Abstract

Over 240 million people are infected with schistosomiasis, predominately in low- and middle-income countries. The main control strategy recommended by the World Health Organization (WHO) is praziquantel mass drug administration. However, hotspots, where transmission is not reducing, remain. In a Schistosoma mansoni high endemicity communities, we used community surveys to demonstrate that praziquantel coverage remains low. Furthermore, using Kato-Katz and point-of-care circulating cathodic antigen tests we demonstrate low clearance rates and rapid reinfection. Additional interventions are needed to reach the ambitious WHO 2030 goals for schistosomiasis. Therefore, we elicit community preferences towards alternative water access, sanitation and hygiene (WASH) interventions that would reduce individuals’ risk of contracting, or transmitting, S. mansoni with the aim of identifying popular and affordable WASH -based interventions. We administered a discrete choice experiment to understand community preferences for improved WASH interventions. New sources of potable water and open defection fines were the highest valued interventions, closely followed by new latrines, five minutes’ walk from their home. There was a strong negative preference for the status quo, indicating that whatever the interventions, people wanted to see something done and were willing to work and/or pay for this. Infrastructure interventions that provide safe drinking water and latrines near homes were more popular, may therefore have higher uptake, and therefore be more sustainable, than other WASH -based interventions.

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