Barriers in the control of Schistosomiasis with Mass distribution of Praziquantel in Bauchi State, Nigeria
Authors and Affiliations:
A Phenomenological study
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Adeyemo Sunday Charles 1✉ Email Email
Obehi Are-Daniel 2
Oluwafemi 2
Adeleke Folasade Yetunde 3
Abdulwaris Salisu Maleka 4
Akintade Odunlami Joseph 1
Ajayi Ayodele Raphael 5
Abdulsalam Hussaini Muhammad 4 Email
Nafi’u Rabiu 4 Email
Usman Yunusa 4 Email
1 Department of Public Health Institut Superiure De Santé ISS Niamey Niger Republic
2 Faculty of Medicine, Health and Social Care Canterbury Christ Church University Canterbury United Kingdom
3 Department of NHIS Uniosun University Teaching Hospital Osogbo Osun State Nigeria
4 Bauchi State Primary Health Board Bauchi Nigeria
5 Department of Psychiatry Afe Babalola Teaching Hospital Complex Ado-Ekiti, Ekiti Nigeria
Adeyemo Sunday Charles
• Department of Public Health, Institut Superiure De Santé ISS, Niamey, Niger Republic
Email: charlespatho@gmail.com
Are-Daniel Obehi Oluwafemi
• Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, United Kingdom
Adeleke Folasade Yetunde
• Department of NHIS, Uniosun University Teaching Hospital, Osogbo, Osun State, Nigeria
Email: adeyemoyetty76@gmail.com
Abdulwaris Salisu Maleka
• Bauchi State Primary Health Board, Bauchi, Nigeria
Email: abdulwarismaleka1@gmail.com
Akintade Odunlami Joseph
• Department of Public Health, Institut Superiure De Santé ISS, Niamey, Niger Republic
Email: josephakintade11@yahoo.com
Ajayi Ayodele Raphael
• Department of Psychiatry, Afe Babalola Teaching Hospital Complex, Ado-Ekiti, Ekiti, Nigeria
Email: ajayiayodeleraphael@gmail.com
Abdulsalam Hussaini Muhammad
• Bauchi State Primary Health Board, Bauchi, Nigeria
Email: hussainiabdulsalam11@gmail.com
Nafi'u Rabiu
• Bauchi State Primary Health Board, Bauchi, Nigeria
Email: nafiurabiu417@gmail.com
Usman Yunusa
• Bauchi State Primary Health Board, Bauchi, Nigeria
Email: usmanyunusa240@gmail.com
Adeyemo Sunday Charles
Department of Public Health, Institut Superiure De Santé ISS, Niamey, Niger Republic
Email: charlespatho@gmail.com
Corresponding Author:
Abstract
Schistosomiasis is a major public health problem in sub-Saharan Africa and major public health concern. There has been reportage of over 700 million of population at risk arising from an estimated affected population of at least 230 million worldwide. Estimates indicate that approximately 29 million individuals in Nigeria are infected with S. haematobium, while an alarming 101.3 million people are considered at risk.
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Despite the World Health Organization's recommendations for the widespread distribution of Praziquantel and the efforts of the Bauchi government to ensure access to clean water and health education in accordance with these guidelines, the prevalence of the issue continues to be alarmingly high. This study aims to explore the factors contributing to the failure of widespread distribution of Praziquantel to reduce the prevalence of schistosomiasis in Bauchi State, with a specific focus on the Dass local government area.
The research is conducted in the Dass Local Government Area (LGA) of Bauchi State, Nigeria, which is positioned in the north-eastern region of the country. In-depth interviews were carried out with 20 stakeholders at the local government level. Coding was done using qualitative analysis software, ATLAS TI software for the data management and analysis data were coded into themes based on the research objectives.
The inadequate involvement of government and NGOs and Community-related factors including fear of side effects and stigmatization where among factors highlighted as major barriers. This research underscores the various obstacles to successful schistosomiasis management in Dass Local Government via mass drug administration (MDA). Tackling issues associated with drug availability, the well-being of healthcare personnel, community education, and logistical challenges necessitates a collaborative effort among multiple stakeholders.
