, Mauritania. We applied a questionnaire to collect quantitative data at the household level in Korhogo (n = 1456) and Kaédi (n = 1453). Focus group discussions (Korhogo: n = 32, Kaédi: n = 32) and participatory photography (photovoice) (Korhogo: n = 16, Kaédi: n = 16) were conducted within the communities to gather qualitative data. In addition, semi-structured interviews were used to discuss with key informants from control programmes, non-governmental organizations and health districts (Korhogo: n = 8, Kaédi: n = 7)., Results: The study demonstrated that schistosomiasis is not well known by the communities; 64.1% claimed to know the causes of the disease, but the reality is different. This knowledge is more from cultural than biomedical source. It was observed that social construction of the disease is different from the biomedical definition. In Korhogo, schistosomiasis was often associated with several other diseases, notably stomach ulcer and gonorrhoea. The populations believe that schistosomiasis is caused by exposure to goat or dog urine in the environment. In Kaédi, schistosomiasis is considered as a disease transmitted by environmenal elements such as sunshine and dirty water. In both settings, the care-seeking pathways were found to be strongly influenced by local customs and self-medication acquired from the informal sector., Conclusions: This study revealed that knowledge about the aetiology, transmission, symptoms, prevention and treatment of schistosomiasis among the populations in Korhogo and Kaédi is based on their local culture. Deep-rooted habits could therefore pose a significant obstacle to the elimination of schistosomiasis.

Background: Schistosomiasis, a worldwide concern, has received attention in Swaziland through control programs such as deworming programs, education programs, and school health programs; however, these programs neglect the importance of monitoring and evaluation strategies such as assessing children's knowledge, attitudes and practices (KAPs) and the prevalence of the disease. Children are a high-risk group because of their water contact practices, and need to be informed about schistosomiasis to influence their attitudes and practices. Social and cultural factors are involved in schistosomiasis control because they instill myths and misconceptions about the disease. As a result, children in the community may be comfortable with bad practices. This study aimed to assess the KAPs of schoolchildren on schistosomiasis, and to identify practices that support or hinder the progress of schistosomiasis control., Methods: In 2014, a descriptive quantitative cross-sectional survey was conducted through questionnaires among Siphofaneni primary schools, an area hit by schistosomiasis in the Lowveld of Swaziland. A logistic regression model was applied to analyze the data., Results: Moderate knowledge, good attitudes, and fairly good practices were observed in the children. However, practices of certain children were risky and they still had some misconceptions. Knowledge was correlated with practice and with predictors of good and bad practices such as male sex, always urinating in water, and always using river water for domestic practices., Conclusion: This study suggests that empowering children with knowledge and attempting to modify their water contact, and improved human waste disposal practices are necessary for schistosomiasis control., (Copyright © 2016. Published by Elsevier B.V.)

Background: Schistosomiasis remains a global health problem with an estimated 250 million people in 78 countries infected, of whom 85% live in Sub-Saharan Africa. Preventive chemotherapy remains the key public health strategy to combat schistosomiasis worldwide. Recently the WHO emphasized on the use of integrative approaches in the control and elimination of schistosomiasis. However, a detailed understanding of sociocultural factors that may influence the uptake of the intended health activities and services is vital. Thus, our study sought to understand the knowledge, attitudes, perceptions, beliefs and practices about schistosomiasis in various communities in Sub-Saharan Africa., Methods: A systematic search of literature for the period 2006-2016 was done on Medline, PubMed, CINAHL, Psych info and Google Scholar using the following key words "Schistosomiasis, S. mansoni, S. haematobium, knowledge, attitudes, perceptions, beliefs and practices in Sub-Saharan Africa" in combination with Bolean operators (OR, AND). In this context, we reviewed studies conducted among school children, community members and caregivers of preschool children. Thematic analysis was utilised for the overall synthesis of the selected studies. This was done after reading the articles in depth. Themes were identified and examined for similarities, differences and contradictions., Results: Gaps in schistosomiasis related knowledge and sociocultural barriers towards the uptake of preventive and treatment services among communities in Sub-Saharan Africa were identified. In addition to limited knowledge and negative attitudes, risky water related practices among community members, school children and caregivers of preschool children were identified as key factors promoting transmission of the disease., Conclusion: The study concluded that a comprehensive health education programme using contextual and standardised training tools may improve peoples' knowledge, attitudes and practices in relation to schistosomiasis prevention and control. Findings also highlight the significance of including caregivers in the planning and implementation schistosomiasis control programs targeting pre-school children.

