Abstract
BACKGROUND: Central to the uptake of praziquantel for control and elimination of schistosomiasis as a public health problem is an understanding of the socio-cultural factors influencing adherence to Mass Drug Administration (MDA) among schoolchildren. METHODS: An ethnographic study was conducted to examine socio-cultural factors influencing adherence to MDA among schoolchildren living in the high transmission schistosomiasis area along Lake Albert, Hoima District, Uganda. Nineteen in-depth interviews (IDIs) with schoolchildren, 19 IDIs with parents, 18 Key Informant Interviews, 12 Focus Group Discussions with schoolchildren and unstructured participant observations were conducted. Data was analysed using reflexive thematic analysis. Code reports were inductively generated. RESULTS: Family influence, availability of pre-treatment snacks, increased knowledge of the effectiveness of praziquantel and the reasons why some experience side effects facilitated praziquantel uptake. This was despite the raised fear of side effects associated with praziquantel, the bitter taste, size, and smell of praziquantel. Children reported that the presence and proximity of sanitation facilities for management of side effects was important. They also suggested lesson free time during MDA would help them manage side-effects. CONCLUSIONS: Programmatic factors that could facilitate MDA uptake include continuous health education through integration of schistosomiasis into the school curriculum in transmission hotspots and investment in provision of a pre-treatment snack to reduce side effects. Sanitation as a facilitator of MDA uptake strengthens the argument for continued and expanded integration with the WASH sector for schistosomiasis control.