By Ezenwaka, CO; Obinede, SC (2024). Greener Journal of Biological Sciences, 14(1): 14-21.
Return to Issue
Full text – PDF
Full text – HTM
Full text – EPUB
Table of Contents
Vol. 14(1), pp. 14-21, 2024
ISSN: 2276-7762
Copyright ©2024, Creative Commons Attribution 4.0 International.
https://gjournals.org/GJBS
Department of Biology, Federal University Otuoke, Bayelsa State, Nigeria.
Type: Research
Full Text: PDF, PHP, HTML, EPUB, MP3
Urinary schistosomiasis remains a significant public health challenge in sub-Saharan Africa, particularly in rural areas like Otuoke and Otuaba communities in Bayelsa State, Nigeria. This study assessed the knowledge, attitudes, and perceptions (KAP) of urinary schistosomiasis among residents of these communities. Through structured questionnaires administered to 227 respondents, data were collected and analyzed using Chi-square test. Results indicated a varied level of understanding among respondents; with males being more responsive than females. While symptoms like blood in urine were recognized, there was limited knowledge regarding the cause and proper diagnosis of the disease. Attitudes towards individuals with the disease were generally positive, yet some exhibited indifferent behaviours. Factors such as contact with freshwater sources and activities involving freshwater bodies showed significant associations with schistosomiasis. The study underscores the importance of tailored interventions to improve community awareness and practices, aiming to reduce the prevalence and impact of urinary schistosomiasis in these communities. Additionally, similarities and differences between the KAP of the residents of both communities provide insights for targeted intervention strategies.
Published: 15/03/2024
Ezenwaka, Chinonye Oluchi
E-mail: chyladyn@yahoo.com;
sobinede@gmail.com
Phone: 09123126745
Urinary schistosomiasis, also known as urogenital schistosomiasis, is a significant public health concern in sub-Saharan Africa, particularly in rural areas with limited access to clean water and sanitation (Minjibir et al., 2020). This neglected tropical disease (NTD) caused by the parasite Schistosoma haematobium presents symptoms such as haematuria (blood in urine), dysuria (painful urination), and bladder wall damage, potentially leading to severe complications like hydronephrosis (kidney swelling) and squamous cell carcinoma (Tamomh et al., 2018; Surakat et al, 2020)
Nigeria bears a substantial burden of schistosomiasis globally, with approximately 29 million infected individuals, including 16 million children, and an estimated 101 million people at risk due to factors such as widespread snail hosts, inadequate sanitation, poverty, and limited healthcare access (Atalabi et al., 2016; Kone, 2022; Saidu et al., 2023). Despite efforts by the Federal Ministry of Health (FMOH) and the National Schistosomiasis Control Program (NSCP) to reduce prevalence, progress has been hindered by challenges such as the lack of baseline data on disease distribution (Ekpo et al., 2008; Oluwole et al., 2022).
Studies have shown that educating at-risk populations can significantly improve disease control, particularly in highly endemic areas. To propose effective behavioural change strategies and implement tailored interventions, it is essential to assess the knowledge, attitudes, and practices (KAP) of local populations in endemic areas. KAP surveys serve as valuable tools for understanding the local context, informing targeted intervention strategies (Sady et al., 2015; Sacolo et al., 2018; Rassi et al., 2019; Feng et al., 2023).
This study aimed at assessing the KAP of residents of Otuoke and Otuaba, identifying factors contributing to inadequate knowledge, negative attitudes, and suboptimal practices regarding schistosomiasis. By addressing these gaps and understanding cultural, social and behavioural determinants, the study result provides baseline information for the design and implementation of interventions that will enhance community awareness and practices, ultimately seeking to reduce the prevalence and impact of urinary schistosomiasis within the study area and potentially inform broader NTD control efforts.