Background: By means of meta-analysis of information from all relevant epidemiologic studies, we examined the hypothesis that Schistosoma infection in school-aged children (SAC) is associated with educational loss and cognitive deficits., Methodology/principal Findings: This review was prospectively registered in the PROSPERO database (CRD42016040052). Medline, Biosis, and Web of Science were searched for studies published before August 2016 that evaluated associations between Schistosoma infection and cognitive or educational outcomes. Cognitive function was defined in four domains-learning, memory, reaction time, and innate intelligence. Educational outcome measures were defined as attendance and scholastic achievement. Risk of bias (ROB) was evaluated using the Newcastle-Ottawa quality assessment scale. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated to compare cognitive and educational measures for Schistosoma infected /not dewormed vs. uninfected/dewormed children. Sensitivity analyses by study design, ROB, and sequential exclusion of individual studies were implemented. Thirty studies from 14 countries, including 38,992 SAC between 5-19 years old, were identified. Compared to uninfected children and children dewormed with praziquantel, the presence of Schistosoma infection and/or non-dewormed status was associated with deficits in school attendance (SMD = -0.36, 95%CI: -0.60, -0.12), scholastic achievement (SMD = -0.58, 95%CI: -0.96, -0.20), learning (SMD = -0.39, 95%CI: -0.70, -0.09) and memory (SMD = -0.28, 95%CI: -0.52, -0.04) tests. By contrast, Schistosoma-infected/non-dewormed and uninfected/dewormed children were similar with respect to performance in tests of reaction time (SMD = -0.06, 95%CI: -0.42, 0.30) and intelligence (SMD = -0.25, 95%CI: -0.57, 0.06). Schistosoma infection-associated deficits in educational measures were robust among observational studies, but not among interventional studies. The significance of infection-associated deficits in scholastic achievement was sensitive to ROB. Schistosoma infection-related deficits in learning and memory tests were invariant by ROB and study design., Conclusion/significance: Schistosoma infection/non-treatment was significantly associated with educational, learning, and memory deficits in SAC. Early treatment of children in Schistosoma-endemic regions could potentially mitigate these deficits., Trial Registration: ClinicalTrials.gov CRD42016040052.

Background: Schistosomiasis remains a major public health problem in Kenya. Inadequate knowledge, attitudes and practices (KAP) on causative factors are some of the critical factors for the increased prevalence. The study assessed KAP on the control and prevention of schistosomiasis infection in Mwea division, Kirinyaga County-Kenya. Four hundred and sixty five house-hold heads were enrolled in this study by use of simple random sampling technique., Methods: The study employed an analytical descriptive cross sectional design utilizing both quantitative and qualitative data collection methods. A pretested structured questionnaire, Focus Group Discusions (FGDs) and Key Informant Interviews (KII) guides were used for data collection. Descriptive statistics and Chi square tests and Fisher's exact tests were computed where applicable. Data from the FGDs and KIIs were analyzed using NUID.IST NUIRO.6 software., Results: Significant associations between knowledge and demographic factors i.e. age (p = 0.011), education level (p = 0.046), were reported. Handwashing after visiting the toilet (p = 0.001), having a toilet facility at home (p = 0.014); raring animals at home (p = 0.031), households being affected by floods (p = 0.005) and frequency of visits to the paddies (p = 0.037) had a significant association with respondents practices and schistosomiasis infection. Further significance was reported on households being affected by floods during the rainy season (p < 0.001), sources of water in a household (p < 0.047) and having a temporary water body in the area (p = 0.024) with increase in schistosomiasis infection. Results revealed that respondents practices were not significantly associated with gender (p = 0.060), marital status (p = 0.71), wearing of protective gear (p = 0.142) and working on the paddies (p = 0.144)., Conclusions: This study reveals that knowledge about the cause, transmission, symptoms and prevention of schistosomiasis among the Mwea population was inadequate, and that this could be a challenging obstacle to the elimination of schistosomiasis in these communities. Due to various dominant risk factors, different control strategies should be designed. Therefore, there is a need for integrated control programme to have a lasting impact on transmission of schistosomiasis infection. Control programs like mass drug administration need to go beyond anti-helminthic treatment and that there is a need of a more comprehensive approach including access to clean water, sanitation and hygiene. School and community-based health education is also imperative among these communities to significantly reduce the transmission and morbidity from schistosomiasis.

This is a case report of a 24-year-old Ethiopian woman with a medical history of hepatosplenic schistosomiasis. She suffers from chronic liver failure and portal hypertension. She has been hospitalised for 'hysteria' in the past but did not receive follow-up, outpatient treatment or psychiatric evaluation. After discontinuing her medications and leaving her family to use holy water, a religious medicine used by many Ethiopians, she was found at a nearby monastery. She was non-communicative and difficult to arouse. The patient was rushed to nearby University of Gondar Hospital where she received treatment for hepatic encephalopathy and spontaneous bacterial peritonitis. Her illness is the result of neglected tropical disease, reliance on traditional medicine as opposed to biomedical services and the poor state of psychiatric care in the developing world., (2016 BMJ Publishing Group Ltd.)

Objective: To investigate the effect of nursing with solution focused approach in advanced schistosomiasis patients., Methods: Fifty three patients with advanced schistosomiasis in the Liujiahu Hospital for Schistosomiasis Control of Yiyang City were randomized selected and separated into an intervention group and a control group. The patients of the intervention group received the conventional nursing plus solution focused approach, while the patients of the control group received only the conventional nursing. The effectiveness of nursing and treatment was evaluated in the two groups comparatively., Results: The knowledge of self-care skills, medical compliance behaviors and services satisfaction degree in the intervention group were higher than those in the control group (χ 2 = 3.78, 2.87, 4.09 respectively, all P < 0.05). The occurrence rate of upper gastrointestinal bleeding in the intervention group was significantly lower than that in the control group (χ 2 = 4.894, P < 0.05). The average hospitalization duration of the intervention group was shorter than that of the control group ( t = 4.17, P < 0.05)., Conclusions: The solution focused approach is a feasible and effective method in course of nursing of advanced schistosomiasis patients. It enhances the confidence of the patients and the trustiness of the patients to the health care providers. The complications and the hospitalization duration of the patients are reduced.

