Assessment of community knowledge, attitudes, and practices related to schistosomiasis in a hyper-endemic region of the Democratic Republic of Congo: mixed methods

Schistosomiasis remains a significant public health challenge in the Democratic Republic of the Congo (DRC). While the current control efforts rely on mass drug administration, understanding community knowledge and perceptions of the disease is essential for sustainable control. This study explored the knowledge, attitudes, and practices related to schistosomiasis in a hyper-endemic region of the DRC. Between August and November 2022, a mixed-methods approach consisting of a structured questionnaire administered to 349 household heads and eight focus group discussions (FGDs) was conducted in Kasaï-Oriental Province. Descriptive statistics were performed on the quantitative data using Stata 12.0 software, while the FGDs were analyzed using Atlas.ti with a thematic content approach. Of the 349 household heads surveyed (193 males and 156 females), 97.7% had heard of schistosomiasis, mainly from community members (55.1%). The majority of respondents (93.3%) attributed the disease to worms, and 92.4% correctly identified at least one symptom. Although 97% considered schistosomiasis a serious disease, only 41% believed it could be prevented, and just 26% thought it could be treated. However, only 17.3% would seek a diagnosis and treatment at a health facility, while 78.9% would self-medicate at home using traditional medicine. While 62.2% demonstrated good knowledge of schistosomiasis, only 9.1% had positive attitudes, and 19.4% engaged in good practices. Focus group discussions confirmed awareness of the disease, but also revealed persistent misconceptions and structural barriers, notably a lack of access to clean water. Despite a relatively good knowledge of the disease, misconceptions and sanitation issues continue to sustain transmission of schistosomes. Strengthened health education program and improved access to WASH could be essential to deal with schistosomes’ transmission in this area.