Insufficient Water, Sanitation, and Healthcare Facilities Hinder Schistosomiasis Control in Endemic Areas: A Mixed Methods Study

IntroductionSchistosomiasis remains a significant public health issue in sub-Saharan Africa, particularly in resource-limited settings. This mixed-methods study assesses the knowledge, attitudes, and practices (KAP) related to schistosomiasis in two communities in Zimbabwes Chiredzi district: Hippo Valley Estate (HVE) and Chipimbi. MethodologyIn August 2022, a total of 279 household adults were surveyed using semi-structured questionnaires, selected through systematic random sampling. Additionally, four key informants were interviewed, and eight focus group discussions (FGDs) were conducted. Cramers V ({varphi}) and Gamma ({gamma}) coefficients were used to determine associations between sociodemographic factors and KAP variables, with a p-value of 0.05 indicating statistical significance. Quantitative data were analyzed using frequencies, percentages, and chi-square tests, while qualitative data were analyzed by identifying themes and sub-themes. ResultsAwareness of schistosomiasis was high, with 87.5% of respondents having heard of the disease and 86% knowing its transmission modes and symptoms. However, misconceptions persist, such as the belief that walking barefoot or eating unwashed fruits are major risk factors. Only 7% recognized the importance of avoiding unsafe water, a challenge further amplified in both communities due to their reliance on water for irrigation in HVE and as a primary water source in Chipimbi, especially when stored water is depleted. Although 98% emphasized the importance of latrine use, open defecation remains prevalent due to insufficient latrine coverage in Chipimbi (14%) and occasional water shortages for flushing in HVE. Both communities showed positive attitudes toward treatment, but access to healthcare facilities remains a significant barrier due to selective treatment, long distances, and inadequate facilities. ConclusionDespite high awareness and positive attitudes, inadequate water, sanitation, and healthcare facilities hinder effective schistosomiasis control. Enhancing community-based awareness, improving access to clean water, and increasing latrine coverage are crucial steps toward sustainable schistosomiasis management Author SummarySchistosomiasis, a neglected tropical disease, remains a persistent public health challenge, particularly in resource-limited areas. In Zimbabwe, despite six rounds of mass drug administration, with a general prevalence rate of 23%. This study examines two contrasting communities in Zimbabwes Chiredzi district: Hippo Valley Estate (HVE), which has benefited from extensive interventions including safe water provision, high latrine coverage, snail control, and regular treatment programs, and Chipimbi, which has not received any such interventions. Both communities are located in an area heavily impacted by large-scale sugarcane irrigation, a factor known to exacerbate schistosomiasis transmission. The study assesses the knowledge, attitudes, and practices (KAP) related to schistosomiasis through surveys and focus group discussions. Findings reveal high awareness of schistosomiasis and its symptoms in both communities, but with persistent misconceptions about risk factors. Despite positive attitudes toward treatment, significant barriers remain, particularly in access to healthcare. Moreover, risky practices like open defecation and unsafe water contact persist due to inadequate water and sanitation infrastructure. This study underscores the need for continued and tailored public health interventions that address misconceptions, improve infrastructure, and enhance healthcare access to effectively control schistosomiasis in these communities.