Keywords:
Chemotherapy
Praziquantel
Tropical disease
Prevalence
Schistosomiasis
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1.0 Introduction
Schistosomiasis is a waterborne parasitic disease with the most prevalent symptom being hematuria and hematochezia [1]. It is a major public health problem in sub-Saharan Africa, a water-based, vector-borne disease endemic to many countries, WHO, in a 2013 submission highlights the most affected countries, naming the African region is the most affected, with 42 countries endemic for the infection, where it affects millions of individuals and populations living in low-resource countries with poor and insufficient water supply and sanitation systems (WHO, 2023). Being a neglected Tropical Disease (NTD) and major public health concern, it has been regarded as the most widespread of all human parasitic diseases, and holds second position, behind malaria with respect to its public health and socioeconomic significance in tropical and subtropical regions [2]. There has been reportage of over 700 million of population at risk arising from an estimated affected population of at least 230 million worldwide. [3]. Three primary species of schistosomes affects human, Schistosoma japonicum, S. haematobium, and S. mansoni. These species are primarily responsible for the two major forms of schistosomiasis, intestinal and urogenital. [4]. In a recent WHO’s disability-adjusted-life-years (DALYs) estimation, schistosomiasis leads to an annual reduction of up to 4.5 million [5]. Notable decrease in infection and morbidity has been accomplished in some countries of Africa through concerted global efforts to eliminate schistosomiasis and other NTDs by deworming with the inclusion of preventive chemotherapy [6].
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Both S. haematobium and S. mansoni are present in Nigeria, with S. haematobium having a wider distribution. The estimate reveals that about 29 million people in Nigeria carry the S. haematobium infection [7], while a staggering 101.3 million are at risk. The significant prevalence of S. haematobium presents a considerable public health concern in Nigeria. The World Health Organization (WHO) has unveiled its innovative 2021–2030 path forward, dedicated to eradicating Neglected Tropical Diseases (NTDs) by 2030 (WHO, 2022). This action plan aligns seamlessly with the global Sustainable Development Goals. A key focus of this strategic framework is the complete global eradication of schistosomiasis as a public health issue (WHO, 2022). Some of WHO’s recommendation include; WASH interventions, environmental interventions (water engineering and focal snail control with molluscicides) and behavioural change interventions as essential measures to help reduce transmission of Schistosoma spp. in endemic areas., For communities with an endemic prevalence of Schistosoma spp. infection exceeding 10%, the World Health Organization suggests yearly preventive chemotherapy. This involves administering a single dose of praziquantel with a treatment coverage of 75% or higher. This recommendation is valid for all individuals aged 2 years and above, including adults and pregnant women beyond their first trimester. This move aims to curb the morbid effects of schistosomiasis and progressively eradicate the disease as a public health concern. Praziquantel stands as the premier treatment option for schistosomiasis infection, serving as a tried-and-true solution in multiple countries for over three decades as per WHO's (2013) report. Through implementing the mass drug administration (MDA) approach, nations once plagued by schistosomiasis have either eradicated this threat entirely, or reduced its impact to barely noticeable levels [8].
Even with these recommendation by WHO of mass distribution of Praziquantel and Bauchi government’s effort to provide provision of portable water and health education in line with WHO’s recommendation, the prevalence remains very high, this has been confirmed by a twelve-month epidemio-ecological study on the prevalence of schistosomiasis which was conducted in Bauchi State, from January to December, 2016, It showed statistically significance infection rate across board [9].
In-depth studies challenges associated with the distribution of praziquantel from the perspectives of healthcare workers which is the value in this current research is essential for the effective design, implementation, and sustainability of these programs. Understanding their perspectives allows researchers and policymakers to identify challenges, optimize strategies, and ensure the long-term impact of these programs [10]. Healthcare workers operate at the intersection of policy and practice, making their insights critical for addressing the complexities of MDA programs [11]. Their perspectives can align with systems thinking approaches, which emphasize the interconnectivity of different components in healthcare delivery. By leveraging these insights, MDA programs can become more responsive and adaptive to local contexts, ultimately improving coverage and compliance rates. In-depth studies also contribute to equity and inclusivity by highlighting healthcare workers’ roles in reaching marginalized populations [12].
This current study seeks to investigate the reasons the mass distribution of Praziquantel has not flattened the curve in prevalence of schistosomiasis in Bauchi state and particularly in Dass local government area.
