02799nas a2200301   4500000000100000008004100001653002000042653002300062653002700085653002000112100001200132700001100144700001000155700001100165700001000176700001400186700001500200700001200215700001500227700001400242700001300256700001700269700001300286245016000299856016200459520186200621022001402483       2019                            d10aschistosomiasis10aLocal perspectives10aWater contact behavior10aDisease control1 aLund AJ1 aSam MM1 aSy AB1 aSow OW1 aAli S1 aSokolow S1 aMerrell SB1 aBruce J1 aJouanard N1 aSenghor S1 aRiveau G1 aLopez-Carr D1 aDe Leo G00aUnavoidable Risks: Local Perspectives on Water Contact Behavior and Implications for Schistosomiasis Control in an Agricultural Region of Northern Senegal.  uhttp://www.ajtmh.org/docserver/fulltext/10.4269/ajtmh.19-0099/tpmd190099.pdf?expires=1567416545&id=id&accname=guest&checksum=68F1D67610185BBAB866B2B27E12CD823 a<p>Human schistosomiasis is a snail-borne parasitic disease affecting more than 200 million people worldwide. Direct contact with snail-infested freshwater is the primary route of exposure. Water management infrastructure, including dams and irrigation schemes, expands snail habitat, increasing the risk across the landscape. The Diama Dam, built on the lower basin of the Senegal River to prevent saltwater intrusion and promote year-round agriculture in the drought-prone Sahel, is a paradigmatic case. Since dam completion in 1986, the rural population-whose livelihoods rely mostly on agriculture-has suffered high rates of schistosome infection. The region remains one of the most hyperendemic regions in the world. Because of the convergence between livelihoods and environmental conditions favorable to transmission, schistosomiasis is considered an illustrative case of a disease-driven poverty trap (DDPT). The literature to date on the topic, however, remains largely theoretical. With qualitative data generated from 12 focus groups in four villages, we conducted team-based theme analysis to investigate how perception of schistosomiasis risk and reported preventive behaviors may suggest the presence of a DDPT. Our analysis reveals three key findings: 1) rural villagers understand schistosomiasis risk (i.e., where and when infections occur), 2) accordingly, they adopt some preventive behaviors, but ultimately, 3) exposure persists, because of circumstances characteristic of rural livelihoods. These findings highlight the capacity of local populations to participate actively in schistosomiasis control programs and the limitations of widespread drug treatment campaigns. Interventions that target the environmental reservoir of disease may provide opportunities to reduce exposure while maintaining resource-dependent livelihoods.</p>
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