The study was conducted in Otuoke and Otuaba communities in Ogbia Local Government Area of Bayelsa State. They are located 17 kilometres from Yenagoa, the Capital of the State. The vegetations in the area are typical tropical rain forest. The Coordinates is 4°41′22.417″N 7°17′43.470″E. The people speak the Ijaw and Ogbia dialect. They are predominantly farmers and fishermen. Plantain, Banana, Palm nuts and Cassava are produced in commercial quantities in these communities (Smith, 2010). Also, Fresh water fish and Snails are common in the areas. There is also functional borehole in the communities. Some places in the communities lack toilet facilities and bushes are used for toilet purposes. There is a make-shift toilet created at the bank of the Otuoke River with faeces directly flowing into the river. There is presence of a market and two hospitals including the university clinic. There are State primary and secondary schools in the boundary of Otuoke and Otuaba communities which serve both communities. There is a traditional leader referred to as “king” that serves both communities. He is being assisted by some elders in both communities. The community Developmental Committee (CDC) oversees that peace and development are maintained in both communities. The leadership is changed continually by election. “Pidgin English” is used as a means of communication with foreigners (Fig. 1).
Fig. 1: Map of Ogbia Local Government Area showing Otuoke/Otuaba communities (Oborie and Nwankwoala, 2012).
Questionnaires were administered randomly to 227 willing respondents in both communities. The respondents were permanent residents of both communities. Visitors were not included in the study.
Structured questionnaires were administered to the residents of both communities to elicit information on their level of knowledge, attitude, and perception (KAP) about urinary schistosomiasis. The interviews were conducted in English language and the local dialect through an interpreter for better understanding and communication. Information on their demographic data was gathered from their response to questions on the questionnaire.
Statistical Package for Social Sciences (SPSS) version 25.0 was used in carting out Chi-square analysis on the data collated from the study. Level of significance was set at α = 0.05
Out of the 227 people who were administered the questionnaire, 125 (55.07%) respondents were from Otuoke community and 102 (44.93%) respondents from Otuaba community. Gender-specific response showed that males 129 (56.8%) responded more to the questionnaire than the females 98 (43.1%). Respondents within the age group between 5-9 years were the least to respond (1.76%), followed by those within the age group 10-14 years (10.57%). Respondents within the ages of 20-25 years had the highest response rate (51.98%) (Table 1).
Table 1. Gender and age distribution of the respondents in the study area.
Sex
Table 2 below shows the relationship between level of knowledge between Otuoke and Otuaba, and gender. Female respondents in Otuoke were more knowledgeable community than males, while male respondents were more knowledgeable than females in Otuaba community. There was no significant association (p=0.29) between gender and the communities in terms of level of knowledge (Table 2).
Table 2: Gender-related level of knowledge among the respondents in both communities.
knowledgeable
Table 3 below shows the details of knowledge of the respondents in the study area about Urinary schistosomiasis. About 66% of the respondents in Otuoke community had no idea about the cause of Urinary schistosomiasis, while 44% of the respondent in Otuaba had no idea about the cause. Only 26% and 22% in Otuoke and Otuaba respectively linked the cause of the disease to worm. There was no significant difference in the level of knowledge of the respondents about all the studied variables in the two communities (Table 3).
Table 3: Details of the knowledge about Urinary schistosomiasis in Otuoke and Otuaba communities
About
Schistosomiasis
Not heard about Schistosomiasis
83
69
Worm
Inherited
Witchcraft
No idea
26
11
8
66
21
7
13
44
Frequent Urination
Blood in urine
Abdominal pain
Pain while urinating
Cough
Diarrhoea
18
36
22
17
10
28
12
Blood examination
Stool examination
Others
43
37
34
15
31
Traditional Healer
Local drug store
Church and mosque
19
14
The results presented in Table 4 below showed that there was a significant relationship (p=0.0002) between “contact with freshwater sources” and Urinary schistosomiasis in Otuoke and Otuaba communities. Similarly, there was a significant relationship (p=0.000005) between “activities with freshwater” and urinary schistosomiasis in Otuoke and Otuaba communities.
Table 4: Attitude-related distribution in Otuoke/Otuaba communities
No concern
Stream
Well
Tap water
33
79
29
54
71
53
9
32
Freshwater Sources
No
49
68
25
87
73
Sustainable control and prevention of Urinary schistosomiasis requires an understanding of the communities’ knowledge, attitude and perception (KAP) of the disease in endemic areas. Such information is useful in planning and implementation of control strategies for schistosomiasis control and reducing its morbidity (WHO, 2022).
