Awareness and knowledge of schistosomiasis infection and prevention in the "Three Gorges Dam" reservoir area: A cross-sectional study on local residents and health personnel

Background: Schistosomiasis is a severe public health problem in China. It has been predicted that the ecological changes caused by the "Three Gorges Dam" , the world's largest hydropower project, could potentially aggravate the spread of schistosomiasis in the area. This study focused on investigating (a) local residents' knowledge on the potential risks of schistosomiasis and (b) the capability of local health personnel in preventing schistosomiasis. Materials and methods: A quantitative survey combined with qualitative interviews was conducted in three counties of the reservoir area during November and December 2008. A total of 1386 inhabitants and 180 local health personals participated in questionnaire survey; 18 inhabitants, 21 health professionals, and 8 local government officials were interviewed. Results: Of the surveyed inhabitants, 66.3% had no access to safe drinking water; 47.9% had water-contact regularly through farming or swimming; 58.7% did not have hygienic toilets; and only 13.7% used methane for energy. Besides, only 3.8% of the inhabitants had knowledge scores higher than 6 points within the range 0-10. Educational level, occupation and income were significant predictors of knowledge score (P<. 0.05). Only about 5% of the inhabitants had some knowledge on schistosomiasis. Among health professionals surveyed, 6.7% had college or higher education; 26.7% had prior schistosomiasis control experience; 75.6% did not receive any relevant training in the past year; and only 52.2% had basic knowledge of schistosomiasis. The logistic regression analysis identified occupation and time at work as significant factors to their knowledge level (P<. 0.05). Moreover, the surveillance work was often severely hindered by a shortage of funding, and challenged by monitoring of migrant population. There were very limited training opportunities for the health workers, and almost no health education for inhabitants, if any, neither efficient nor effective. Conclusion: Although there were multiple risks for potential Schistosoma japonicum infections in the study area, the knowledge level on schistosomiasis and surveillance was relatively low both in local residents and health personnel. Thus, more health education and professional training are urgently required to local residents and health personnel, respectively. By considering limited activities in surveillance and health education been implemented, a strategy plan on intervention to ensure a stronger inter-sectoral cooperation is recommended in order to reduce schistosomiasis transmission risks in this area.