Objective: To explore the impact of self-efficacy on the behavior of contacting schistosome cercarial infested water among middle school students., Methods: In the transmission control area and endemic control area of the schistosomiasis endemic regions in Hubei Province, a total of 3 204 middle school students were selected through the stratified cluster random sampling method and investigated by questionnaires., Results: The incidence rates of contacting infested water with Oncomelania hupensis snails during the past 3 and 12 months among the middle school students were 11.4% (364/3 204) and 14.8% (474/3 204) respectively, while those of contacting indefinite infested water during the past 3 and 12 months were 23.8% (762/3 204) and 28.0% (898/3 204) respectively. The awareness rate of schistosomiasis prevention and control knowledge was 82.1% (2 631/3 204). There were "knowledge-practice separation"in the prevention and control of schistosomiasis among the middle school students. The correlation analysis and Logistic regression analysis showed that the self-efficacy of schistosomiasis protective behavior of middle school students was a protective factor for contacting with infested water, with the adjusted odds ratio values of 0.882, 0.886, 0.914 and 0.927., Conclusions: Self-efficacy of schistosomiasis protective behavior is a protective factor for contacting with infested water among middle school students, and improving their self-efficacy may be an effective strategy to settle the problem of"knowledge-practice separation".

Objective: To analyze the evolution process, discourse and semantic meaning of schistosomiasis prevention and control, so as to provide suggestions for control work., Methods: The official documents and mainstream media reports of schistosomiasis prevention and control were selected at different periods as discourse samples, and the deep social reasons behind the strategy change and the semantic meaning of the utterance were analyzed at different periods., Results: The discourse of schistosomiasis prevention and control experienced the evolution of the political discourse, pluralistic discourse and public discourse, and the semantic connotations showed the authority conflict semantic features, and then transferred to semantic cooperation., Conclusion: The prevention and control of schistosomiasis have different semantic meanings at different periods, and the prevention and control work should correspond to a social practice, seek truth from facts, correctly understand the actual situation, and then establish the effective control policy.

Objective: To investigate the cognitive levels of people from Chaohu area, Anhui Province about the prevention and control knowledge of schistosomiasis before the water transfer project operation, so as to provide the reference for formulating the health education intervention., Methods: A schistosomiasis questionnaire survey was conducted among the students, fishermen, boat people and villagers from Chaohu selected by the random cluster sampling from May to October, 2014., Results: A total of 1 140 questionnaires were issued with the actual recovery of 1 096 copies and 1 032 valid questionnaires. The awareness rate of prevention and control knowledge of schistosomiasis was from 11.72% to 71.71%. The highest awareness rate was in the "know schistosomiasis", however the lowest awareness rate was in the "know the intermediate host of schistosomiasis". Catching fish or shrimp in river or lake was the main way of contacting water in production activities (39.05%), and swimming or playing in river or lake was the main way of contacting water in life activities (63.18%). The prevention and control knowledge of schistosomiasis by teaching was at a rate of 41.47% on average, and the main way was anti-schistosomiasis professionals going to countryside to do health education (49.53%). That the feces directly discharged into water accounted for 91.14% in fishman and boatman., Conclusion: It is necessary for people from Chaohu to carry out various forms of health education of schistosomiasis prevention and control before the water transfer project operation.

Schistosomiasis and intestinal worm infections are widespread diseases of public health importance in Tanzania. A study on perceptions and practices related to schistosomiasis and intestinal worm infections was undertaken among a community population of Kome Island in Sengerema District, north-western Tanzania, where intestinal schistosomiasis and intestinal worm infections are endemic. Schistosomiasis and intestinal worm-related perceptions and practices were assessed before and 3 years after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention as a control measure. Data were obtained from baseline and post-intervention knowledge, attitudes, and practices (KAP) questionnaire surveys conducted twice in 2009 and 2012 among 82 individuals aged ≥15 years. We found significant increases in respondents' knowledge of the cause, transmission, symptoms, health consequences, and prevention of schistosomiasis and intestinal worm infections after PHAST intervention. The increase in respondents' knowledge on almost all aspects of the said infections was translated into actions to control schistosomiasis and intestinal worm infections. This has not been achieved by chance, but due to well-designed and locally-adapted PHAST intervention. We conclude that despite criticisms, PHAST approach is still useful in empowering communities to control water, sanitation, and hygiene related infectious diseases such as schistosomiasis and intestinal worm infections.

Objective: To understand the psychological experiences of advanced schistosomiasis patients, so as to provide the evidence for formulating a systematic and scientific nursing scheme., Methods: Twenty advanced schistosomiasis patients were studied with the qualitative research method., Results: There were 70% (14/20) patients with labor limited, 50% (10/20) with a moderate anxiety, irritability and other negative emotions, and 65% (13/20) with moderate discomfort., Conclusions: Most of advanced schistosomiasis patients have negative emotions. Therefore, the suitable psychological nursing should be given to these patients to improve their quality of life.

Objective: To evaluate the implementation and effect of the program of treatment and assistance to advanced schistosomiasis patients in Qianjiang City., Methods: The data about the program from 2004 to 2012 were collected and analyzed, and the analysis of cost-effectiveness was performed. Meanwhile, 160 patients were sampled and surveyed about the recovery of their health., Results: From 2004 to 2012, totally 2 363 person-times' patients received the treatment, and 339 patients were cured clinically. On average, each patient received 3.11 times of treatment and 22.28 d of hospitalization, the treatment cost was 5,382.87 yuan per year for each patient, and the cost-effectiveness was 12.7 thousand yuan per life-year-saved., Conclusion: The program of treatment and assistance to advanced schistosomiasis patients cures a part of patients and improves the working capacity and life quality of the patients.