The result of this study revealed that knowledge, attitude and the perception of the respondents about the disease varied greatly. The males in the communities were more responsive to the questions during the study, hence the reason they have the highest percentage of respondents (129) than the females (98). This could be due to the boldness of the males as they responded more freely to questions than the females who were shy and sometimes run away from interviews. Most female in the communities also withdrew from answering certain questions about the infection, most especially when asked if they have had the disease or seen “blood in their urine” recently. This corresponds with the findings of Awi-waadu and Ezenwaka (2009) in Abua/Odual Local Government Area of Rivers State that males (55.5%) responded more than females (44.5%).
Only a handful (1.76%) of children aged 5-9 years were able to respond to questions and they indicated that they reported to their parents when they saw a “reddish substance” in their urine. Respondents aged 20-25 years responded more freely, indicating more willingness to answer questions about the disease. This could be due to their knowledge of the disease and the ability to be vocal about the symptoms and manifestations, and also the general conception that any infection that involves blood coming out of the body is very serious (Yohana et al., 2022).
The knowledge about the cause of the disease was widely distributed as most respondents claimed not to have any idea about the cause of the disease. This was in sync with a similar study by Yohana et al. (2022) where a general lack of knowledge about the disease was reported. This could be due to the fact that they believed the infection will heal on its own or that it is caused by various fetish means. Some respondents reported that the disease was caused by witchcraft with some making reference to disobeying certain traditional rules and regulations in the study area.
The admittance of blood in the urine which is the characteristic symptom of the infection (Tamomh et al., 2018; Surakat et al., 2020) by a good number of respondents suggests that the disease is likely present in the communities. This calls for concern and shows that appropriate measures has not been ideally implemented to prevent the occurrence of the disease in both communities.
The knowledge about the proper way of diagnosing the infection was poor as also reported by Noriode et al. (2018). This could be because of other complications that may arise from the disease progression. The admittance of examination of blood samples could be influenced as being a popular choice due to the fact that most diseases occurring in the study area are diagnosed through blood examination including the disease.
The choice of various avenues for treatment by the respondents could mostly be due to financial reasons as they perceived that it is more cost-friendly to go to the local drug stores than going to the hospital. Churches and mosques were the least places recognized for attaining treatment. Some respondents preferred going to local traditional healers for treatment and these were mostly traditionalists, elderly people and also those with the least educational background. In general, the result revealed that the proportion of the level of knowledge about Urinary schistosomiasis did not differ between Otuoke and Otuaba communities. This may be possible since both communities are located in Bayelsa and do share similar cultural and belief system.
The attitude towards individuals with the disease was positive as most respondents indicated that a concerning attitude was shown towards those with the disease. This could be due to the general belief that a disease or infection that includes blood coming out of the body is termed serious. While there was a level of concern among certain individuals regarding the disease, a proportion exhibited neutral or indifferent attitudes. Addressing these attitudes is crucial to foster a community-wide understanding of the importance of supportive attitudes towards affected individuals and the significance of disease prevention (Hambury et al., 2021).
The respondents that indicated their source of water to be from borehole (tap water) were found to have attained a certain level of education and understand the effect of unclean water. Some respondents reported using freshwater from streams for various domestic activities and took actions to protect themselves from various contamination, such as ‘’the addition of a little quantity of soda ash” as indicated by one respondent. Although these methods are rudial, they prove that implementation of recommended preventive measures and educational awareness about the disease will go a long way in fighting against the disease (Folefac et al., 2018; Alo et al., 2021).
The type of toilet facility in a community plays an important role in the prevention of so many infectious diseases. It was observed that majority of the respondents made use of a water closet although there is presence of make-shift toilets close to the Otuoke River. It was also noticed that the sewage from this toilet drains directly into the river. This could be the means of toilet used by those who indicated the use of other facilities. This behavioural practice could be one of the factors contributing to the spread of the disease in the study area (Shabani et al., 2022).
Those who engaged in activities that involve fresh water wore little or no footwear and were scantily dressed. The lack of proper protective measures may contribute to the penetration of the Schistosoma larvae into the body (Kulinkina et al., 2023; Tadele et al., 2023).
