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

Abstract

Abstract Introduction Schistosomiasis 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 Zimbabwe’s Chiredzi district: Hippo Valley Estate (HVE) and Chipimbi. Methodology In 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. Cramer’s V (φ) and Gamma (γ) 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. Results Awareness 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. Conclusion Despite 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