Knowledge and perceptions of schistosomiasis, a water-borne disease, in two semi-arid rural areas of South Africa (Ndumo) and Zimbabwe (Ntalale)

Schistosomiasis is a serious water-borne disease of public health importance in southern Africa and is characterised by high morbidity and negative socio-economic repercussions. Limited knowledge on the mode of transmission and treatment contribute towards increase in the risk of infection. This study assessed community knowledge levels, perceptions and the co-constructed realities of social actors with regards to schistosomiasis in rural resource-poor communities of Ndumo in South Africa and Ntalale in Zimbabwe. We hypothesised that there was association between community knowledge level on schistosomiasis and location of residency and socio-demographic factors. Two-hundred and eight questionnaires were used to gather quantitative data on socio-demographics and knowledge levels while 18 focus group discussions were used to collect qualitative data on perceptions and social constructs. The Fisher's exact and Chi-square tests were used to determine the differences in community knowledge levels based on localities, gender, religion and age. Results showed that awareness level of schistosomiasis was assessed as ‘good’ in both Ndumo (91%) and Ntalale (81%). Majority of the respondents identified schistosomiasis as a water-borne disease with significantly higher proportion in Ndumo (89%) compared to Ntalale (68%) (p = 0.005). A significant proportion of participants in both localities were aware of the symptoms of schistosomiasis especially the passing of urine with blood (82.5% in Ndumo and 77.0% in Ntalale; p = 0.039). However, presence of schistosomiasis eggs in human stool apart from urine as a sign of infection was highly acknowledged in Ntalale (57.4%) compared to Ndumo (11.7%; p < 0.001). Knowledge on the body parts affected by the infection was low in both localities with 36.9% in Ntalale compared to 1.0% in Ndumo (p < 0.001). In both study areas, local understanding of schistosomiasis was limited to passing urine with blood, a symptom only seen in cases of urinary schistosomiasis. All the participants associated schistosomiasis with being water-borne, but had divergent perceptions on the symptoms, lifecycle and treatment of the infection. Trends of schistosomiasis and at-risk populations were perceived differently in Ndumo and Ntalale. Although respondents from the two localities acknowledged schistosomiasis as water-borne disease, the study showed lack of in-depth knowledge on the life cycle of the diseases. We therefore recommend that health education be implemented together with other strategies such as improvement in access to water and sanitation in the two study areas to achieve effective control and prevention of the disease.