2.0 Materials and Methods
2.1 Study area and population
The study is situated in Dass Local Government Area (LGA) of Bauchi State, Nigeria, a region located in the north-eastern part of the country, the Fig. 1 below shows a the map of Bauchi state highlighting Dass local government. Dass LGA is characterized by a mix of rural and semi-urban settlements and spans an area of approximately 982 square kilometers. The terrain of the area comprises plains and hills, influencing both settlement patterns and agricultural activities, which are the predominant economic practices of the inhabitants. The people are primarily subsistence farmers, though some engage in animal husbandry, small-scale trading, and craftsmanship.
Fig. 1
Bauchi state map showing Dass local government [13]
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Healthcare delivery in Dass LGA relies heavily on the efforts of community health extension workers (CHEWs), nurses, and other health personnel who often work under resource-constrained conditions. These workers play critical roles in implementing public health programs, including mass drug administration campaigns, antenatal care, and immunization drives. Traditional medicine and community-based health practices also play an important role in the healthcare landscape of Dass LGA [14].
2.2 Research team
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The core research team was composed of three males and three female researchers: two public health personnel, an epidemiologist and a data analyst, two interpreters. The team also included healthcare practitioners and community health extension workers who provided ground-level insights into aspects of praziquantel distribution. These practitioners shared their experiences with supply chain challenges, resource limitation and patient compliance.
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The team included community mobilizers and local guides although not formally part of the technical team, were integral to the success of the research.
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The interviewers, transcribers and translators were born in the area and are familiar with the local culture; they were fluent in the Hausa language. The healthcare professionals performed the semi-structured interviews (SSI) and the in-depth interviews. Two of the interviewers and two professional translators translated the interviews from Hausa into English.
2.3 Study design
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Snow ball and purposive sampling strategy was employed to select participants for face-to face in-depth interview and Focus Group Discussions (FGDs). Purposive sampling method identifies participants with relevant experience and ensures that those who have sufficient knowledge in research scope are selected. In-depth interviews were conducted with 20 stake holders at the local government level. There were nine males and eleven females. There were seven community health workers, six nurses/midwives, two Pharmacist and two public health specialists. – all stationed at different communities. This enabled us to capture wide range of perspective from participants irrespective of their socioeconomic status and geographical location within Dass local government.
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Community contact persons assisted in recruiting the eligible participants for the in-depth interview. Diversity in age, gender and residence (urban or regional/rural) was ensured where possible.
2.4 Data collection
Qualitative data were collected through expert interviews [15]. In this study, semi-structured interview guides were developed for the in-depth interview (Additional file 1). In total, 20 interviews were conducted between July and October 2024. After the introduction of the study and its objectives, key questions were asked with a focus on the following four areas: (1) opinions regarding barriers influencing Praziquantel treatment for Schistosomiasis, (2) perceived involvement of authority (3) possible benchmark measures and (4) suggested solutions and recommendation. These four areas were chosen to present a broad view of the actual situations of people with chronic conditions and enabled us to adopt a holistic perspective. Interviews and group discussions were audio–recorded, translated and transcribed into English and proof read by the field team. Interviews lasted between 20 and 45 min when saturation was reached. Triangulation was done through cross-verification of data from interviews, and observations to ensure credibility.
2.5 Data analysis
Data was transcribed verbatim. The conventional content analysis approach was used to interpret meaning from the content of data due to the inductive nature of this qualitative design [16]. Some of the transcripts were translated from the local language to English and verified by experts to enhance accuracy. Transcripts were analysed by using a coding scheme developed from the topics. Data were thoroughly examined by researchers, and relevant perceptions were coded as concepts. Coding was done using qualitative analysis software, ATLAS.ti software for the data management. Thematic analysis was then carried out by comparing themes and discussed to enhance understanding of data. The research team ensured that the themes were linked to research questions and study objectives.
2.6 Ethical consideration
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The study was approved by National Code for Health Research Ethics, Bauchi State (NCHRE) (Protocol approval No: NREC/040/11/19B/2021/081, Reg No: BSMOH/REC/81/2023). In line with Good Clinical Practice, the goals of the study were explained to each participant of the study in plain words in English or in Hausa before enrolment using the participant information leaflet. The right to withdraw was explained and enough time was given to discuss doubts and open questions.
