SCHISTOSOMIASIS & WATER CONTACT
ETHIOPIA & TANZANIA, February/March 2019
Following the successful Acting for Health (AFH) workshops at the WISER (Water Infrastructure for Schistosomiasis Endemic Regions) stakeholder meeting which took place in Addis Ababa, Ethiopia and Mwanze, Tanzania on the 24th and 27th April 2018 - AFH were invited to deploy a full study in both countries. This took place in February and March 2019.
WISER is a three-year research programme led by Dr. Michael Templeton, in collaboration with the groups of Dr. Feleke Zewge at Addis Ababa University, Ethiopia, Dr. Safari M. Kinung’hi at the National Institute for Medical Research, Mwanza, Tanzania, Dr. Aidan Emery at the Natural History Museum in London and Pr. Paul Freemont at Imperial College London.
It aims to address the gaps in critical knowledge of schistosomiasis control through a collaboration between water engineers, synthetic biologists, parasitologists and social scientists in the UK, Ethiopia and Tanzania, in the hope of developing invaluable new knowledge and tools to guide the design of sustainable water infrastructure for schistosomiasis-endemic regions.
The WISER project seeks to address schistosomiasis infection by reducing contact with water infested with the parasites which cause schistosomiasis. The project aims to tackle this in three ways:
- improving the treatment of water so it is safe from parasites (investigating chlorine doses, developing filters to remove parasites, ...)
- improving the measurement of parasites in water to asses whether the water body is a risk
- improving education and communication of risks posed by water bodies; this includes innovative communication approaches such as those used by Acting for Health to share complex and important health messages
Schistosomiasis is a parasitic disease caused by flatworms which affects over 250 million people worldwide. Due to this parasite’s complex life-cycle which involves aquatic snails, populations living near contaminated water sources and with inadequate infrastructure are most at risk – many individuals in poorer communities are at a high risk of contracting schistosomiasis, particularly when living near and using infested water for fishing, washing, bathing…
Treatment with the drug praziquantel is the primary form of treatment, with a single dose of the drug having been shown to reduce the burden of infection and severity of symptoms. However, re-infection will quickly occur when people are re-exposed to infested fresh water. Education campaigns about the risks of exposure to contaminated water and improved water supply and sanitation should in theory break the life cycle of the disease. Unfortunately however, there is very limited and incomplete information available regarding the effectiveness of water treatment processes at removing or inactivating cercariae of different Schistosoma. Also, there are no rapid means for detecting cercariae in water samples and determining their viability, which makes assessing the risk and degree of contamination of a water body and testing the effectiveness of water treatment processes as barriers against cercariae very difficult.
Working with a preselected ( by the University of Addis Ababa, Ethiopia and NIMR Tanzania ) cohort of local people from Kemise , Ethiopia and MwaKalima, Tanzania who represented various strata of the population: teachers, parents, fisherfolk, children, health workers etc and using a neutral theatre forum to enable the participants to explore, in a manner that is most relevant to them, the issue of schistosomiasis in order to:
· uncover attitudes to the disease and treatment
· uncover misunderstandings around the disease and treatment
· establish the level of priority the disease is given in the community
· explore problems caused by the disease
· explore water contact behaviours that lead to infection / re-infection
· explore potential solutions
· uncover resistors / barriers to treatment / solutions
· present these findings to the assembled Ministry of Health stakeholders, NGOs and others in the form of a performance of scenes
· create ‘community champions’ / advocates
· explore the value of methodologies of the science of acting & theatre of the oppressed in this context
· to demonstrate the power of our approach and to use the pilot as the basis for justification of a larger, wider study to be conducted in January and February 2019
The Acting for Health interventions are designed to use theatre as a lingua franca to engage and give a voice to groups affected by specific public health issues, no matter how complex, in order to trigger effective, appropriate and sustainable solutions to public health challenges.
During both workshops, the Acting for Health intervention brought together a varied group of participants including from the local community, research project and government; held a series of hands on activities and workshops to draw out some of the main barriers to schistosomiasis control; developed a communication tools to raise awareness and solutions to ongoing schistosomiasis infections.
CONCLUSIONS & NEXT STEPS
We are following up with impact evaluation in July 2019 and a peer review paper with an aim to getting this published towards the end of 2019. The paper will have impact measures aswell as a series of recommendations to policy makers.