Generally on attitude of the respondents on the disease, both communities shared similar attitude towards the disease but when it comes to “contact with freshwater sources” and “activities with freshwater”, both communities had varying view, with residents in Otuoke having less contact with freshwater and reduced freshwater activities than residents Otuaba. Owing to the fact that a former president of Nigeria was from Otuoke, the community must have enjoyed some level of development, awareness and education that kept them away from exposures that can make them vulnerable to Urinary schistosomiasis.
The knowledge, attitude and perception (KAP) study conducted in Otuoke and Otuaba communities indicated poor knowledge regarding urinary schistosomiasis. This knowledge deficit poses a significant challenge to disease prevention and control efforts within the community. The KAP between both communities are majorly similar although Otuoke residents had lower contact and activities with freshwater than Otuaba residents.
Competing interests: No conflict of interest exists.
Authors’ contributions: ECO designed the study protocol. OSC performed the field data collection. Both authors analyzed and interpreted the data. OSC wrote the initial manuscript. All authors read and approved the final manuscript.
Acknowledgements: The authors acknowledge the residents of Otuoke and Otuaba communities for their consent to this study. Mr. Amadi, Fyneface of PAMO University, Port Harcourt, Rivers State, is greatly appreciated for his technical support.
Alo C, Akamike I, Agbo U, Eze I, Madudueze U, Okedo-Alex I, Azuogu B, Una A, Elum P, Ugochukwu C, Nwonwu E and Ogbonnaya L (2021). Prevalence, knowledge, attitude and preventive practices regarding intestinal and urinary parasites among primary school children in a rural community in Ebonyi State, Nigeria. J. Epidemiol Soc. Niger. 4 (1): 39-50.
Atalabi TE, Lawal U and Ipinlaye SJ (2016). Prevalence and intensity of genito-urinary schistosomiasis and associated risk factors among junior high school students in two local government areas around Zobe Dam in Katsina State, Nigeria. Parasit Vectors 9: 388.
Awi-Waadu G and Ezenwaka CO (2009). Urinary schistosomiasis in Abua/Odual Local Government Area, Rivers State, Nigeria. Afr. J. Appl Zool Env. Biol. 11: 116-123.
Ekpo UF, Mafiana CF, Adeofun CO, Solarin ART and Idowu AB (2008). Geographical information system and predictive risk maps of urinary schistosomiasis in Ogun State, Nigeria. BMC Infect. Dis. 8: 74. https://doi.org/10.1186/1471-2334-8-74.
Feng J, Wang X, Zhang X, Hu H, Xue J, Cao C, Xu J, Yang P and Li S (2023). Effect of Health Education on Schistosomiasis Control Knowledge, Attitude, and Practice after Schistosomiasis Blocking: Results of a Longitudinal Observational Study in the Field. Trop Med. Infect. Dis. 8 (5): 267.
Folefac LN, Nde-Fon P, Verla VS, Tangye MN, Njunda AL and Luma HN (2018). Knowledge, attitudes and practices regarding urinary schistosomiasis among adults in the Ekombe Bonji Health Area, Cameroon. Pan Afr Med J. 29: 161.
Hambury SD, Grobler AD and Melariri PE (2021). Knowledge, attitudes, and practices on urinary schistosomiasis among primary schoolchildren in Nelson Mandela Bay, South Africa. J. Parasitol Res. 2021, 6774434.
Kone KJ, Onifade AK and Dada EO (2022). Occurrence of urinary schistosomiasis and associated bacteria in parts of Ondo State, Nigeria. PLOS Glob Public Health 2 (10): e0001119.
Kulinkina AV, Farnham A, Biritwum NK, Utzinger J and Walz Y (2023). How do disease-control measures impact spatial predictions of schistosomiasis and hookworm? The example of predicting school-based prevalence before and after preventive chemotherapy in Ghana. PLoS Negl Trop Dis. 17 (6): e0011424.
Minjibir AA, Mu’azu L, Tinuoye and Ali M (2020). Prevalence of Schistosomiasis among Primary Pupils in Dawakin-Kudu Local Government Area Kano State, Nigeria. ARC J Urol. 5 (1): 15-20.
Noriode RM, Idowu ET, Otubanjo OA and Mafe MA. (2018). Urinary schistosomiasis in school aged children of two rural endemic communities in Edo State, Nigeria. J Infect Public Health 11 (3): 384-388.
