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Ministry of Health Schistosomiasis Prevention Communication Campaign Plan

1. Background/Introduction The Ministry of Health Vector Control Division has been implementing the National

Schistosomiasis Control Program since 2003 with the goal of controlling morbidity from

Schistosomiasis through mass treatment in endemic areas of Uganda. Commonly known as

Bilharzia, the disease is endemic to 81 districts of Uganda, and is most prevalent in areas

surrounding lakes and rivers, and urban areas including Kampala. Recent surveys show that

approximately five million people are infected and approximately 18 million are at risk. A list of

the 81 endemic districts is attached (see Appendix A).

Bilharzia basics

There are two forms of Bilharzia in Uganda. S. mansoni, which is most common, attacks the

intestines and is excreted through faeces. S. haemotobium, which is less common, attacks the

kidneys and is excreted through urine. S. haemotobium is only prevalent in four districts of

Uganda; S. mansoni is prevalent in 81 districts.

Source: Adriko, Moses. Schistosomiasis Control in Uganda: Control Strategies/Interventions and Challenges,

presentation during Schistosomiasis Prevention Communication Campaign Partner Planning Meeting, March 13th – 14th 2017.

Bilharzia is a serious disease, causing disability and death. When untreated, it leads to anemia,

extreme fatigue, liver damage, cancer, and may attack other organs. Among preschool and school

aged children, it causes stunted growth, impaired cognition, and poor school performance.

Poor sanitation and contact with contaminated water are the main causes of Bilharzia infection.

Bilharzia is a tropical disease caused by worms that are hosted in fresh water snails. When the

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worms are released into the water by infected snails, they can enter humans through their skin.

Once in the human body, they move through the blood stream to the liver and other body organs

where they reproduce. New worms are then excreted in human faeces or urine. If the faeces or

urine is not disposed of properly, the worms enter lake, river or wetlands water, where they inhabit

snails and look for new human hosts to infect.

Consequently, the best ways to prevent Bilharzia are to avoid contact with contaminated water and

to defecate and urinate in toilets or latrines—not in the open or in water. Avoiding contact with

contaminated water will protect individuals for getting the infection. Avoiding open defecation

and urination will break the transmission cycle and protect entire communities from Bilharzia.

The other way to prevent Bilharzia morbidity is for school children and adults to take the

Praziquantel provided by the Ministry of Health once each year in the 43 highly endemic districts

and every two years in 38 low endemic districts. Praziquantel treats the infection, and prevents

illness from Bilharzia. However, the only way to ensure that people do not become re-infected is

to stop exposure to water contaminated with Bilharzia.

Bilharzia Prevalence

In October, 2016, PMA2020, a survey conducted by the Makerere University School of Public

Health and the Gates Reproductive Health Institute, conducted a sample survey of approximately

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4,500 male and female respondents 2 years of age and older across all regions of the country.

According to preliminary results of this survey, 22% of people in Uganda are infected with

Schistosomiasis; and this proportion does not differ by wealth status. Wealthy and poor people

are equally as likely to be infected with Bilharzia. Prevalence varies by region from a high of

32% in Northern Uganda to a low of 16% in Western Uganda. Children between two and five

years of age had higher prevalence (31%) than the national average (22%). And people who

openly defecate are significantly more likely to have Bilharzia than those who do not.

Awareness and Sources of Information Concerning Bilharzia

Awareness of Bilharzia is low, even in endemic districts. According to PMA2020 survey

preliminary results, only 54% of respondents had ever heard of Bilharzia; the most common

sources of information about Bilharzia were schools, family and friends, and the radio.

Interestingly, only 15.5% had heard about Bilharzia from a health professional and 11.6% from a

VHT member. Only 39% knew that Bilharzia is contracted from contact with contaminated water;

38% said they did not know how it is acquired and 63% did not know how Bilharzia is passed

from person to person.

About this Campaign Plan

In late 2016, Mr. T.J. Mather, a private American philanthropist, provided some funding to the

Johns Hopkins Center for Communication Programs (CCP) to support the Ministry of Health

Vector Control Division to implement a media campaign aimed at preventing Schistosomiasis in

Uganda. Mr. T.J. Mather is also supporting PMA2020 to conduct two rounds of national surveys

in Uganda to determine the prevalence and behavioral determinants of Bilharzia. During the first

few months of 2017, CCP conducted a literature review and, in March, 2017, assisted the Vector

Control Division to conduct a meeting of stakeholders to design the campaign. A list of the

stakeholders who participated in that meeting may be found in Appendix B.