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Each participant signed the informed written consent form and received a copy of the pre-prepared consent forms using participants’ signature or thumb print. All participants were anonymized in transcription and, once transcribed, all audio data was deleted.
2.7 Reflexivity
To reduce the impact of language, gender and cultural barriers, the field researchers included male and female researchers. To deepen insights and ensure findings reflected the research context, in situ analyses were regularly reviewed by study team members who had undertaken the data collection. [17].
3.0 Results
4.1 Sociodemographic characteristics of informants
Table 1 below describes the sociodemographic characteristics of informants. The health workers were aged within 26-50years. There were nine males and eleven females. There were seven community health workers, six nurses/midwives, two Pharmacists and two public health specialists. Three of the health workers had diploma and higher each, one had post-graduate degree while others had undergraduate degrees. The work experience of the health workers ranged from 6-30years.
Table 1
Sociodemographic characteristics of informants
Informant ID
Age
Gender
Cadre
Education
Work experience
N1
46–50
Female
Nurse / midwife
Higher diploma
21 years – 30 years
N2
36–40
Female
Community health workers
Diploma
11 years – 20 years
N3
41–45
Male
Community health workers
Undergraduate degree
11 years – 20 years
N4
26–30
Female
Nurse / midwife
Undergraduate degree
6years – 10 years
N5
36–40
Female
Pharmacist
Undergraduate degree
6years – 10 years
N6
26–30
Female
Community health workers
Diploma
6years – 10 years
N7
36–40
Male
Nurse /midwife
Post-graduate degree
11years − 20 years
N8
26–30
Female
Community health workers
Higher diploma
6years − 10years
N9
26–30
Female
Nurses /midwife
Undergraduate degree
6years – 10 years
N10
36–40
Female
Nurses /midwife
Undergraduate degree
11 years – 20 years
N11
41–45
Male
Public health specialist
Undergraduate degree
6years – 10 years
N12
26–30
Male
Public health specialist
Undergraduate degree
Below 5years
N13
36–40
Male
Community Health Workers
Diploma
11 years – 20 years
N14
36–40
Male
Community health worker
Diploma
6years – 10 years
N15
31–35
Female
Doctor
Undergraduate degree
6years – 10 years
N16
26–30
Male
Doctor
Undergraduate degree
6years – 10 years
N17
41–45
Male
Doctor
Postgraduate degree
11 years – 20 years
N18
31–35
Male
Pharmacist
Higher diploma
6years – 10 years
N19
36–40
Female
Nurse/Midwife
Undergraduate degree
6years – 10 years
N20
31–35
Female
Community health worker
Undergraduate degree
6years – 10 years
1. Experience of healthcare workers in Praziquantel distribution in Dass Local Government
Majority of the respondents reported that the Praziquantel drug is often out of stock, which leads to delayed treatment. Some health workers reported that irregular schedule of treatment, i.e. the treatment being available for only twice a year, limits access to the drug. Some health workers also reported shortage or lack of trained staff to carry out the drug administration, making the work cumbersome to the available workers.
Most of the time when we want to give people drug, it is not available’ (N4)
We are not plenty that are working in this community, it is stressful for us’ (N6)
The government is not sending enough drugs to the health center’ (N9)
One of the health care workers also reported experiencing a child collapsing after taking the drug due to hunger, some health workers also reported patients complaining of stomach pain.
The drug can have side effect when taking on empty stomach’ (N5)
2. Key barriers faced by health care workers in Praziquantel distribution in Dass Local Government.
Majority of the health care workers reported that some community members are not willing to take the drug due to past experience of having side effects during previous mass drug administration. Some of the health care workers reported that some people that have schistosomiasis are not willing to present for treatment due to stigmatization. Also, some community members are not aware of the importance of the drug, therefore they are not willing to take the drug.
Most people don’t know about the drug and some of them are afraid that it will hurt them’ (N11)
3. Logistical and Operational Challenges
Majority of the health care workers reported that house-to-house administration of the drug is stressful. They also reported that the stipends paid to the health workers involved in distributing the drugs is not encouraging. Some of the health workers also reported that the number of health workers in the community are low compared to the population, leading to high workload on those available. Lack of data collection and analysis tools to track the coverage of the drug administration was also reported among the health care workers.
