Evaluation of the health-related quality of life of children in Schistosoma haematobium-endemic communities in Kenya: a cross-sectional study.

BACKGROUND: Schistosomiasis remains a global public health challenge, with 93% of the ~237 million infections occurring in sub-Saharan Africa. Though rarely fatal, its recurring nature makes it a lifetime disorder with significant chronic health burdens. Much of its negative health impact is due to non-specific conditions such as anemia, undernutrition, pain, exercise intolerance, poor school performance, and decreased work capacity. This makes it difficult to estimate the disease burden specific to schistosomiasis using the standard DALY metric. METHODOLOGY/PRINCIPAL FINDINGS: In our study, we used Pediatric Quality of Life Inventory (PedsQL), a modular instrument available for ages 2-18 years, to assess health-related quality of life (HrQoL) among children living in a Schistosoma haematobium-endemic area in coastal Kenya. The PedsQL questionnaires were administered by interview to children aged 5-18 years (and their parents) in five villages spread across three districts. HrQoL (total score) was significantly lower in villages with high prevalence of S. haematobium (-4.0%, p<0.001) and among the lower socioeconomic quartiles (-2.0%, p<0.05). A greater effect was seen in the psychosocial scales as compared to the physical function scale. In moderate prevalence villages, detection of any parasite eggs in the urine was associated with a significant 2.1% (p<0.05) reduction in total score. The PedsQL reliabilities were generally high (Cronbach alphas ≥0.70), floor effects were acceptable, and identification of children from low socioeconomic standing was valid. CONCLUSIONS/SIGNIFICANCE: We conclude that exposure to urogenital schistosomiasis is associated with a 2-4% reduction in HrQoL. Further research is warranted to determine the reproducibility and responsiveness properties of QoL testing in relation to schistosomiasis. We anticipate that a case definition based on more sensitive parasitological diagnosis among younger children will better define the immediate and long-term HrQoL impact of Schistosoma infection

Community-based natural resource use and management of Bigodi Wetland Sanctuary, Uganda, for livelihood benefits

publisher versionConservation and sustainable management of wetlands requires participation of local stakeholders, including communities. The Bigodi Wetland is unusual because it is situated in a common property landscape but the local community has been running a successful community-based natural resource management programme (CBNRM) for the wetland for over a decade. Whilst external visitors to the wetland provide ecotourism revenues we sought to quantify community benefits through the use of wetland goods such as firewood, plant fibres, and the like, and costs associated with wild animals damaging farming activities. We interviewed 68 households living close to the wetland and valued their cash and non-cash incomes from farming and collection of non-timber forest products (NTFPs) and water. The majority of households collected a wide variety of plant and fish resources and water from the wetland for household use and livestock. Overall, 53% of total household cash and non-cash income was from collected products, mostly the wetland, 28% from arable agriculture, 12% from livestock and 7% from employment and cash transfers. Female-headed households had lower incomes than male-headed ones, and with a greater reliance on NTFPs. Annual losses due to wildlife damage were estimated at 4.2% of total gross income. Most respondents felt that the wetland was important for their livelihoods, with more than 80% identifying health, education, craft materials and firewood as key benefits. Ninety-five percent felt that the wetland was in a good condition and that most residents observed the agreed CBNRM rules regarding use of the wetland. This study confirms the success of the locally run CBNRM processes underlying the significant role that the wetland plays in local livelihoods