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The breakdown in mass drug administration for bilharzia

CPAID comics series

 

Current strategies have failed to account for the lived realities of people who rely on the water bodies, where the snail vectors involved in the parasite life cycle live.

Dr Georgina Pearson

 

View the comic here or scroll down below.

As part of a series of six comics on public authority in different countries across Africa, Ugandan artist Dianah Bwengye has collaborated with researcher Gloria Kiconco to illustrate why mass drug administration in Uganda has failed to adequately control schistosomiasis (bilharzia) in many areas. The cartoon contextualises issues raised by district health officers and local communities on health control programmes, following a trip to Jinja, on the northern shore of Lake Victoria, and Pakwach in the Uganda’s northwest.

Contextualising schistosomiasis (bilharzia) control efforts

Weak Links tells the story of a journalist who seeks to find out more about mass drug administration in Uganda, after learning about the prevalence of schistosomiasis despite long-term health programmes. Hearing from local leaders, health-workers and fisherfolk, the story explains that providing pharmaceuticals without a deeper discussion on health and primary health care is ineffectual. Current strategies have failed to account for the lived realities of people who rely on the water bodies, where the snail vectors involved in the parasite life cycle live. 

The comic includes public health knowledge that is tailored to Ugandan contexts. Artists Mirembe Musisi and Victor Ndula and two District Vector Control Officers in Uganda worked with members of the LEAD project team to produce a transmission diagram illustrating the life cycle of the schistosome. Included within the cartoon itself (page 7), the diagram and the story are intended as tools to disseminate contextually relevant knowledge about the transmission of schistosomiasis, and to recount the experiences of health workers who are responsible for the delivery of health interventions within communities affected.

View the comic here or scroll down below.

Researchers: Georgina Pearson, Gloria Kiconco, Cristin Fergus, Tim Allen, Melissa Parker, Polly Savage and Kara Blackmore (project management)

Learn more about the research

LEAD project research at the Firoz Lalji Institute for Africa

Mass drug administration, or ‘preventative chemotherapy’, is the large-scale distribution of pharmaceuticals used to treat various so-called ‘neglected tropical diseases’. Schistosomiasis, or bilharzia as it is commonly known, has been one such targeted disease, in populations or sub-populations within defined geographic areas without individual diagnosis. Despite these efforts aimed at controlling the disease, schistosomiasis continues to be prevalent and highly endemic in many areas. Why have mass drug administration campaigns failed?

Researchers based at LSE and the London School of Hygiene and Tropical Medicine have been examining this question in particular localities in Eastern Africa since 2005. A common thread in this research is that the strategy does not take into account local perspectives nor local evidence, leading to the continued implementation of ‘one size fits all’, top-down approaches to public health control, without genuine feedback from individuals living and working in these areas. 

In 2019, the LEAD team at the Firoz Lalji Institute for Africa facilitated a series of participatory workshops in Uganda and Malawi with health practitioners and those involved in schistosomiasis treatment and control at village, district and national levels. The aim was to create links between these practitioners and national level policymakers, with discussions focusing on the socio-political, economic and environmental complexities of programme implementation and the specificities of local circumstances. 

Public health practitioners participating in the LEAD workshops echoed findings from previous anthropological research in this area. The issues range from the inappropriate ways in which existing health information materials depict people from different areas, offer patronising narratives, incomprehensible artwork or biologically incomplete storylines, as well as ignore the social context in the localities where the parasites and people co-exist. Public health practitioners described how failings in communication led to a lack of knowledge and, in-turn, undiagnosed conditions at critical junctures of disease onset. ‘Trickle down’ dissemination of health advice is rarely effective; poor quality, or absent, health communication materials can significantly reduce uptake of the public health control programmes on offer, and even prompt resistance to mass drug distributions. 

Read LEAD project research outputs

Papers

Further reading:

View the LEAD project webpage for all research outputs.


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This comic was created by Cartoon Movement, a publishing platform for high quality editorial cartoons and comics journalism from all over the globe.