Some tropical diseases are the direct cause of severe disturbances of cerebral function while others affect only finer cerebral systems controlling fears, anxiety and personality traits. The mechanisms by which psychiatric symptoms are produced in tropical disorders are not any different from the mechanisms that relate to any physical disorders. Neuropsychiatric symptoms may be caused by a number of different mechanisms including bacterial toxins, release of cytokines, hyperthermia, shock (poor perfusion), acute renal insufficiency, pulmonary failure (shock lung), coagulopathy, disruption of the blood-brain barrier, and/or the nest of pathogens into the central nervous system. The following tropical illnesses can be associated with neuropsychiatric symptoms: neurocysticercosis, malaria, trypanosomiasis, dengue, and schistosomiasis. Neurological and psychiatric impairments induced by tropical diseases both represent a major category of invalidating disorders, which cause profound changes in the nervous system functions, often associated with severe sequels or late-onset disturbances. It is therefore important to disseminate knowledge of the neuropsychiatric symptoms accompanying tropical diseases in order to increase the awareness of these problems and challenges.

Objective: To explore the design and application of psychological intervention paths for ascites type of advanced schistosomiasis patients., Methods: A total of 156 ascites type of advanced schistosomiasis patients were divided into an intervention group and a control group with 78 cases each. A psychological intervention path table was designed in accordance with the psychological characteristics and demands of the advanced schistosomiasis patients. Five steps were used to guide the nurses involved to carry out the psychological intervention., Results: Before the intervention, there were no statistically significant differences (all P > 0.05) between two groups in SAS, SDS, WHOQOL-BRER scores, but after the intervention, all the evaluation indexes improved in the intervention group and there were statistically significant differences between the intervention group and control group in SAS, SDS, WHOQOL-BRER scores (all P < 0.05)., Conclusion: The application of psychological intervention paths for ascites type of advanced schistosomiasis patients can improve their negative emotions and qualities of life.

Objective: To explore the status of depression in patients with advanced schistosomiasis and its influencing factors, so as to provide the evidence for improving psychological interventions., Methods: A total of 206 patients with advanced schistosomiasis were investigated with the self-designed general information questionnaire, the Self-Rating Depression Scale, and WHOQOL-BREF Form., Results: Among the 206 cases, the incidence of depression was 69.4%, and depression was negatively related to the quality of life (P = 0.000). The multiple logistic regression analysis showed that the times of hospitalization (β = 0.442, P = 0.007) was a risk factor for depression, while the high education levels (β = -0.583, P = 0.011) and the history of portal hypertension operation (β = -0.917, P = 0.000) were the protective factors., Conclusion: The incidence of depression in advanced schistosomiasis patients is high, and it is influenced by various factors. Therefore, we should take corresponding interventions to reduce its occurrence.

Objective: To assess the quality of life (QOL) of advanced schistosomiasis patients, and understand its influencing factors., Methods: A questionnaire survey was carried out by using WHOQOL-BREF, and the information of demography, family, illness, health status, and health service was collected., Results: Among the 217 advanced patients, the average age was (75.33 ± 6.94) years, the ratio of male to female was 2:5, 89.86% of them were farmers, 75.58% were illiterate or semi-illiterate, and 88.94% belonged to the splenomegaly type. Totally 61.29% of the cases had the scores over average for the overall QOL, but the scores for the health and well-being were lower. There were a significant difference among the average scores of different domains of QOL (χ2 = 23.46, P < 0.01). Both the year of being diagnosed and clinical classification was not associated with the scores of QOL. Regularly taking physical activities was significantly associated with each of all the 4 domains. The factors such as onset of acute disease in 2 weeks, taking therapeutic pills daily, marital status, age, etc. impacted the specific domains of QOL. The overall QOL and the 4 domains of the patients were at medium level; meanwhile, the score of physiological domain was lower than the scores of the other 3 domains., Conclusions: The QOL(s) of advanced schistosomiasis patients in Qingpu District are relatively good. It is important to provide effective community health services and encourage the patients to take part in tempered sports or physical activities in order to keep their normal activities of daily living.

Objective: To explore the reasonable nursing interventions of advanced schistosomiasis patients., Methods: The medical records of 52 advanced schistosomiasis patients hospitalized from 2008 to 2013 were collected, and the nursing interventions were summarized., Results: The 52 cases of advanced schistosomiasis included 38 men and 14 women, with a mean age of 65.8 years (57-75 years). Totally 53.8% of the subjects were schistosome positive by IHA test, 67.3% positive by ELISA, and 21.2% positive of HBsAg. There were 13 cases of ascites type, 34 cases of megalosplenia type, and 5 cases of dwarfism type of advanced schistosomiasis. Following the therapy together with nursing interventions, 73.1% achieved clinical cure, 23.1% achieved stable, and 3.8% achieved improvement. The major nursing interventions involved basic nursing, diet nursing, treatment nursing, physiological nursing and surgical nursing., Conclusion: The scientific and reasonable nursing interventions can improve the therapeutic efficacy and prognosis in advanced schistosomiasis patients, as well as improve their quality of life.