This document describes the Schistosomiasis Prevention Communication Campaign that will be

implemented with funding from TJ Mather, and with the partnership of stakeholders involved in

Schistosomiasis control in Uganda. It is based on the input from stakeholders during the March

2017 campaign planning meeting, and draws from the National NTD Communication Strategy. It

describes the problem to be addressed, the intended audiences for the campaign, communication

objectives for each audience, key messages and the communication channels that will be used.

2. Situation Analysis

a. Problem statement: Schistosomiasis prevalence and related morbidity is high in

Uganda.

b. Root cause analysis

Direct causes • Frequent contact with contaminated water

• Mothers bathing and letting children play in contaminated water

• Open defecation and urination, especially in or near bodies of water

• Use of latrines that are close to bodies of water

• Not taking Praziquantel when provided

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Indirect causes • Low perceived risk of infection

• Inadequate knowledge about Schistosomiasis: how it is caused and

how to prevent and treat it

• Myths surrounding Bilharzia—that it is caused by witchcraft or a curse

Contact with contaminated water:

• Occupations and chores that require contact with contaminated water

(eg. fishing, paddy rice farming, loading canoes, washing laundry)

• Lack of access to sources of clean water

• Preference for lake and river water over borehole water

• Children like to play/swim in the water; and parents do not restrict this

activity

Latrine use:

• Lack of access to improved latrines

• Preference for open defecation

• Do not see the need for latrines

• Do not consider a baby’s faeces to be dirty

• Cannot afford to build and maintain a latrine

• Concerns about who can share latrines (eg. in-laws and pregnant

women)

• Some fishermen defecate in the lake to attract fish

Taking Praziquantel:

• Many people do not see the need for medicine when they are not

feeling sick

• Praziquantel tablets are large, smell bad, and taste bad

• Side effects from Praziquantel

• Lack of food to take with Praziquantel to reduce side effects

• VHTs sometimes do not distribute Praziquantel to everyone in their

communities; men are particularly likely to be left out

• Adults do not seek out Praziquantel even when they know that it is

supposed to be distributed during a certain time period

• Some parents discourage their children from taking Praziquantel

distributed at school

Consequences • Anaemia

• Cancer of bladder or liver

• Irreversible organ damage (eg. liver, spleen)

• Ascites and distended abdomen

• Death

• Stigma and social isolation due to abnormally distended abdomen

• Infertility

• Growth stunting, impaired cognition and poor performance at school

among children

• Poor school attendance and drop outs

• Reduced family income due to inability to work

• Costs to the health care system for diagnosis and treatment

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2. Underlying Theory of Behaviour Change The Schistosomiasis Prevention Communication Campaign strategy is based on the Extended

Parallel Process Model (EPPM) of behavior change communication. According to this model

developed by Dr. Kim Witte, the degree to which a person feels threatened by a health issue

determines his or her motivation to act, while one’s confidence to effectively reduce or prevent

the threat determines what action they will take.

There are four key variables in the EPPM model: two related to beliefs about the threat and two

related to beliefs about efficacy. In the case of Bilharzia, the questions we asked were as follows:

Threat variables:

• Perceived severity–How serious does our audience thing the consequences will be if they

became infected with Bilharzia?

• Perceived susceptibility–How likely does the audience think it is that they might contract

Bilharzia?

Efficacy variables:

• Response efficacy–How effective does this audience think the proposed solutions are,

such as avoiding contact with water in lakes, rivers or wetlands, at preventing Bilharzia

infection?

• Self-efficacy–How confident is the audience that they could successfully avoid contact

with water in a lake, river, or wetland?

EPPM can be used to identify four distinct audience segments with different combinations

of efficacy and threat beliefs. Each segment will respond differently to Bilharzia prevention and,

so, will need to be addressed with different health message strategies that increase threat

perceptions or increase efficacy beliefs.

High Efficacy

Belief in effectiveness of solutions and

confidence to practice them

Low Efficacy Doubts about effectiveness of

solutions and about one's ability to practice them

High Threat Belief that the threat is harmful and that one is

at-risk

Danger Control People take protective action

to avoid or reduce the threat.

