T risk for numerous neglected tropical diseases such chagas disease, filariasis, and schistosomiasis [46?8]. Results of our informative in-depth, CBR-5884 site qualitative investigation of schistosomiasis among school-aged children suggested that despite previous initiatives related to urogenital schistosomiasis control and prevention in Zanzibar [29,44,49], people’s knowledge about disease symptoms, transmission, and prevention were poor. Our findings identified several barriers to optimal disease prevention and control. First, we observed that school-aged children regularly exposed themselves to contaminated natural, open freshwater bodies through recreational and domestic activities of daily living with little knowledge about routes of schistosomiasis transmission, which is in line with findings from previous studies in Zanzibar, Cyclosporine site Tanzania, Zimbabwe, and Western Kenya [50?2]. Second, S. haematobium infection was often viewed as an infection with an intestinal worm of little significance, not typically associated with severe health consequences, and little to no disease stigma. This is in contrast to reports from previous research in Nigeria, where individuals with schistosomiasis disease were stigmatized by others [53]. The Health Belief Model posits that perceived seriousness along with perceived susceptibility, perceived benefits, and perceived barriers are critical constructs used to explain and influence changes in health behaviors [54,55]. It also specifies that if individuals perceive a negative health outcome to be severe and perceive themselves to be susceptible to those negative outcomes, they are more likely to adopt positive protective behaviors [17,54,55]. Drawing upon the constructs of this behavioral theory supports shifting the context of schistosomiasis to that of a blood fluke, with serious health consequences such as bladder cancer and infertility, rather than the current perception of a less severe “worm.” Elaborating on the perceived seriousness of the infection, whether through medical information or increased awareness of the serious effects of the disease on a person’s life, is critical to address in a behavioral intervention [17,54,56]. There is evidence that theorybased, behavioral interventions can increase effectiveness among a variety of public health issues [57?0]. Synthesis of behavioral intervention research and non-regulatory interventions most often advocates the application of behavioral theory as an integral step in intervention design and evaluation [55,61]. Third, many people described abdominal pain, blood in the urine (hematuria), pain or burning during urination (dysuria), and commonly genital itching as symptoms of infection. However, as observed in studies conducted elsewhere in sub-Saharan Africa [62], these symptoms were also perceived as sexually transmitted infections that indeed may appear similar to symptoms of urogenital schistosomiasis. A person with a sexually transmitted infection may bePLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.July 11,12 /Community Perceptions about Schistosomiasis in Zanzibarreluctant to seek treatment due to shame and stigma [53,62]. Therefore, correcting the misperception that schistosomiasis is a sexually transmitted disease, while at the same time supporting the need to seek treatment for any and all similar symptoms, could be an important component of a schistosomiasis educational campaign to improve treatment seeking. Fourth, first line treatment for a fe.T risk for numerous neglected tropical diseases such chagas disease, filariasis, and schistosomiasis [46?8]. Results of our informative in-depth, qualitative investigation of schistosomiasis among school-aged children suggested that despite previous initiatives related to urogenital schistosomiasis control and prevention in Zanzibar [29,44,49], people’s knowledge about disease symptoms, transmission, and prevention were poor. Our findings identified several barriers to optimal disease prevention and control. First, we observed that school-aged children regularly exposed themselves to contaminated natural, open freshwater bodies through recreational and domestic activities of daily living with little knowledge about routes of schistosomiasis transmission, which is in line with findings from previous studies in Zanzibar, Tanzania, Zimbabwe, and Western Kenya [50?2]. Second, S. haematobium infection was often viewed as an infection with an intestinal worm of little significance, not typically associated with severe health consequences, and little to no disease stigma. This is in contrast to reports from previous research in Nigeria, where individuals with schistosomiasis disease were stigmatized by others [53]. The Health Belief Model posits that perceived seriousness along with perceived susceptibility, perceived benefits, and perceived barriers are critical constructs used to explain and influence changes in health behaviors [54,55]. It also specifies that if individuals perceive a negative health outcome to be severe and perceive themselves to be susceptible to those negative outcomes, they are more likely to adopt positive protective behaviors [17,54,55]. Drawing upon the constructs of this behavioral theory supports shifting the context of schistosomiasis to that of a blood fluke, with serious health consequences such as bladder cancer and infertility, rather than the current perception of a less severe “worm.” Elaborating on the perceived seriousness of the infection, whether through medical information or increased awareness of the serious effects of the disease on a person’s life, is critical to address in a behavioral intervention [17,54,56]. There is evidence that theorybased, behavioral interventions can increase effectiveness among a variety of public health issues [57?0]. Synthesis of behavioral intervention research and non-regulatory interventions most often advocates the application of behavioral theory as an integral step in intervention design and evaluation [55,61]. Third, many people described abdominal pain, blood in the urine (hematuria), pain or burning during urination (dysuria), and commonly genital itching as symptoms of infection. However, as observed in studies conducted elsewhere in sub-Saharan Africa [62], these symptoms were also perceived as sexually transmitted infections that indeed may appear similar to symptoms of urogenital schistosomiasis. A person with a sexually transmitted infection may bePLOS Neglected Tropical Diseases | DOI:10.1371/journal.pntd.July 11,12 /Community Perceptions about Schistosomiasis in Zanzibarreluctant to seek treatment due to shame and stigma [53,62]. Therefore, correcting the misperception that schistosomiasis is a sexually transmitted disease, while at the same time supporting the need to seek treatment for any and all similar symptoms, could be an important component of a schistosomiasis educational campaign to improve treatment seeking. Fourth, first line treatment for a fe.
