The social context of schistosomiasis and its control. An introduction and annotated bibliography

Overview

 Schistosomiasis is widely recognized as a disease that is socially determined. An understanding of the social and behavioural factors linked to disease transmission and control should play a vital role in designing policies and strategies for schistosomiasis prevention and control. To this must be added the awareness that schistosomiasis is also a disease of poverty. It still survives in poverty-stricken, remote areas where there is little or no safe water or sanitation, and health care is scarce or non-existent. For a variety of complex reasons, many of which are addressed in this book, the disease is particularly prevalent in sub-Saharan Africa, and persists in certain areas of rural China. This concern for human behaviour in an environment of poverty echoes the concerns of the new research priority for “diseases of poverty” identified by the Special Programme for Research & Training in Tropical Diseases.

Schistosomiasis is recognized by the World Health Organization as a neglected tropical disease. However, it does not survive in tropical areas because of their unique climatic characteristics but because of poverty and neglect on the part of local, national and global actors.

Among its other merits, this book brings to our attention one of the most pressing dilemmas in the field of public health. In the case of schistosomiasis, most so-called integrated approaches have neglected preventive strategies in favour of treatment. If we opt for a truly integrated approach, we need to update strategies that have often focused on spreading messages forbidding certain behaviours. Such strategies are often not based on an understanding of local rationales for such behaviours. Rather, they originate in top-down policies designed by health policy-makers and managers who rarely visit affected populations or make an effort to understand the local social context of disease transmission and control. This approach (in Africa at least) had its origins in colonial policies based on the assumption that “experts” knew best and needed to tell “ignorant” locals how to protect themselves against disease. This book reminds us of the need for grounded social science research to improve both preventive and curative approaches to schistosomiasis control.

The great virtue of this book is that it presents a micro as well as a macro view of schistosomiasis. It presents evidence for the complexity of the behaviour of people in endemic areas exposed to schistosomiasis, and of health personnel who provide schistosomiasis control services. This evidence, in turn, suggests ways in which preventive programmes can be updated and made relevant to real-life situations in remote rural areas by using the insights of social scientists – medical anthropolo-gists, health geographers, sociologists and others – whose skills enable them to explore the social context of schistosomiasis transmission and control at the micro level, in the setting in which the infection is transmitted and where efforts are made to control it. From this perspective there is no “quick fix”, which highlights the importance of a schistosomiasis control policy that allows scope for local-level decision-making rather than depending on a “one-size-fits-all” strategy.