Strategy: Provide calls to action

Fear Control People are too afraid to act,

just try to reduce their fear and feel better. Strategy: Educate about

solutions Low Threat

Belief that the threat is trivial and that one is not

at-risk

Lesser Amount of Danger Control

People know what to do but are not really

motivated to do much. Strategy: Educate about risk

No Response People don’t feel at risk and

don’t know what to do about it anyway.

Strategy: Educate about risk and about solutions

Source: HC3 Project, The Extended Parallel Process Model: An HC3 Research Primer, on www.healthcommcapacity.org, accessed 2 April

2017

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It is important, when using the EPPM model to design health communication campaigns, to

balance messages that encourage individuals to accurately assess their level of risk with

messages that empower them to overcome or avoid that risk. If individuals perceive the threat to

be higher than their perceived ability to do something about it, then behavior change is unlikely

to occur.

3. Campaign Plan The Schistosomiasis Prevention Communication Campaign supports the National Neglected

Tropical Diseases (NTD) Communication Strategy. However, whereas the national strategy

integrates communication about all NTDs, the campaign described in this document will focus

on Schistosomiasis prevention.

The Schistosomiasis Prevention Communication Campaign will focus on two primary audiences

identified in the national strategy:

1) Adults who are at high risk of Schistosomiasis. These include parents of children who

are also at risk. These adults live in endemic districts of Uganda, and have frequent

contact with lakes or rivers.

2) School aged children ( 5 – 12 year old) living in endemic districts of Uganda near lakes

or rivers.

Secondary audiences for this campaign are: teachers, health workers including VHTs, political,

religious, and traditional leaders living in endemic districts of Uganda in communities near lakes

or rivers.

The specific communication strategy for each of these key audience segments is outlined below.

a. Audience 1: Adults who are at high risk of Schistosomiasis.

This audience includes men and women 18 – 60 years of age who live in endemic districts of

Uganda in communities near wetlands, rivers or lakes. Many are parents of school age children

and preschool age children.

Audience description • Live in peri-urban and rural areas in the 81 endemic districts.

• Have frequent contact with water (fisher folk, rice paddy

growers, water transporters, shell collectors, people who

engage in recreational activities in lakes/rivers, people who

use the lakes/rivers for domestic chores)

• Most are married and cohabiting; many have pre-school and

school going children.

• Most have some primary or higher education

• Low and middle income

• Some move from place to in search of work.

Desired behaviors • Limit exposure to lake or river water by themselves and their

children

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• Use latrines properly and ensure that their children use them;

do not practice open defecate or defecate in rivers, lakes, or

wetlands

• Construct latrines if they do not have them

• Take Praziquantel (PZQ) and encourage their children to take

it during MDA.

Current behavior • They swim, fish, bathe, wade, wash in wetlands, rivers or

lakes

• They do not use protective wear when they are in contact with

wetlands, lakes and rivers.

• Some continue to practice open defecation; some defecate in

wetlands, lakes or rivers

• Some do not have latrines while others who have latrines

work away from home and do not always have access

• Some do not seek for PZQ and/or refuse to take it when

offered during MDA.

• Some do not allow their children to take PZQ when offered at

school

Key constraints to the

adoption of desired

behaviors

• Lack of awareness about Schistosomiasis—how one gets

it, how it is spread from person to person, and how it can

be prevented

• Low perception of risk of Schistosomiasis

• Those who come into contact with river, lake or wetland

water in order to make a living or do household chores do

not believe they can reduce their contact with the water

• Many do not appreciate the dangers of open defecation

• Latrines are often not appealing (dirty and foul smelling)

• Cultural beliefs about latrine use such as the belief that in-

laws should not share the same latrine and pregnant women

should not use latrines

• Some think that latrines are expensive and complicated to

build

• Particularly women do not feel technically competent to build

latrines and need technical assistance

• Some lack access to latrines or have to pay to use them

• Some are discouraged from using latrines because they are

dilapidated or poorly constructed

• When people are far from home, it is inconvenient or

impossible to access latrines when in need

• Some fishermen put human faeces into the water to attract

fish

• Many are not aware that water may be contaminated with

Bilharzia

• Many believe that moving water is clean

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• Some families lack appropriate facilities to store water for

domestic use

• Many lack alternative sources of safe water

• Majority do not have protective wear (eg. boots)