Introduction: Intestinal schistosomiasis is widely distributed around Lake Victoria in Kenya where about 16 million people in 56 districts are at risk of the infection with over 9.1 million infected. Its existence in rural settings has been extensively studied compared to urban settings where there is limited information about the disease coupled with low level of awareness. This study therefore assessed community awareness on existence, signs and symptoms, causes, transmission, control and risk factors for contracting schistosomiasis as well as attitudes, health seeking behaviour and environmental antecedents that affect its control so as to identify knowledge gaps that need to be addressed in order to strengthen schistosomiasis control interventions in informal urban settings., Methods: The study was carried out in an informal urban settlement where the prevalence of intestinal schistosomiasis was previously reported to be the highest (36%) among the eight informal settlements of Kisumu city. The study adopted cross-sectional design and purposive sampling technique. Eight focus group discussions were conducted with adult community members and eight key informant interviews with opinion leaders. Data was audio recorded transcribed, coded and thematically analyzed using ATLAS.ti version 6 software., Results: Most respondents stated having heard about schistosomiasis but very few had the correct knowledge of signs and symptoms, causes, transmission and control of schistosomiasis. However, there was moderate knowledge of risk factors and at high risk groups. Their attitudes towards schistosomiasis and its control were generally indifferent with a general belief that they had no control over their environmental circumstances to reduce transmission., Discussion/conclusion: Although schistosomiasis was prevalent in the study area, majority of the people in the community had low awareness. This study, therefore, stresses the need for health education to raise community's awareness on schistosomiasis in such settings in order to augment prevention, control and elimination efforts.

Schistosomiasis is a chronic and debilitating parasitic disease acquired through contact with infested freshwater. An essential component of its control is passive case finding, which, in order to be effective, requires a detailed understanding of health-seeking behaviour. This study aimed to systematically review evidence on health-seeking behaviour for schistosomiasis, in order to determine factors influencing use or non-use of modern health services for the infection. Quantitative, qualitative and mixed method studies reporting on factors related to seeking treatment from modern health services for schistosomiasis were obtained, combining electronic and hand searching. Data extraction and quality assessment of the included articles were performed, with all studies qualitatively analysed using thematic synthesis. A total of 19 studies were included in the review. Six themes were identified from the analysis: biomedical knowledge on schistosomiasis, perceptions of modern treatment and health services, financial considerations of treatment, perceptions on the symptoms, stigma of the infection, and physical location and community. These findings were consistent across studies of different design, setting and quality. Many of the themes identified echo existing literature on health-seeking behaviour. The synthesis also highlighted the role of stigma, and aspects of the physical location and community that may affect treatment-seeking for schistosomiasis. Health education programmes that intend to improve the utilisation of modern health services for the infection need to acknowledge the multiple determinants influencing their use. Future research should move beyond describing health-seeking behaviour to identifying the factors that underlay such behaviour.

Objective: To explore the self-management behavior of patients with advanced schistosomiasis, so as to provide the evidence for improving clinical nursing., Methods: A total of 18 patients with advanced schistosomiasis were interviewed in depth by using a semi structured interview method. The results were analyzed with Miles and Huberman content analysis method., Results: Most of the patients with advanced schistosomiasis had self-management control behavior and were cooperated with medical assistance because of their seriously illness. Based on data analysis, the symptom management, follow-up management, a healthy lifestyle, medication awareness, and emotional management were obtained., Conclusion: The patients with advanced schistosomiasis have self management control behavior. Health care workers should promote the patients, their families and social people to participate in the self-management behavior of advanced schistosomiasis patients.

Objective: To evaluate the effect of nursing intervention on the quality of life of patients with advanced schistosomiasis., Methods: A total of 226 cases of advanced schistosomiasis were randomly divided into a control group and an experimental group (113 cases each). The patients in the control group received the conventional nursing, while the patients in the experimental group received the conventional nursing plus other interventions such as the health education, psychological counseling and diet guidance. The complications and scores of life quality of the patients in the 2 groups were observed and compared., Results: The awareness of knowledge about the disease improved from 67.7% to 98.9%, the incidence of complications decreased from 28.3% to 13.3%, and the scores of life quality improved significantly in the experimental group, which were much better than those in the control group., Conclusion: The nursing intervention on the quality of life of patients with advanced schistosomiasis is effective.

Objective: To understand the satisfaction and the awareness rate of the replacement of bovine with machine for schistosomiasis control among residents in Jiangling County, Hubei Province., Methods: Three villages, Yugu, Jinqi and Huazhang, were chosen randomly to be investigated, each family filled a questionnaire, and 363 questionnaires were obtained at the end of the survey. The data were analyzed with SPSS 11.5., Results: Among 363 households, 210 (68.0%) households raised bovine during the last 3 years. There were no significant differences in the awareness rates of the replacement of bovine with machine and the knowledge of schistosomiasis control between the bovine-raising families and non-raising families (P > 0.05), while the satisfaction rates between the bovine-raising families and non-raising showed a statistically significant difference (P < 0.05). Among the 187 households who purchased agricultural machinery, the very satisfied, satisfied, general, unsatisfied and very unsatisfied rates were 9.1%, 43.3%, 42.2%, 3.7% and 1.1% respectively in evaluating the service of agricultural machinery organizations., Conclusion: The satisfaction and the awareness rate of the replacement of bovine with machine of residents in schistosomiasis endemic areas are relatively perfect.

