Research Article: Assessment of urogenital schistosomiasis knowledge among primary and junior high school students in the Eastern Region of Ghana: A cross-sectional study

Date Published: June 13, 2019

Publisher: Public Library of Science

Author(s): Rachel A. Martel, Bernard Gyamfi Osei, Alexandra V. Kulinkina, Elena N. Naumova, Abdul Aziz Abdulai, David Tybor, Karen Claire Kosinski, Abdallah M. Samy.


Knowledge of urogenital schistosomiasis can empower individuals to limit surface water contact and participate in mass drug administration campaigns, but nothing is currently known about the schistosomiasis knowledge that schoolchildren have in Ghana. We developed and implemented a survey tool aiming to assess the knowledge of urogenital schistosomiasis (treatment, transmission, prevention, symptoms) among science teaches and primary and junior high school students in the Eastern Region of Ghana.

We developed a 22-question knowledge survey tool and administered it to 875 primary and 938 junior high school students from 74 schools in 37 communities in the Eastern Region of Ghana. Teachers (n = 57) answered 20 questions matched to student questions. We compared knowledge scores (as percent of correct answers) across topics, gender, and class year and assessed associations with teacher’s knowledge scores using t-tests, chi-squared tests, univariate, and multivariate linear regression, respectively.

Students performed best when asked about symptoms (mean±SD: 76±21% correct) and prevention (mean±SD: 69±25% correct) compared with transmission (mean±SD: 50±15% correct) and treatment (mean±SD: 44±23% correct) (p<0.0005). Teachers performed best on prevention (mean±SD: 93±12% correct, p<0.0005) and poorest on treatment (mean±SD: 69±16% correct, p<0.001). When listing five facts about urogenital schistosomiasis, teachers averaged 2.9±1.2 correct. Multiple regression models suggest that gender, class year, teacher score, and town of residency explain ~27% of variability in student scores. On average, junior high school students outperformed primary school students by 10.2 percentage points (CI95%: 8.6–11.8); boys outperformed girls by 3.5 percentage points (CI95%: 2.3–4.7). Our survey parsed four components of student and teacher knowledge. We found strong knowledge in several realms, as well as knowledge gaps, especially on transmission and treatment. Addressing relevant gaps among students and science teachers in UGS-endemic areas may help high-risk groups recognize risky water contact activities, improve participation in mass drug administration, and spark interest in science by making it practical.

Partial Text

Schistosomiasis affects an estimated 200 million people [[1]]; over 90% of cases are in sub-Saharan Africa, and reducing this disease burden is a high priority [[2]]. Urogenital schistosomiasis (UGS), caused by Schistosoma haematobium, is the most common form of schistosomiasis in sub-Saharan Africa and is contracted through skin contact with surface water containing schistosome cercariae [[1], [2]]. The main risk factors for a schistosome infection are availability and use of surface water sources for domestic, recreational, and occupational purposes [[1]]. School-aged children are the demographic group most commonly affected by UGS [[1], [3]]. Estimated annual incidence among school-aged children in some towns in the Eastern Region of Ghana is 50% [[4]]; recreational swimming, being male, increasing age within adolescence, prior positive UGS status, and contact with surface water, are all possible risk factors for UGS infections in endemic locations [[4], [5]]. Control of UGS is mainly through school-based mass drug administration (MDA) with praziquantel, but MDA must be matched with complementary components such as health education and water, sanitation, and hygiene improvements [[6], [7], [8]].