• The PZQ is not attractive to use (large, foul smelling, bad

taste)

• Fear of PZQ side effects (diarrhea, vomiting, skin rash,

body fatigue and abdominal pains)

• Some parents/guardians do not allow their children to take

PZQ because they think the side effects are worse than the

disease

• Some do not think they need PZQ because they do not feel

sick and so refuse to take it

Perceived Threat vs. Efficacy to Act: This audience does not feel at risk of Bilharzia and

knows little about the consequences of Bilharzia; they also do not appreciate the need to change

because they do not know how to prevent Bilharzia. Thus, the campaign needs to educate them

about both the dangers of Bilharzia and how to prevent it.

Communication objective: As a result of our communication campaign, high risk adults will:

• Know the dangers of bilharzia and how it can be prevented

• Believe that they and their children are at risk and can take action to prevent bilharzia, and

• Adopt desired behaviors and inculcate them in their children.

Key benefit statement: If you learn all you can about Bilharzia and commit to protecting

yourself and your children from Bilharzia, you and your children will feel well, and will be

more productive.

Support points: This is how we will convince our audience that they will feel well and be

more productive if they learn about Bilharzia and take action to protect themselves and their

children from it.

• Explain the Bilharzia life cycle, showing how it is transmitted and prevented.

• If you get in contact with contaminated water, the worms can get into your body.

• When you have the worms in your body, there may be no signs & symptoms for some time.

• If left untreated, Bilharzia causes persistent abdominal pain, diarrhea and fatigue, and may

lead to serious disease.

• When a person feels that way, she/he is not able to be productive or do well in school and

may not feel good about themselves.

• If you have it for a long time, it will cause liver damage, you may vomit blood and your

stomach may swell. This situation is irreversible—it cannot be cured.

• There are things you can do to reduce the risk of Bilharzia for you and your family:

o Avoid contact with lake, river or wetland waters as much as possible. If you must

come in contact with the water, do it before 8:00 am when the worms are less likely

to be swimming around.

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o Take PZQ during MDA and encourage your children to take the PZQ they are given

at school. Swallowing PZQ kills any worms in your body.

o Always use a latrine and make sure everyone in your family uses a latrine. Do not

defecate or urinate outside a latrine, and especially do not defecate in rivers, lakes or

wetlands. This is how the worms get into the water.

• Give examples and testimonies from people who used to suffer from Bilharzia and have

adopted preventive practices. Now, they feel well and are more productive.

Key message content: In addition to the support points, this is essential content to be

communicated through various media.

• Bilharzia, how it is spread and its dangers;

• Bilharzia is not caused by witchcraft; it can be prevented and treated;

• How to reduce the risk to bilharzia for yourself and your children;

a. If you/your child have to be in the water for any reason, do it before 8.00 am when there

are not so many worms in the water

b. Bathe yourself/your children with water from a protected water source if you have one.

Avoid bathing yourself/your children in the rivers or lakes.

c. If you must bathe in lake or river water, collect water for bathing and keep it for 24 hours

before you/your children use it. Do not bathe in lakes or rivers

d. If you/your children have to wade in the water, wear boots

e. If you/your children have to do anything in the lake or rivers, limit the amount of time

they spend in the water

f. During MDA, take your PZQ as instructed and ensure that your children take it as well

• PZQ is not a vaccine against Bilharzia but a treatment for Bilharzia. You have to continue

protecting yourself and your children to avoid getting Bilharzia again.

• PZQ can have side effects. Take food before PZQ to reduce the extent of the side effects.

• If you or your child have frequent bloody diarrhea and feel abdominal pain, it could be

Bilharzia. Visit the nearest health facility.

• If everybody uses a latrine, the bilharzia transmission cycle will be terminated. Always use

a latrine. Do not defecate or urinate outside a latrine. And, never defecate in rivers, lakes

or wetlands.

Communication channels/approaches: These are the media and approaches that will be used

to communicate these messages to this audience. Due to budgetary constraints, the campaign

will predominately use mass media. As radio is far more pervasive than television in Uganda,

radio will be the locomotive of the campaign.