Objective: To understand the status of schistosomiasis control knowledge and the effect of interventions among primary school pupils in the areas of schistosomiasis transmission interrupted., Methods: Six kinds of information materials about schistosomiasis control, including the schistosomiasis health education teaching material, schistosomiasis health education box, schistosomiasis health education stationary kits, schistosomiasis health education ball-point pen, collections of wall charts about schistosomiasis control and schistosomiasis health education curriculum schedule, were used to spread the schistosomiasis control information in the experimental group, and then, the effect was evaluated., Results: The awareness rates, correct rates of attitude, and persuasion rates of schistosomiasis control had no significant difference between the experimental group and control group before the intervention (P > 0.05). The awareness rate, correct rate of attitude, and persuasion rate of schistosomiasis control increased from 12.88%, 6.82% and 3.79% before the intervention to 97.64%, 62.20%, 71.65% after the intervention, respectively, in the experiment group (P < 0.01), but in the control group, there was no significant difference between the pre- and post-intervention (P > 0.05). The collections of wall charts about schistosomiasis control and schistosomiasis health education box were more favorable., Conclusion: The effect of schistosomiasis health education is very well in the areas of schistosomiasis transmission interrupted

Objective: To evaluate the efficacy of cognitive behavioral therapy for depression in advanced schistosomiasis patients., Methods: A total of 60 advanced schistosomiasis patients with major depressive disorder were divided into a combination therapy group (30 cases) who received sertraline plus cognitive behavior therapy and a monotherapy group (30 cases) who received sertraline only. Before the treatment and at the 1st, 2nd, 4th, 8th week after the treatment, the efficacy and safety were assessed with the HAMD17 item score and the related factor points and TESS. The effective rate, side effect rate and relapse rate in six months were calculated and compared between the two groups., Results: At the end of 8th week after the treatment, the total scores of HAMD, factor scores of cognitive impairment, retardation factor scores and sleep disturbance factor scores in the 2 groups were statistically decreased compared with those before the treatment (P < 0.05 or P < 0.01). The factor scores in the combined therapy group were lower than those in the monotherapy group. The effective rate in the combination therapy group was 86.7% (26/30), and it was significantly higher than that in the monotherapy group (56.7%, 17/30), (chi2 = 6.65, P < 0.05). The doses of the drug were lower in the combination therapy group than those in the monotherapy group (t = 2.25, P < 0.05). Within six months, the relapse rate was 13.3% in the combination therapy group, and it was significantly lower than that in the monotherapy group (46.7%) (chi2 = 7.937, P < 0.025). The side effect rate was 23.3% in the combination therapy group and that was 26.7% in the monotherapy group, and there was no statistically significant difference between the two groups (P > 0.05)., Conclusion: The combination therapy (drug combined with cognitive behavioral therapy) is effective in advanced schistosomiasis patients with depression, and it also can reduce the amount of medication and the relapse.

Objective: To observe the compliance of film-coated praziquantel tablets in the schistosomiasis transmission controlled areas, so as to provide the evidence for the establishment of chemotherapy intervention measures in these areas., Methods: In the areas of schistosomiasis transmission controlled in Sichuan Province, 234 people were selected as film-coated praziquantel group (FCPG), and 203 people were selected as praziquantel group (PG). A questionnaire survey was implemented and the compliance of chemotherapy of the 2 groups was compared., Results: In PG, all the people indicated that the praziquantel tablets has bad smell, 98.0% of the people had side-effects, such as nausea, headache, 69.5% thought the medicine was harmful to health subjectively, and 99.5% thought that it was too much dose of tablets for taking one time. In FCPG, all the people indicated that the film-coated praziquantel tablets had no bad smell, 18.8% of the people had side-effects, and 74.4% would like to choose film-coated praziquantel tablets. The rates of knowledge of praziquantel of PG and FCPG were 50.7% and 29.1%, respectively ( chi2 = 21.449, P = 0.01)., Conclusions: The film-coated praziquantel tablets have no bad smell and lighter side-effects. The compliance of the film-coated praziquantel tablets is high in the areas of schistosomiasis transmission controlled, so the film-coated praziquantel tablets are worth to popularize and apply.

Objective: To evaluate the quality of a questionnaire about schistosomiasis knowledge of the pupils in Wuxing Farm School in Nanchang City., Methods: The quality of the questionnaire about schistosomiasis knowledge was evaluated through reliability, validity, discrimination and some other indexes., Results: The entire reliability of the survey was high with its split-half reliability of 0.68 and Cronbach alpha coefficient of 0.627. The content validity was good: the exploratory factor analysis revealed 5 common factors from 13 questionnaire items which could account for 58.3% of the total variance; the confirmatory factor analysis revealed that the construct validity of 13 questionnaire items was better than that of the whole questionnaire (17 items in total) (chi2 = 90.5, df = 65, GFI = 0.92, AGFI = 0.88, NFI = 0.58, CFI = 0.817, RMSEA = 0.049); the difficulty and the discrimination coefficients of the questionnaire were suitable, being 0.595 and 0.42 respectively., Conclusion: The questionnaire is qualified in general, but parts of the items need to be revised to perfect.

Objective: To investigate the depression prevalence of patients with advanced schistosomiasis, as well as their quality of life., Methods: A total of 356 patients with advanced schistosomiasis were investigated with the Self-rating Depression Scale (SDS) and SF-36 scale for their situation of depression and quality of life., Results: Among 356 cases, 306 effective questionnaires were collected. The prevalence of depression was 48.70%. The scores of 8 dimensions of SF-36 of the patients with depression were significantly lower than those of the patients without depression (all P values were less than 0.01), and there were negative correlations between SDS scores and scores of all the dimensions of SF-36 (r values were between -0.839 and -0.182, all P values were less than 0.001)., Conclusions: The prevalence of depression of patients with advanced schistosomiasis is high, and their quality of life is low. Besides active treatment, we should give more attention to their mental health.

