Potential Barriers and Facilitators Prior to Introduction of Novel Treatment Option for Schistosomiasis among Pre-School Age Children in Two Endemic Counties of Kenya

Abstract

Schistosomiasis is a water-borne parasitic infection with more than 200 million people infected globally, and over 93% of these cases occurring in sub-Saharan Africa. It is estimated that more than six million people in Kenya are also infected with the disease. Currently, schistosomiasis is estimated to be 11.8% in the country. Treating preschool age children (PSAC) in Kenya for schistosomiasis has remained a challenge due to lack of an appropriate pediatric formulation. In response to this unmet need, the Paediatric Praziquantel Consortium has developed a novel paediatric treatment option ArPraziquantel (ArPZQ) for PSAC. In advance to its roll-out, a cross-sectional study was conducted in eight villages in Kwale and Homa Bay counties of Kenya. The main objective was to assess potential barriers and facilitators towards the pilot roll-out of ArPZQ treatment option for schistosomiasis among PSAC. Convergent parallel mixed method approach was used for data collection. A multistage sampling strategy was applied. The study population were community members and healthcare workers in the study area. Quantitative data were collected via a questionnaire which was administered to 690 parents/guardians of PSAC at household level. Qualitative data involved key informant interviews with 17 opinion leaders and 28 healthcare workers, and 12 focus group discussions with parents/guardians of PSAC and 7 with community health promoters (CHPs). Preferred drug delivery approaches were analyzed using frequencies, proportions and odds ratio. While qualitative data were analyzed using a thematic approach. Majority of the 690 respondents were women 594 (86.1%) with a mean age of 34.1 (SD=11.3, min-max=18-86). Most participants had heard of schistosomiasis and perceived it to be a serious disease whose treatment should be prioritised. Some people believed schistosomiasis was caused by witchcraft while others regarded it as a sexually transmitted infection. Community-based mass drug administration (cMDA) was the most preferred method of drug delivery mentioned by 598 participants (86.7%), followed by health facility/fixed points by 398 participants (57.7%). The findings were similar to the results of qualitative interviews where most participants reported that their preference for cMDA because of convenience and the involvement of CHPs familiar with local contexts in distribution campaigns. Some participants also preferred health facilities/fixed points, although a few health workers expressed concern about this approach due to understaffing and overcrowding of facilities. Appropriate timing of the drug distribution, not to interfere with farming activities, was considered critical, irrespective of the approach used. The study concluded that, community members know and perceive schistosomiasis to be serious, but misinformation about its cause is prevalent. All profiles of study participants preferred cMDA over the other drug delivery approaches due to the convenience of receiving drugs at home and providing explanations about the new drug. For positive outcomes of the pilot roll-out, adequate planning, increased awareness creation to change the perceptions in relation to schistosomiasis prevention and control, proper timings and community involvement are highly recommended.