1.) Radio spots: The main communication channel will be 45 – 60 minutes radio spots,

broadcast repeatedly in the languages most commonly understood in highly endemic districts

of Uganda.

2.) Radio talk shows: The campaign will schedule programs on existing radio call-in talk

shows already broadcasting in endemic districts. This will involve organizing Bilharzia

experts and briefing them and the radio presenters who host the programs on how to speak

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simply and clearly about Bilharzia, providing them with an outline for the program together

with answers to frequently asked questions about Bilharzia.

3.) Translate an existing video documentary about Bilharzia into local languages most

commonly understood in endemic areas of the country. The documentary will be

disseminated through RTI Envision during its Bilharzia sensitization sessions during MDA,

and to WASH partners working in endemic districts. Also, if budget allows, we will

broadcast it on a few TV stations.

4.) Optional channels if budget allows:

o Video animation: This could be produced as a short stand-alone video showing the

Bilharzia life cycle and how it can be interrupted through preventive actions. It

could also be inserted into the existing Bilharzia documentary. The video can be

used during community dialogues about Bilharzia, played at health facilities that

have DVD players, and broadcast on TV. We can load it on YouTube so it is

available for anyone to view.

o Job aid for health workers: There is already a chart that the Health Education and

Promotion Division of the Ministry of Health has prepared. This could be

reproduced and distributed to health workers and VHTs working in endemic

districts. However, to be most effective, the health workers and VHTs will need to

be oriented to this job aid and its use. We will need to explore which organizations

could support the orientation and dissemination of the job aid.

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b. Audience 2: School age children

This audience is between 5 and 12 years of age, both boys and girls, who live in endemic

districts of Uganda in communities near to lakes, rivers or wetlands.

Audience description • Live in rural and peri urban areas of the 81 endemic districts,

in communities near to rivers, lakes or wetlands

• Most attend government or private schools

• Most attend day schools but some also attend boarding

schools

• Day scholars walk to school

• When away from school they often engage in snail collection,

chasing birds in the rice fields, swimming in the waters,

collecting water and firewood, or helping with the washing in

a lake or river or pond

• Many bathe directly in the waters (lake)

• Some collect clay for family pot making

Desired behaviors • Avoid contact with lake, river, or wetland water

• Take praziquantel (PZQ) as instructed

• Always use latrines for defecation and urination; stop open

defecation

Current behaviors • They swim, fish, bathe, wash, play in the rivers and lakes

• They fetch water without protective wear

• Some of them shun PZQ during MDA, running away from

school to avoid taking it.

• Most use the latrine when in school

• Sometimes they do not use a latrine even when they have

one at home or school.

• There are some children without latrines at home.

• When they are far from home or school and are in need, most

practice open defecation.

Key constraints to

adopting the desired

behaviours

• Lack of awareness about Schistosomiasis—how one gets

it, how it is spread from person to person, and how it can

be prevented

• Low perception of risk of Schistosomiasis

• Belief that abdominal ascites is caused by witchcraft and

is something to be avoided

• Lack awareness that water may be contaminated with

Bilharzia

• Belief that lake water or fast moving water is clean

• Some households lack appropriate facilities to store water for

bathing and washing

• Many families lack access to alternative sources of safe

water

• Most families do not provide boots to children who have to

stand in water or walk through water

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• Children like to play and swim in water, particularly when

the weather is hot

• The PZQ is not attractive to use (large, foul smelling tables

that taste bad)

• Many children fear PZQ side effects (diarrhea, vomiting,

skin rash, body fatigue and abdominal pains)

• They don’t have any food to take before they take PZQ to

reduce the chance of side effects

• Some parents/guardians do not allow their children to take

PZQ

• Some children do not think they need PZQ because they

do not feel sick and so refuse to take it.

• Some children are not awareness of the dangers of open

defecation

• Sometimes latrines are not appealing (dirty and foul

smelling)

• Some latrines are unsafe, dilapidated and poorly maintained.

Some have collapsing walls and holes too large for children.

• Some parents do not train or insist that their children use

latrines

• Cultural beliefs about latrine use such as the belief that in-

laws should not share the same latrine and pregnant women

should not use latrines

• Some families have no latrines.

