Community insights into societal causes of and solutions for schistosomiasis transmission in Lake Albert fishing villages: A participatory approach

Abstract

Introduction

Schistosomiasis presents a significant public health concern with debilitating effects on millions of people, mostly in sub-Saharan Africa. In Uganda, despite intervention via mass drug administration (MDA) of praziquantel to combat the disease, prevalence remains alarmingly high within hotspots such as Lake Albert. Integrated control methods, including water-contact reducing behavioural change, have therefore been advocated. Despite the potential benefits of community involvement in the design of schistosomiasis behavioural change interventions, this approach has not been implemented in these Ugandan hotspots. Utilising community involvement, this study explored societal resource-based causes of lake-derived schistosomiasis transmission in hotspot communities of Hoima, western Uganda, how changing levels in these resources and access to them are altering infection-risk behaviour, and locally devised solutions for reducing infection-risk behaviours.

Materials and methods

A bottom-up participatory qualitative research design was employed. Purposive sampling was utilised to select 84 community advisory board (CAB) members to participate in focus group discussion sessions and participatory workshops. The CAB members comprised of fishermen, housewives, snail harvesters, village health teams, female and male youths, and community leaders. The data collected was analysed thematic-wise.

Results

The importance of the lake includes fish for both consumption and sale, water mainly for domestic use, papyrus for a variety of purposes, including roofing, sleeping mats, and mattresses and other resources such as oil, clay, sand, and salt. Community members reported that local conflicts, unfavourable and restrictive government policies, floods, migration, and instability have changed lake-derived resource levels. Recommendations for minimising contact with the lake suggested by participants were the provision of alternative water sources, promoting education, literacy and vocational skills, financial support, community empowerment and joint collaborative approaches.

Conclusions and recommendations

Despite challenges, Lake Albert provides a significant source of livelihood to communities. Providing alternative water sources and empowering local communities through the provision of alternative livelihood strategies is critical to reducing contact with the lake. A bottom-up participatory approach to community engagement facilitates community understanding of schistosomiasis problems and allows them to devise sustainable solutions to the problem.