After the implementation of health education about schistosomiasis for the middle school students in Three Gorges reservoir areas, the pass rate of knowledge about the schistosomiasis prevention and control of students increased from 6.3% to 75.6%. However, the awareness rate of knowledge about the schistosomiasis control was still lower than 95%, so health education still need to be enhanced.

Objective: To understand the status of health education on schistosomiasis for residents in susceptible zone and provide a reasonable basis for related study., Methods: A questionnaire survey on knowledge, attitude about schistosomiasis of the residents was conducted., Results: Status of education on schistosomiasis of susceptible areas for the residents in general is not optimistic, the frequency of contacting with infected water was high, the demographic characteristics were also significant: (1) The passing rate for the villagers' schistosomiasis knowledge was too low, only 39.6%, the difference between awareness rates of schistosomiasis knowledge among villagers with different educational levels was significant (P < 0.05); (2) The overall level of correct attitude for schistosomiasis control was poor, only 37.7% of the villagers with a good attitude, the differences among villagers with different ages and occupations were significant (both P values < 0.05); (3) 73.5% of the villagers had ever contacted with infected water, and different groups contacted with infected water in different ways, 67.5% of men contacting for bathing, fishing, 63.7% of women contacting for washing clothes., Conclusions: Health education for schistosomiasis control in susceptible zones should be strengthened, the reasons for differences in cognitive level about schistosomiasis control among the villagers with different demographic characteristics and the better models for educational interventions for different villagers need to be explored.

Background: Schistosomiasis causes long-term illness and significant economic burden. Morbidity control through integration within existing health care delivery systems is considered a potentially sustainable and cost-effective approach, but there is paucity of information about health-seeking behaviour., Methods: A questionnaire-based study involving 2,002 subjects was conducted in three regions of Ghana to investigate health-seeking behaviour and utilization of health facilities for symptoms related to urinary (blood in urine and painful urination) and intestinal schistosomiasis (diarrhea, blood in stool, swollen abdomen and abdominal pain). Fever (for malaria) was included for comparison., Results: Only 40% of patients with urinary symptoms sought care compared to >70% with intestinal symptoms and >90% with fever. Overall, about 20% of schistosomiasis-related symptoms were reported to a health facility (hospital or clinic), compared to about 30% for fever. Allopathic self-medication was commonly practiced as alternative action. Health-care seeking was relatively lower for patients with chronic symptoms, but if they took action, they were more likely to visit a health facility. In a multivariate logistic regression analysis, perceived severity was the main predictor for seeking health care or visiting a health facility. Age, socio-economic status, somebody else paying for health care, and time for hospital visit occasionally showed a significant impact, but no clear trend. The effect of geographic location was less marked, although people in the central region, and to a lesser extent the north, were usually less inclined to seek health care than people in the south. Perceived quality of health facility did not demonstrate impact., Conclusion: Perceived severity of the disease is the most important determinant of seeking health care or visiting a health facility in Ghana. Schistosomiasis control by passive case-finding within the regular health care delivery looks promising, but the number not visiting a health facility is large and calls for supplementary control options.

Possible impact of ecological and social environmental changes due to the construction of the Three Gorges Dam on the transmission of schistosomiasis draws great attention of the health authority and publics. This article reviews the situation and progress of research on schistosomiasis transmission in reservoir area from three aspects: the possibility of snail spreading and breeding, imported infection sources and social behavioral factors of the people.

A pilot study was conducted in schoolchildren from three main districts of São Tome to assess the relationship between the prevalence of infections caused by Schistosoma intercalatum or intestinal helminths and individual behaviour and social conditions. Coprological examination revealed an increase of schistosome infections and a persisting high endemicity for ascariasis and trichuriasis. Infection rates were 36.2% for S. intercalatum and 70.8%, 68.5% and 4.6% for Ascaris lumbricoides, Trichuris trichiura and Ancylostomidae, respectively. Out of the 47 children positive for S. intercalatum, 35 (74.5%) were co-infected with one or more geohelminths. Logistic regression analysis of data collected through questionnaire demonstrate that behaviour and/or social conditions in the house were positively associated with S. intercalatum or T. trichiura. Neither sex nor age groups were associated with infections, suggesting that low personal hygiene and sanitation practices were similar for all groups of children. These data are in accordance to those of other studies and highlight the importance of assessing multivariate factors that may contribute to the transmission of these diseases, in order to design integrated control approaches for schistosomiasis and geohelminthiasis which could have more rapid effects on reduction of infections as well as greater cost-effectiveness.

The effect of schistosomiasis on quality of life (QOL) and productivity of workers was examined. In a textile factory in Alexandria, Egypt, personal, occupational and sociodemographic data were collected from 172 workers with schistosomiasis and 172 workers without schistosomiasis. Several indicators of productivity and the World Health Organization QOL brief were used to determine the impact of schistosomiasis. The disease affected the general, physical and independence, psychological and spiritual, and social domains of QOL. Although the productivity score of workers with schistosomiasis did not differ significantly from the control group, they had significantly lower additional hours of work and lower total incentives/month. A significant relationship was found between severity of schistosomiasis and QOL domains and productivity indicators.