Perceived Threat vs. Efficacy to Act: As with adults in high risk communities, school age

children also do not feel threatened by Bilharzia and do not know how to prevent it. So, the

campaign needs to educate them about the dangers of Bilharzia as well as how it can be

prevented.

Communication objective: As a result of our communication campaign, school age children

will:

• Know the dangers of Bilharzia and how it can be prevented,

• Believe that they and their families are at risk of Bilharzia and can take action to prevent

Bilharzia;

• Adopt preventive practices and encourage their families to adopt preventive practices.

Key benefit statement: If you take actions to prevent Bilharzia, you will not get a ball-like

abdomen (ascites).

Support points: This is how we will convince this audience that they can avoid a ball-like

abdomen if they take action to prevent Bilharzia.

• Explain the Bilharzia life cycle, showing how it is transmitted and prevented.

• If you get in contact with contaminated water, the worms can get into your body.

• When you have the worms in your body, there may be no signs & symptoms for some time.

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• If left untreated, Bilharzia causes persistent abdominal pain, diarrhea and fatigue, and may

lead to serious disease.

• If you have it for a long time, your abdomen may swell. This situation is irreversible—it

cannot be cured.

• Luckily, there are things you can do to reduce the risk of Bilharzia:

o Avoid contact with lake, river or wetland waters as much as possible. If you must

come in contact with the water, do it before 8:00 am when the worms are less likely

to be swimming around.

o Take PZQ during MDA. Swallowing PZQ kills any worms in your body.

o Always use a latrine and make sure everyone in your family uses a latrine. Do not

defecate or urinate outside a latrine, and especially do not defecate in rivers, lakes or

wetlands. This is how the worms get into the water.

o

Key message content: In addition to the support points, this is essential content should be

communicated through various media.

• Bilharzia, how it is spread and its dangers;

• Bilharzia is NOT caused by witchcraft; it can be prevented and treated;

• How to reduce your risk of bilharzia:

a) If you have to stand, wade, walk or swim in the water, do it before 8.00 am, when there

are not so many worms in the water.

b) Bathe with water from a protected water source if possible.

c) If you must use water from a river or lake for bathing, collect water and keep it for 24

hours before you use it.

d) If you have to walk in lake, river or wetland water, wear boots.

e) If you have to do anything in a lake, wetland or river, limit the amount of time you

spend in the water.

f) Take your PZQ as instructed

• PZQ is not a vaccine against bilharzia but a treatment for bilharzia. You have to continue

protecting yourself to avoid infection.

• PZQ can have side effects. Bring some food to school with you on the day when they plan to

give you PZQ. Taking food before PZQ can reduce side effects.

• If you have frequent bloody diarrhea and feel abdominal pain, you could have bilharzia. You

need to tell your parent/guardian/teacher.

• If everybody uses a latrine, the Bilharzia transmission cycle will be terminated. Always use a

latrine. Do not defecate or urinate outside a latrine. And, never defecate in rivers, lakes or

wetlands.

Communication channels/approaches: These are the media and approaches that will be used

to communicate these messages to this audience. Due to budgetary constraints, the campaign

will rely heavily on WASH and NTD partners to support in-school activities.

1.) School-based activities: A teachers’ orientation guide and job aid will be developed. The

guide will include activities that teachers can conduct both in the classroom and through

school clubs and assemblies to educate children about Bilharzia and encourage them to take

preventive action. These may include classroom discussions, dramas, assemblies, debates,

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art contests, talking compounds, etc. The same job aid and animated video that will be

reproduced for use by VHTs and health workers will be made available to teachers for use

during Bilharzia education activities.

2.) Reproduce an existing comic book on Bilharzia and distribute to children through primary

schools in endemic districts.

3.) WASH and NTD partners will assist the MOH and District officials to conduct orientations

for school teachers to use the guide, job aid, video and comic book.

c) Secondary Audience: Leaders (political, religious, cultural), health workers

including VHTs, headmasters and teachers

This audience includes both men and women who live and/or work in endemic districts in

communities near rivers, lakes or wetlands. As an audience, they are very similar to the high

risk adult primary audience, and have only limited knowledge about Bilharzia and how it is

prevented and treated. They also feel that they personally are low risk of infection, and do not

think there is much that can be done to protect people from Bilharzia. Many of our secondary

audience also may not support the use of PZQ because of its side effects and because they do not

understand why it is important to treat asymptomatic people.

