A mixed method analysis of the Botswana schistosomiasis control policy and plans using the policy triangle framework

Background The present goal of the World Health Organization(WHO)2021-2030 roadmap for Neglected Tropical Diseases is to eliminate schistosomiasis as a public health problem,and reduce its prevalence of heavy infections to less than 1%.Given the evolution and impact of schistosomiasis in the Ngamiland district of Botswana,the aim of this study was to analyze the control policies for the district using the Policy Triangle Framework.Methods The study used a mixed method approaches of an analysis of policy documents and interviews with 12 informants who were purposively selected.Although the informants were recruited from all levels of the NTD sector,the analysis of the program was predominantly from the Ngamiland district.Data were analyzed using Braun and Clarke’s approach to content analysis.Results The study highlights the presence of clear,objectives and targets for the Ngamiland control policy.Another theme was the success in morbidity control,which was realized primarily through cycles of MDA in schools.The contextual background for the policy was high morbidity and lack of programming data.The implementation process of the policy was centralized at the Ministry of Health(MOH)and WHO,and there was minimal involvement of the communities and other stakeholders.The policy implementation process was impeded by a lack of domestic resources and lack of comprehensive policy content on snail control and no expansion of the policy content beyond SAC.The actors were predominately MOH headquarters and WHO,with little representation of the district,local level settings,NGOs,and private sectors.Conclusions The lack of resources and content in the control of environmental determinants and exclusion of other at-risk groups in the policy,impeded sustained elimination of the disease.There is a need to guide the treatment of preschool-aged children and develop national guidelines on treating foci of intense transmission.Moreover,the dynamic of the environmental transmissions and reorientation of the schistosomiasis policy to respond to the burden of schistosomiasis morbidity,local context,and health system context are required.

Assessment of awareness and knowledge of schistosomiasis among school-aged children(6-13 years)in the Okavango Delta,Botswana

Background:Schistosomiasis is a global health problem affecting 250 million people,with 90%in Sub-Saharan Africa.In Botswana,the burden is high in the Okavango delta because of the water channels.WHO recommends integrated measures,including access to clean water,sanitation,health education,and drugs to control and eliminate schistosomiasis.Gauging knowledge and awareness of schistosomiasis for School-Aged Children(SAC)is crucial.Our study aimed at assessing knowledge and awareness of schistosomiasis among SAC in the Okavango Delta.Methods:A cross-sectional survey assessing awareness and knowledge of schistosomiasis in schools was conducted.480 questionnaires were administered to gather demographic profiles,awareness,and knowledge of risky behaviors.Chi-square and descriptive analysis determined the differences in SAC`s awareness and knowledge levels based on localities,gender,age,and health education.Results:The results showed a low awareness level,with only(42%)of respondents having heard about the disease and(52%)knowing its local name.Younger children from Sekondomboro(83%)and Samochima lacked awareness,while children from Mohembo(77%)and those who had health education(70%)demonstrated significant awareness levels(P≤0.001).Seventy-two percent(72%)lacked knowledge of the cause and(95%)did not know the disease life-cycle.Children from Xakao(91%),(85%)Sepopa,and(75%)of younger children did not know haematuria is a symptom of the disease.Older and SAC with health education were more likely to know that swimming is a risk factor(P≤0.001)and(P≤0.05)respectively.Conclusions:Although respondents from four schools demonstrated some level of awareness of the disease,and knowledge of risky behaviors,the study showed a lack of in-depth knowledge on the life-cycle and cause of the diseases.We,therefore,recommend the implementation of an integrated approach to health education and improvement in access to clean water and sanitation in all study areas.