All workers with schistosomiasis (205 workers) during the field period (April 1998 to March 1999) were included. The study tools included an interviewing schedule, the WHO QOL-brief and a production data format specially designed to obtain data about the productivity of the workers. The data revealed that 78.8% of the schistosomiasis workers suffered from Schistosoma mansoni while only 7.6% suffered from S. haematobium and 13.5% had a mixed infection. Workers infected with S. mansoni tended to have lower mean percent of all the QOL domains and productivity indicators compared with workers infected with S. haematobium but these differences were not statistically significant. Workers with complications of schistosomiasis had significantly lower values for the QOL physical, social relationship and environmental domains (55.27 +/- 15.59, 74.94 +/- 5.34 and 56.39 +/- 15.09 versus 61.38 +/- 5.74, 79.36 +/- 11.96 and 61.64 +/- 7.74 respectively). Moreover, the production score was significantly lower in the workers with complication compared with workers free from schistosomiasis complications. The mean percent of QOL domains decreased as the stage of schistosomiasis increased from stage 1 to stage 4, this was statistically significant for the physical and independence domain. The mean additional hours and production scores decreased successively from stage 1 to stage 4 of schistosomiasis. Thus, special attention should be paid to schistosomiasis workers for early detection and treatment of complications to improve the QOL and increase the productivity of those workers. The impact of the stage of schistosomiasis on productivity and QOL of workers needs further research with a wide spectrum of workload in different industries.

Poor countries can ill-afford ineffective health care. An effective disease intervention is one which produces a net improvement in beneficiaries' quality of life and/or increases life expectancy. Unlike developed countries, very little research has been done in developing countries on the measures of the ultimate output of health care. The objectives of this study were to: (i) apply the existing health-related quality of life (HRQoL) methods in eliciting health state valuations from farmers, teachers and health professionals living and working in the schistosomiasis endemic Mwea Irrigation Scheme in Kenya; (ii) determine whether there is significant difference between average health states valuations from the three main groups of people at risk of schistosomiasis infection; and (iii) assess the relative effect of different respondent characteristics and health states prognosis on valuations. The instrument consists of seven health state descriptions-each defined along six functional dimensions: self-care, mobility, livelihood activities, energy, social participation and pain. Cardinal health state values were measured using a visual-analogue-scale (VAS). Values were elicited from three random samples of farming general public, medical professionals and teachers. The Kruskal-Wallis one-way ANOVA test showed that there is significant difference in the average health state values (for mild, moderate, severe, very severe and comatose states) obtained from the three samples. Generally, except for the valuation of the immediately following state, the other explanatory variables are not statistically significant determinants of valuations for the mild, moderate, severe and very severe states. The results suggest that VAS valuations are primarily affected by prognosis. There is urgent need for more representative and systematic HRQoL studies to test the relevance of the Western-based generic instruments in African countries contexts, with a view to developing more appropriate tool(s) if necessary.

Psychological and social investigations of tropical diseases can make a significant contribution to understanding and managing many illnesses. One-hundred and seventy-five Malawian university students rated peopled who suffered from AIDS, malaria, schistosomiasis and the 'common cold', on 11 psycho-social dimensions related to illness. Analysis of variance and factor analysis was used to distinguish distinctive illness profiles reflecting perceptions of (people with) these illnesses. Results suggested that infirmity was associated with AIDS and that the seriousness of malaria was minimized. Within a context of many threats to health the importance of distinguishing between serious illnesses is emphasized for effective health promotion interventions.

This paper explores the importance of gender differences in the impact of tropical diseases on women. Malaria and schistosomiasis are used as examples but most of the observations also apply to other diseases endemic to developing countries. The distinction between sex and gender is discussed and evidence of sex and gender differences in the determinants and consequences of malaria and schistosomiasis, particularly their economic, social and personal dimensions, is reviewed. Issues on which research and intervention studies are needed are identified.

A sample of 120 individuals--representative of the Malawian population in terms of gender and age distribution--were interviewed regarding their perceptions of the diseases malaria and schistosomiasis. Particular attention was paid to judgements regarding the level, seriousness, predictability and controllability of these health risks. Sample sites were lowland marshland areas where both diseases were highly prevalent. Individuals were also asked about their adherence to recommended malaria and schistosomiasis control and prevention procedures. Respondents commonly rated malaria and schistosomiasis both unpredictable and uncontrollable. For malaria, no risk judgements predicted level of adherence to prevention guidelines. That is, individuals' perception of malaria risk bore no influence on whether or not they engaged in recommended behaviour. For schistosomiasis, seriousness of infection (at one sample site) and the predictability and controllability of infection (at the other sample site) predicted such adherence. Analysis of the influence of factors such as age, gender and level of education confirmed distinct patterning or responses for the two health risks. Whilst adherence to preventative guidelines for schistosomiasis is influenced by personal perceptions of risk, it appears that social factors may exert more influence on the extent of compliance with malaria control and prevention procedures. Distinct approaches to health education regarding malaria and schistosomiasis may, therefore, be warranted, with the former emphasising community responsibility and participation, and the latter individual actions which may reduce risk.

An ethological study was undertaken in two primary schools in Natal to assess the effect of schistosome infections on the spontaneous activity of schoolchildren in endemic areas. Results indicate that there is selective exposure of more active children to the disease. In low-level infections with Schistosoma haematobium (less than 1000 eggs excreted in a 2-hour midday period) or S. mansoni (less than 1000 eggs/g dry weight of stool) there is little evidence of a decrease in energetic activity under normal conditions in subjects with higher egg counts or infections with both schistosomes activity levels generally fall, especially under hot, humid weather conditions, when the fall in activity is greater than that for control subjects.