‘….It is stressful to be going from house to house to give drugs to the children….in some houses they will not even allow you.’ (N2)
‘….The amount we are paid is too low compared to the work we do…’ (N3)
Another major challenge reported among the health care workers was transportation. Most of the health workers reported that bad roads and lack of reliable vehicles has made it difficult to reach some parts of the communities for drug administration.
‘…The roads are bad and there is no proper arrangement for our transportation…By the time you get to the communities, you are already tired....’ (N10)
4. Community-Level Factors Affecting Mass Drug Administration
The success of mass drug administration for schistosomiasis heavily depends on how well the community accepts and participates in the program. Several community-level factors have been identified that prevent the acceptance of Praziquantel treatment. A major barrier reported among the health workers is the lack of knowledge or awareness among community members about schistosomiasis and the benefits of treatment.
‘….Many people in the community do not fully understand the importance of taking Praziquantel, which leads to low participation rates….’ (N7)
Also, some of the health care workers reported that the some community members prefer to patronize traditional healers, therefore they do not show any interest in taking the drug. Due to lack of knowledge about drug which has led to fear of side effect among the community members, some mothers do not allow their children to receive the treatment.
5. Policy-related and structural barriers
Though none of health care workers reported policies that serve as barrier to the mass drug administration, majority of the health care workers reported that there is no adequate support from the government towards the implementation of mass drug administration of Praziquantel. The workers reported that there is no constant or sufficient supply of the drug and there is poor welfare of the health care workers. Also, there is low staffing, especially of trained health workers, leading to heavy workload on the available ones.
‘Government and NGOs should provide drugs…they should make it available’ (N17)
‘The government is not sensitive to the needs of the health care workers, and they expect us to be effective.’(N19)
‘…..When the drug is not available, how do we distribute it? .....’ (N20)
6. Recommendations by health workers to improve the effectiveness of mass drug administration
Majority of the health workers recommended enhancing Community Engagement through health education and awareness in schools and communities. They also recommended involvement of community leaders as well as religious leaders. Also, height and age-based distribution, which will ensure proper dosage being given to children.
‘…If we involve the leaders in each community, and leaders in the religious setting, to talk to people about the drug, they will be willing to use the drug….’ (N12)
Another important recommendation raised by the health workers is strengthening health workers through training programs that will equip them with necessary knowledge on distribution protocols, management of supply chains and the safety measures to undertake in the drug administration. Also, they recommended that the welfare of the health care workers should be improved on, in order to ensure they are well motivated to perform their duties.
‘….If the government can invest in the health workers, by training us, and giving enough money, I am sure there will be improvement…’ (N13)
The health care workers also recommended that the government should get more involved in providing easy access and constant supply of praziquantel in order to meet the health needs of the people. They also recommended that surveys should be carried out in order to assess the coverage of the drug administration and its effectiveness. Some of the health care workers also recommended that there should be establishment of policies that support school-based and community-based treatment programs.
‘….If the drug is available, we will give it to people….’ (N18)
The health care workers also recommended that accurate records to individuals who are receiving treatment should be maintained. This will help to ensure proper follow-up on those receiving treatment and have insight into the coverage of the drug administration.
4.0 Discussion
Perception of treatment acceptance
In the current study, the healthcare workers interviewed identified knowledge of praziquantel as the primary reason for its acceptance among the public as reflected in the Fig. 2 below, this is in tandem with a study by Coulibaly J.T et al [45]. This finding emphasizes the crucial role of awareness and understanding in fostering trust and compliance with treatment programs [18].
Fig. 2
Figure showing reasons for treatment acceptance
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This observation aligns with similar findings in other studies, where knowledge is consistently linked to higher acceptance rates. For example, research in endemic areas has shown that targeted health education campaigns significantly increase uptake by dispelling myths and addressing concerns about side effects or the necessity of treatment [19]. In such contexts, informed individuals often act as community advocates, further amplifying the reach and impact of education efforts [20]. However, other studies have revealed contrasting scenarios where limited knowledge or misinformation undermines acceptance [21]. In some cases, even when praziquantel is readily available, misconceptions about its purpose or fear of adverse effects lead to reluctance or outright refusal [22]. These findings highlight that knowledge, while critical, must be accurate, culturally relevant, and delivered in ways that resonate with the target population. While increasing awareness is vital, it must be integrated with efforts to address logistical, social, and systemic barriers to ensure comprehensive and sustainable acceptance of the drug in schistosomiasis control programs.