Desired behavior: To encourage people in their communities to take action to prevent

Bilharzia; to support latrine construction, maintenance and use; to encourage everyone to take

PZQ during MDA; and to take every opportunity to educate people in their communities about

Bilharzia and how it can be prevented.

Key Constraints:

• Lack of awareness about Bilharzia—how one gets it, how it is spread from person to

person, and how it can be prevented

• Do not see Bilharzia as a serious concern; low perception of risk of Bilharzia

• Lack awareness that water may be contaminated with Bilharzia

• Belief that lake water or fast moving water is clean

• Fear of PZQ side effects (diarrhea, vomiting, skin rash, body fatigue and abdominal

pains)

• Many do not understand why people who have no symptoms should take PZQ

• Do not understand the relationship between latrine use and Bilharzia

• Cultural beliefs concerning latrine use (in-laws should not share latrines, pregnant women

should not use latrines, etc.)

• Some leaders have not prioritized latrine construction, maintenance and use.

Threat vs. Efficacy: This audience does not see Bilharzia as a serious threat to the communities

they serve; they also do not appreciate the effectiveness of PQZ treatment and do not believe it is

possible for community members to avoid contact with water or to use latrines consistently.

Thus, the campaign needs to educate this audience about the dangers of Bilharzia, and convince

them that communities can prevent Bilharzia through consistent latrine use, limiting contact with

surface water, and taking PZQ to treat infection.

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Communication Objective: As a result of this campaign, leaders, health workers including

VHTs, headmasters and teachers will:

• Know what Bilharzia is, its consequences, and how it can be prevented;

• Believe that Bilharzia can be prevented in their community;

• Encourage school children and adults in communities at high risk of Bilharzia to take

action to prevent Bilharzia.

Key Promise/Benefit Statement: If you help enlighten your community about Bilharzia and its

prevention and encourage school children and adults to take action to prevent it, members of

your community will be less likely to get Bilharzia, will be more productive, and will respect

your leadership.

Support Points:

• Basic information about Bilharzia; what it is, how it is transmitted, and how it can be preven

ted.

• Statistics showing the number of people who are infected with Bilharzia in their districts.

• The consequences of Bilharzia—health, social and economic.

• Example of a leader or health worker who was able to change the situation in a community or

district, demonstrating the improvement in people’s lives and their positive attitude toward

the leader or health worker.

Message Content:

• Bilharzia is NOT caused by witchcraft; it can be prevented and treated;

• How to reduce the risk of bilharzia in your community:

g) Encourage people who have to stand, wade, walk or swim in the water, to do it before

8.00 am, when there are not so many worms in the water.

h) Encourage people to bathe with water from a protected water source if possible.

i) If the community does not have access to protected water, advocate for the funding and

assistance required to provide safe water (eg. borehole).

j) If peoely must use water from a river or lake for bathing, they should collect water and

keep it for 24 hours before using it.

k) If they have to walk in lake, river or wetland water, they should wear boots.

l) If they have to do anything in a lake, wetland or river without protection, they should

limit the amount of time they spend in the water.

m) Encourage men, women and children to take their PZQ as instructed

• PZQ is not a vaccine against bilharzia but a treatment for bilharzia. You have to continue

protecting yourself to avoid infection.

• PZQ can have side effects. Taking food before PZQ can reduce side effects.

• Frequent bloody diarrhea and abdominal pain are symptoms of Bilharzia. People who

experience these symptoms should visit a health facility and get checked.

• If everybody uses a latrine, the Bilharzia transmission cycle will be terminated. Set an

example. Ensure you and everyone in your family uses a latrine at all times.

• Encourage everyone in your community to always use a latrine. They should not defecate or

urinate outside a latrine. And, never defecate in rivers, lakes or wetlands.

• As a leader in your community, encourage families that have no latrines or whose latrines are

dilapidated to build latrines. Reach out to organizations that support latrine construction for

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advice concerning design and materials. Seek support for families who need to build latrines.

It is for the protection of the entire community.

• Include a list of organizations that can provide advice and support for latrine use.

Communication Channels and Approaches:

• Fact sheet for community leaders and health workers/VHTs.

