Tackling schistosomiasis in fisherfolk communities in Uganda: Enablers and challenges for implementing paediatric schistosomiasis mass drug administration from the perspective of district health authorities.

Background: Schistosomiasis remains a significant public health issue in Uganda, particularly among fishing communities. This study, nested within a larger community-based study (ADOPT) on introducing a new child-friendly praziquantel formulation for schistosomiasis, arpraziquantel, explored enablers and challenges perceived by district health authorities for implementing a mass drug administration (MDA) programme with arpraziquantel.

Methods: Respondents in this cross-sectional study were purposively selected in Bugiri and Hoima districts, Uganda. Key informant interviews were conducted in July 2022 and thematically analysed using the World Health Organization health system building blocks framework.

Results: In general, arpraziquantel is expected to be widely accepted, though some may oppose it for religious or political reasons, belief in witchcraft as a cause of schistosomiasis, or fear of side effects. High awareness of disease burden and the acceptance of the existing schistosomiasis MDA for adults and school-aged children were identified as enablers for successful implementation. Key implementation challenges include limited resources for sustained biannual MDAs, adequate remuneration of village health teams (VHTs), inadequate staff training, time constraints, uneven VHT workload, and weaknesses in the referral systems. Migration, difficulties sensitising mobile parents, and delayed meals due to poverty-complicating drug absorption requiring a full stomach-further hinder efforts.

Discussion: This study underscores the importance of addressing health systems' challenges through targeted measures to ensure effective and sustainable MDA of arpraziquantel, including enhanced training of VHTs and other staff, sensitisation of parents and key stakeholders at all levels, and adequate responses to potentially emerging side effects.