Perception of treatment impact
In the current study, healthcare workers reported that most members of the public associated praziquantel treatment with noticeable improvement, suggesting a positive perception of the drug’s efficacy, Fig. 3 below shows a quantitative representation of this information. These findings are similar to study by Coulibaly J.T et al [45], where there was a positive response with respect to improvement in treatment with praziquantel, across the three communities, a recent cohort study by [23] also highlighted the effectiveness of praziquantel in reducing morbidity among moderate-to-heavy infected children. This finding aligns with studies in other endemic regions where patient-reported outcomes often contribute significantly to the acceptance and uptake of treatment as observed in study from Brazil and involving patients with S. mansoni infection [24].
Fig. 3
Figure showing perceived impact of drug
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Though there were reports of adverse effects or praziquantel particularly when taken on empty stomach, the perception of improvement was more and reinforces trust in the medication and healthcare system, creating a feedback loop that encourages broader participation in mass drug administration (MDA) programs [20]. Research in some communities have documented instances where mild side effects, such as nausea, dizziness, vomiting, abdominal pain/discomfort, itching, and headache which were largely self-limited [25], overshadowed the perceived benefits, leading to reduced compliance in subsequent treatment cycles. In such contexts, the public’s perception of improvement is less pronounced, emphasizing the need for tailored communication about side effects and the long-term benefits of the drug. The emphasis on perceived improvement in the current study as revealed in the Fig. 3 above highlights the importance of addressing public expectations in MDA campaigns. While this perception is a valuable driver of acceptance, other studies underline the necessity of complementing it with robust educational efforts to ensure that individuals understand the preventive and community-wide benefits of praziquantel, even in the absence of immediate, tangible improvements [26]. This balanced approach is crucial for sustaining long-term participation and achieving disease elimination.
Perception of preferred location for treatment
In the current study, healthcare workers observed that most members of the public expressed a preference for house-to-house administration as the preferred location for praziquantel treatment, this is reflected in the Fig. 4 below. This is also supported by a previous study by Coulibaly J.T et al [45] where the same perception was observed in most of the communities. This preference likely reflects the convenience, accessibility, and personalized nature of such an approach which minimizes the barriers to participation, such as travel time and costs, that are often associated with fixed-site distribution methods. House-to-house distribution also allows healthcare workers to engage directly with individuals in their own environments, addressing misconceptions and fostering trust more effectively [27].
Fig. 4
Figure showing preferred location to facilitate treatment
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In contrast, other studies have highlighted the challenges of house-to-house treatment compared to other delivery models [28]. Research in some endemic areas have found that while house-to-house distribution improves coverage, it can be resource-intensive, requiring significant logistical planning, funding, and manpower [29]. Moreover, the preference for house-to-house treatment may also reflect mistrust or discomfort with other treatment locations. Studies in some regions have reported that individuals are less likely to seek treatment at public health facilities due to stigma, fear of side effects, or lack of awareness [30]. The house-to-house approach mitigates these concerns by bringing treatment directly to individuals in a familiar setting, potentially increasing uptake. Critically, while house-to-house treatment has its advantages, its sustainability can be a concern, especially in resource-constrained settings. Other studies suggest that a hybrid approach, combining fixed-site and house-to-house strategies, may offer a balanced solution. Such an approach could leverage the strengths of both models, ensuring broader coverage while managing resource demands [31]. The preference for house-to-house treatment observed in the current study as shown in the Fig. 4 above underscores the importance of tailoring praziquantel delivery strategies to community needs and preferences, while also considering logistical and financial feasibility to ensure long-term program success.
Perceived factors limiting access to Pranziquantel
The findings in this current study highlights the critical challenges in achieving effective mass drug administration (MDA) of Praziquantel and provide insight into potential strategies for improvement.
