A novel community-based water recreation area for schistosomiasis control in rural Ghana

Primary prevention of schistosome infection has received little attention of late. We describe a novel water recreation area (WRA) to reduce Schistosoma haematobium infection rates in Adasawase, Ghana. Urogenital schistosomiasis is a water-based parasitic disease that affects over 100 million people worldwide, primarily children in the rural tropics. The disease is contracted via dermal contact with contaminated water. Widespread distribution of praziquantel is presently used to control morbidity, but chemotherapy does not confer immunity and reinfection can have severe health impacts. In 2008, an estimated 44% of school-aged children in Adasawase had S. haematobium eggs in their urine. Recreational contact with water was the primary transmission route. In collaboration with community members, a novel WRA was constructed. The WRA is groundwater and rainwater fed and serves more than 100 children at any given time. It was constructed from local materials and labor, designed to last more than 30 years, and minimizes exposure to S. haematobium. One year after construction, the annual incidence of S. haematobium infection dropped from 18.6% in 2009 to 4.6% in 2010, respectively (p<0.001). Given the promising evidence, the data will be examined more rigorously to characterize factors that influence water contact and infection risk.