ArticleTropical medicine & international health : TM & IH2026
Community Health Workers' Multiple Understandings of Schistosomiasis Transmission Pathways: Exploring Contextual Factors in Côte d'Ivoire, Kenya and Uganda.
Article in Tropical medicine & international health : TM & IH, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveSchistosomiasis remains a public health concern in sub-Saharan Africa, affecting over 250 million people. In endemic settings, schistosomiasis transmission is not always understood exclusively in biomedical terms. Community health workers (CHWs) contribute to schistosomiasis control through mass drug administration and health education, yet limited evidence exists on how they understand schistosomiasis transmission. This study explores how CHWs in Côte d'Ivoire, Kenya and Uganda explain schistosomiasis transmission and how these explanations relate to wider disease and training contexts.
methodsThis paper draws on the CHW component of a larger mixed-methods study conducted in Côte d'Ivoire, Kenya and Uganda, with multiple respondent groups. We present findings from interviews and focus group discussions with CHWs. Data were analysed thematically, at both semantic (descriptive) and latent (interpretive) level, employing Kleinman's framework of explanatory models and Good's work on semantic networks to support interpretation.
resultsCHWs expressed multiple understandings of schistosomiasis transmission. Most described schistosomiasis transmission in biomedical terms, often emphasising skin contact with contaminated water. Others combined biomedical terms with locally circulating ideas about disease transmission, linking infection to drinking unsafe water, stepping on faeces, flies or other diseases such as trachoma or diarrhoeal illnesses. These understandings emerged in relation to a complex disease landscape in which signs, symptoms and perceived transmission routes overlapped. They were also situated within uneven training experiences, including irregular refresher sessions, variable access to schistosomiasis-specific training and training focused mainly on treatment campaign logistics.
conclusionCHWs' varying understandings of schistosomiasis reflect not only individual knowledge but also the broader disease landscape and training contexts in which they work. Strengthening schistosomiasis communication therefore requires attention to how CHWs interpret, adapt and combine disease-specific information with other sources of knowledge, and to how training can better prepare them to navigate similarities and differences between disease-specific messages in everyday practice.
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