Tamomh AG, Abakr AD and Nour BYM (2018). Urinary schistosomiasis among basic school children in a new irrigated sugar scheme area, White Nile State, Sudan. J Microbiol Exp. 6 (2): 93-96.
Oborie, E and Nwankwoala, H (2012). Relationships between Geoelectrical and Groundwater Parameters in Parts of Ogbia, Bayelsa Sate, Central Niger Delta. Cont J. Earth Sci. 7: 29-39.
Oluwole AS, Ekpo UF, Nebe OJ, Akpan NM , Jacob SM, Amazigo UV and Stothard JR (2022). The new WHO guideline for control and elimination of human schistosomiasis: implications for the Schistosomiasis Elimination Programme in Nigeria. Infect Dis Poverty. 11, 111. https://doi.org/10.1186/s40249-022-01034-3.
Rassi C, Martin S, Graham K, de Cola MA, Christiansen-Jucht C, Smith LE, Jive E, Phillips AE, Newell JN and Massangaie M (2019). Knowledge, attitudes and practices with regard to schistosomiasis prevention and control: Two cross-sectional household surveys before and after a Community Dialogue intervention in Nampula province, Mozambique. PLoS Negl Trop Dis. 13 (2): e0007138.
Sacolo H, Chimbari M and Kalinda C (2018). Knowledge, attitudes and practices on Schistosomiasis in sub-Saharan Africa: a systematic review. BMC Infect. Dis. 18 (1): 46. https://doi.org/10.1186/s12879-017-2923-6.
Sady H, Al-Mekhlafi HM, Atroosh WM, Al-Delaimy AK, Nasr NA, Dawaki S, Al-Areeqi MA, Ithoi I, Abdulsalam AM, Chua KH and Surin J (2015). Knowledge, attitude, and practices towards schistosomiasis among rural population in Yemen. Parasit Vectors 8, 436. https://doi.org/10.1186/s13071-015-1050-8.
Saidu U, Ibrahim MA, de Koning HP, McKerrow JH, Caffrey CR and Balogun EO (2023). Human schistosomiasis in Nigeria: present status, diagnosis, chemotherapy, and herbal medicines. Parasitol Res. 122: 2751-2772.
Shabani M, Zacharia A, Mushi V, Joseph M, Kinabo C and Makene T. (2022). Prevalence and predictors of intestinal schistosomiasis among the adult population, and water and sanitation conditions – A community-based cross-section study at Muleba District, Tanzania. Rwanda Med. J. 79 (1): 36-43.
Smith J (2010). Geography of Bayelsa State. Lagos publishers, 76.
Surakat OA, Alabi OR, Ogundana TE, Rufai M, Adeleke MA, Sam-Wobo SO and Mafiana CF (2020). Evaluation of Water Sanitation and Hygiene (WASH) Facilities and Its Association with Urinary Schistosomiasis in Selected Settlements of Osun State, Nigeria. Pan Afr J. Life Sci. 4(2): 51-58.
Tadele T, Astatkie A, Tadesse BT, Makonnen E, Aklillu E and Mequanente A. (2023). Efficacy and safety of praziquantel treatment against Schistosoma mansoni infection among pre-school age children in southern Ethiopia. Trop Med Health 51, 72. doi: 10.1186/s41182-023-00562-4. PMID: 38124206; PMCID: PMC10731898.
World Health Organization (WHO) (2022). WHO launches new guideline for the control and elimination of human schistosomiasis. 14 February 2022; 142 Pages. https://www.who.int/publications/i/item/9789240041608.
Yohana C, Kinung’hi SM, Nyundo BA, Rambau PF and Bakuza JS (2022). Knowledge, attitudes and practices on urinary schistosomiasis-related morbidity among communities in Itilima District, Tanzania. Tanz. J. Sci. 48 (4): 875-885.
Ezenwaka, CO; Obinede, SC (2024). Knowledge, Attitude and Perception of Urinary Schistosomiasis among the Residents of Otuoke and Otuaba Communities in Ogbia Local Government Area, Bayelsa State, Nigeria. Greener Journal of Biological Sciences, 14(1): 14-21.
Download [340.85 KB]
Your email address will not be published. Required fields are marked *
Comment *
Name *
Email *
Website
Save my name, email, and website in this browser for the next time I comment.
Post Comment