Fig. 5
Figure showing factors limiting access to pranziquantel
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The outcomes of this study further reveal significant challenges faced by healthcare workers during drug distribution, in addition, stock outs of Praziquantel and irregular treatment schedules disrupted timely drug administration, this is reflected in the Fig. 5 above. Issues with supply of drugs is a major set-back in the mass distribution of Praziquantel as inconsistent supply of drug can frustrate the efforts of the health care workers in the distribution of the drug and render them incapable to meet the health needs of the community members. It has also been documented that inconsistent supply of drug leads to low coverage increases the risk for development of drug resistance [32]. This was also supported by the findings of Griswold [33] who reported that inconsistent drug availability undermines mass drug administration efforts and community trust in such programs.
Additionally, the shortage of trained staff further burdens existing workers, reducing the quality and efficiency of service delivery. WHO Health Systems Framework focuses on the health workforce as a critical building block of effective health systems [34]. Insufficient recruitment and training opportunities for health care workers leads to lack of competence in the administration of the drug which can further increase the risks and side effects associated with drug use. This is supported by the findings of Hoefle-Bénard & Salloch [35] who reported that poor staffing has been a major problem plaguing the health care sector, hindering the capacity of the health systems to carry out important interventions. This is reiterated by Olamiju [36] who reported that heavy work load on health care workers can reduce motivation and performance.
Adverse effects of the drug, such as stomach pain particularly when taken on an empty stomach, were also reported. This can come as a result of failing to explain the precautions to avoid or reduce side effects or issues such as malnutrition among the children. This aligns with studies noting that side effects discourage compliance, particularly in resource-limited settings where access to food before medication is a challenge [37]. The Health Belief Model (HBM) also highlights how personal experiences with side effects, combined with the perceived severity of their condition and the benefits of the medication, shape compliance behaviour [38].
Community-related factors, such as lack of awareness about schistosomiasis, not feeling sick, fear of side effects and stigmatization emerged as significant obstacles to the acceptance of Praziquantel. This can be explained by Health Belief Model. Health care workers reported that some of the community members are unwilling to take the drug because they are not sick or do not think they can be plagued with Schistosomiasis (Perceived susceptibility), some of the community do not have knowledge about the effectiveness of praziquantel (Perceived benefit) (Fig. 2) and others are afraid of the side effects that can ensue from the use of the drug (Perceived barrier). Similarly, Inobaya [39] reported that lack of knowledge about the effectiveness of praziquantel can hinder the acceptance among community members. Also, findings have been reported, with fear and stigmatization being key contributors to low mass drug administration uptake. [40] Additionally, the preference for traditional healers can also be associated with lack of knowledge about the effectiveness of praziquantel.
The inadequate involvement of government and NGOs in ensuring a consistent drug supply and improving healthcare workers’ welfare was highlighted as a major barrier. Government plays important role in maintaining adequate supply of the drug, ensuring the training of health care workers and payment of stipends to health care workers, this was reflected in the responses N17, N19 and N20 above. Leadership and governance are a major building block in the WHO’s Framework for Action, the framework highlights the need to establish strategic policy frameworks that are integrated with robust oversight, coalition development, regulatory measures with a focus on system design, and accountability [41]. The involvement of government is pivotal in the successful implementation of mass distribution of praziquantel. This finding is consistent with studies showing that limited governmental support undermines the success of MDA program. [33] Healthcare workers stressed the importance of having clear policies that promote school-based and community-based MDA strategies as shown in Fig. 4. This reflects best practices from successful drug distribution programs in other regions, which emphasize integrated approaches involving schools and local communities. This is reiterated by Oyeyemi [42] who reported that mass drug administration should be complemented with community awareness programs and education on prevention of Schistosomiasis.
The healthcare workers’ recommendations emphasized community engagement, enhanced training, and improved welfare. Involving community and religious leaders in awareness campaigns can increase acceptance and participation. This recommendation aligns with studies showing the critical role of community leaders in promoting public health interventions. [43] A study by Durrance-Bagale [44] also supports this finding, suggesting that enhanced community engagement is often observed following targeted health education campaigns, which empower communities to take an active role in disease prevention.
Strengthening healthcare worker capacity through training on supply chain management, distribution protocols, and adverse effect management can improve MDA outcomes. Furthermore, ensuring timely payment of stipends and addressing transportation challenges can enhance worker motivation and efficiency.