• Orientation sessions about Bilharzia and how to talk with communities about Bilharzia

prevention, conducted by WASH and NTD partners.

4. Monitoring and Evaluation

The campaign will be evaluated for the proportion of intended audience reached with its

messages, and associated changes in knowledge and attitudes (perceived risk and efficacy)

toward Schistosomiasis, as well as intentions to take preventive actions and actual adoption of

preventive actions. This will be measured through the second round PMA2020 Schistosomiasis

survey in November 2017/

Campaign media messages will be monitored by a media monitoring agency to ensure that radio

and television broadcasts take place as scheduled.

5. Implementation Arrangements The Johns Hopkins Center for Communication Programs (CCP) will assist the Ministry of

Health to design, produce and disseminate campaign messages and materials. This includes

pretesting with intended audiences prior to production and media monitoring. All materials will

be reviewed by the Vector Control Division and a stakeholders group; final materials will be

approved by the Vector Control Division and Health Promotion and Education Division before

dissemination.

Orientation of VHTs, health workers, teachers and leaders as well as community dialogue will be

implemented by the Vector Control Division and its NCD and WASH partners. CCP will assist

with the development of guides, job aids, and orientation materials.

CCP will endeavor to develop and support as much of this plan as is possible within the funding

it has received from Mr. T.J. Mather.

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Appendix A: 81 Endemic Districts of Uganda

ATTACHMENT B: Schisto endemic Districts

1 Kamwenge 2 Ntoroko 3 Rubirizi 4 Apac 5 Kiryandongo 6 Koboko 7 Yumbe 8 Agago 9 Maracha

10 Mayuge 11 Bugiri 12 Buyende 13 Dokolo 14 Lira 15 Iganga 16 Kamuli 17 Luuka 18 Budaka 19 Butaleja 20 Kaliro 21 Katakwi 22 Kumi 23 Namutumba 24 Ngora 25 Pallisa 26 Soroti 27 Tororo 28 Jinja 29 Kaberamaido 30 Buliisa 31 Kasese 32 Hoima 33 Amuru

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34 Arua 35 Omoro 36 Gulu 37 Kitgum 38 Lamwo 39 Nebbi 40 Nwoya 41 Pader 42 Adjumani 43 Alebtong 44 Amolatar 45 Moyo 46 Oyam 47 Namayingo 48 Serere 49 Buikwe 50 Buvuma 51 Gomba 52 Kalangala 53 Kalungu 54 Kayunga 55 Masaka 56 Mityana 57 Mpigi 58 Mubende 59 Mukono 60 Nakasongola 61 Rakai 62 Wakiso 63 Bulambuli 64 Busia 65 Kamuli 66 Kween 67 Manafwa 68 Mbale 69 Sironko 70 Dokolo 71 Maracha 72 Ibanda

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73 Isingiro 74 Kabarole 75 Kibaale 76 Kiruhura 77 Rukungiri 78 Bukedea 79 Kibuku 80 Nakapiripirit 81 Zombo

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Appendix B: Participants of Stakeholders Meeting to Design Campaign Plan

NAMES

ORGANIZATION POSITION

1. Dr Edridah Muheki Neglected Tropical Diseases - MOH

NTD Program Manager

2. Dr Fred Makumbi Makerere University School of Public Health

Associate Professor & Senior Statistician & PI PMA2020 Uganda

3. Dr. John C. Ssempebwa Makerere University School of Public Health

Chair

4. Mr. Moses Adriko Vector Control Division - MOH

Programme Officer, Uganda National Bilharzia and Worm Control programme

5. Dr Simon Muhumuza MUSPH – Dept of Disease Control & Environmental Health

Consultant

6. Cheryl Lettenmaier The Johns Hopkins Center for Communication Programs

Regional Representative

7. Lillian Nakato The Johns Hopkins Center for Communication Programs

Project Manager (Trust Trachoma)

8. Judy Kangahho The Johns Hopkins Center for Communication Programs

Program Support Coordinator

9. Tabuzibwa Michael MOH Health Promotion and Education Division

Senior Health Educator NTD

10. Ms. Betty Nabeeta Mukono District Vector Control Officer

11. Haji Kalungi Mukono District District Health Educator

12. Hannington Buliisa District District Health Educator

13.Taganhye Fred Mayuge District District Health Educator