The need for regular surveys to evaluate MDA coverage and effectiveness is crucial. Accurate data collection and follow-up mechanisms can provide insights into program success and areas for improvement. Evidence suggests that well-coordinated monitoring and evaluation frameworks are vital to achieving Praziquantel distribution goals.
5.0 Conclusion
This study highlights the multifaceted barriers to effective schistosomiasis control in Dass Local Government through MDA. Addressing challenges related to drug supply, healthcare worker welfare, community awareness, and logistical issues requires a multi-stakeholder approach. Addressing these barriers requires strengthening health systems, improving supply chain management, enhancing workforce training, and fostering community participation to ensure the sustainability and effectiveness of mass drug administration programs. These findings underscore the need for coordinated efforts among government, NGOs, and community stakeholders to overcome systemic obstacles and achieve effective schistosomiasis control. Furthermore, by implementing the healthcare workers’ recommendations, such as increasing government involvement, promoting community engagement, and strengthening the capacity of healthcare workers, the effectiveness of MDA programs can be significantly improved.
Abbreviations
MDA Mass Drug Administration
LGA Local Government Area
NGO Non-Governmental Organization
WHO World Health Organization
NTD Neglected Tropical Diseases
WASH Water, Sanitation and Hygiene
SSI Semi-structured Interview
FGD Focused Group Discussion
HBM Health Belief Model
Declarations
Ethics approval and consent to participate
The study was reviewed and approved by National Code for Health Research Ethics, Bauchi State (NCHRE) (Protocol approval No: NREC/040/11/19B/2021/081, Reg No: BSMOH/REC/81/2023) and informed consent was obtained from all participants.
A
In accordance with the principals of the Declaration of Helsinki, study participants were asked for their verbal consent, which was documented on the demographic and questionnaire, and was approved by the National Code for Health Research Ethics, Bauchi State (NCHRE).
Clinical Trial
This study does not involve any clinical trials.
Consent for publications
A
All authors have read and approved the final manuscript and consent to its publication.
Data Availability
Data supporting this study are available upon reasonable request from the corresponding author.
Competing interests
The authors declare no competing interests.
A
Funding
This research did not receive funding from public, commercial or not-for-profit sectors.
A
Author Contribution
A.S.C Department of public health Institut Superiure De sante ISS niamey Niger Republic charlespatho@gmail.comContribution: Conceived the study, supervised the research process, manuscripting and data analysis.A.O.OFaculty of Medicine, Health and Social careCanterbury Christ church University, Canterbury, United Kingdom.Contribution: Contributed to data analysis and interpretation and critically revised the manuscript.A.F.Y Department of NHIS Uniosun University Teaching hospital, Osogbo, Osun state Nigeria adeyemoyetty76@gmail.comContribution: Study design, manuscripting and data analysisAbdulwaris Salisu MalekaBauchi state primary health board, Bauchi, Nigeriaabdulwarismaleka1@gmail.comContribution: Ethical compliance and data analysisA.O.JDepartment of Public Health institut Superiure De Santa ISS, Niamey, Nigeria Republic josephakintade11@yahoo.comContribution: Ethical compliance and analysisA.A.RDepartment of Psychiatry Afe Babalola Teaching hospitals complex, Ado-Ekiti, Ekiti, Nigeria ajayiayodeleraphael@gmail.comContribution: Ethical compliance and analysisA.H.MBauchi state primary health board, Bauchi, Nigeria hussainiabdulsalam11@gmail.comContribution: Data collection N.RBauchi state primary health board, Bauchi, Nigerianafiurabiu417@gmail.comContribution: Data collection U.YBauchi state primary health board, Bauchi, NigeriaUsmanyunusa240@gmail.comContribution: Data collection
AOO (Co-author): Contributed to data analysis and interpretation and critically revised the manuscript.
AFY (Co-author): Study design, manuscripting and data analysis.
ASM, AOJ & AAR (Co-author): Ethical compliance and data analysis.
AHM, NR & UY (co-author): Data collection.
Acknowledgment
The authors acknowledge all those whose impacts made the success of the research possible.
Electronic Supplementary Material
Below is the link to the electronic supplementary material
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Total words in MS: 5488
Total words in Title: 15
Total words in Abstract: 267
Total Keyword count: 5
Total Images in MS: 5
Total Tables in MS: 1
Total Reference count: 45