Knowledge, attitudes and practices of zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania

Knowledge, attitudes and practices of zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, attitudes and practices of zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania Godlisten Shedrack Materu, Jahashi Nzalawahe, Mita Eva Sengupta, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6576554/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Zoonotic fascioliasis and schistosomiasis, which are transmitted by climate-sensitive freshwater snails, are neglected tropical diseases of medical and veterinary importance. Although zoonotic fascioliasis and schistosomiasis have been reported in both humans and domestic ruminants in Tanzania, little is known about the knowledge, attitudes, and practices (KAP) of local communities concerning the occurrence, transmission, and risk factors for zoonotic schistosomiasis and fascioliasis in Tanzania. To address this knowledge gap, we conducted a KAP survey in Lake Victoria and the southern highlands of Tanzania to investigate community KAP regarding the transmission, risk, and prevention of zoonotic schistosomiasis and fascioliasis. Given that climate change potentially causes increased levels of schistosomiasis and fascioliasis, particularly in highland areas, we also investigated the general knowledge of communities about climate change and how climate change may impact schistosomiasis and fascioliasis. Most of the study participants (91.3%) had already heard of zoonotic schistosomiasis, 45.9% had ever heard about zoonotic fascioliasis, and 57.6% were aware of climate change. Nevertheless, only 37.2% knew snails as intermediate hosts of zoonotic fascioliasis and schistosomiasis. The consumption of raw vegetables (57.3%), raw liver (28.3%), and contaminated water (12.1%) was mentioned as how fascioliasis can be transmitted. Among the study participants, 55.7% emphasized that schistosomiasis is transmitted through contact with contaminated water. A lack of coordination between sectors and stakeholders was mentioned by 57.3% of the participants as a common constraint affecting the implementation of zoonotic schistosomiasis and fascioliasis control programs. Approximately 31.8% of the participants understood the link between climate change and zoonotic schistosomiasis and fascioliasis. This study reveals knowledge gaps in risk perception and a lack of coordination between sectors and stakeholders, which calls for the adoption of multidisciplinary and multisectoral approaches to control and prevent zoonotic schistosomiasis and fascioliasis, and the need for appropriate climate change awareness and mitigation initiatives. Fascioliasis Schistosomiasis Climate Trematode Knowledge Attitude Practices Tanzania Introduction Zoonotic fascioliasis and schistosomiasis Fascioliasis and schistosomiasis are zoonotic diseases caused by trematodes of the genera Fasciola and Schistosoma , with a complex transmission cycle involving freshwater snails as intermediate hosts and mammals as definitive hosts [ 1 – 4 ]. Fascioliasis and schistosomiasis are widespread in tropical and subtropical regions where climatic, ecological, and hygienic conditions favor their transmission [ 3 , 5 ]. In addition to their considerable public health burden [ 6 ], fascioliasis and schistosomiasis are responsible for economic loss in livestock, mainly through reduced fertility and productivity, liver dysfunction and condemnation, stunted growth, and premature death [ 7 – 9 ]. Schistosomiasis and fascioliasis infect more than 2.4 million and 200 million people, respectively, with 850 million at risk of both infections [ 10 ]. In Tanzania, the prevalence of schistosomiasis in humans ranges from 12.7–87.6% and ranks second to Nigeria for the country with a high prevalence of schistosomiasis in sub-Saharan Africa (SSA) [ 11 ]. Previous studies in Tanzania reported a prevalence of human fascioliasis of 21% [ 12 ], whereas for animals, the prevalence ranges from 17.8–94% in live animals. Liver condemnations due to fasciolosis may reach up to 100% in some slaughter slabs [ 13 , 14 ]. In Tanzania, it is estimated that the annual direct economic loss due to bovine fascioliasis is US $ 42,191.9, equivalent to US $ 3,515.9 per month [ 15 ]. Climate change and zoonotic fascioliasis and schistosomiasis Climatic factors, such as temperature, can affect the transmission of snail-borne zoonotic diseases such as fascioliasis and schistosomiasis, primarily by affecting the intermediate host snail (IHS) growth, survival, reproduction, dispersal, and parasite development inside the snail. Therefore, rising temperatures and changing patterns of precipitation associated with climate change could strongly impact the distribution and abundance of various species of IHS and their trematode parasites, resulting in a shift in the dynamics and transmission of these parasites to both humans and animals [ 16 , 17 , 2 ]. The free-living stages of the parasite thrive in warm, moist conditions, promoting the reproduction and survival of IHS, such as G. truncatula [ 18 , 19 ]. Because temperature and moisture influence multiple lifecycle stages, changing climatic conditions may affect the timing, intensity, and distribution of fascioliasis outbreaks [ 19 ]. Climate variability, such as precipitation, floods, drought, and pH, among other factors, has been predicted as a potential factor that may influence schistosomiasis transmission [ 20 – 23 ]. People's culture, norms, and KAP can contribute to the spread, control, and elimination of various diseases, including zoonotic diseases [ 24 ]. Evidence shows that people’s perceptions of disease risks, such as transmission and health consequences, influence their attitudes, practices, and behaviors toward the diseases of concern [ 25 ]. The use of raw dairy products, such as butter, buttermilk, and even raw milk without boiling, has been mentioned as one of the practices associated with zoonotic schistosomiasis and fascioliasis transmission [ 26 ]. In Tanzania, there is a lack of information about the community KAP concerning the effects of climate change on zoonotic schistosomiasis and fascioliasis. Based on this background, we aimed to assess community perceptions and practices regarding zoonotic schistosomiasis and fascioliasis transmission in the study area, community perceptions/knowledge of climate change in general and specifically in the context of schistosomiasis and fascioliasis transmission and control, to design local, effective, and accepted control interventions. Materials and methods Study area This study was carried out in Itubukilo village of Bariadi District, Kanyelele village of Misungwi District in the Lake Zone, and Lupembelenga village of the Iringa rural District in the southern highlands of Tanzania. Study design and sample size A mixed-methods KAP survey was carried out using both quantitative and qualitative methods concurrently, giving each method an equal weight [27]. In this regard, the study triangulated quantitative and qualitative research methods of sampling, data collection, analysis, and discussions, enhancing the completeness of the results. This approach helped us explain the findings and answer the research questions [28], i.e., community perceptions and practices regarding zoonotic schistosomiasis and fascioliasis transmission in the study area, community perceptions/knowledge of climate change in general and specifically in the context of schistosomiasis and fascioliasis. The concurrent use of qualitative and quantitative methods has enabled broader coverage and in-depth topic exploration [29]. For the quantitative data, we used a total sample size of 348 individuals calculated via the formula n = (Z 2 * p * (1-p))/d 2 and an expected incidence (p) of human schistosomiasis of 21% [30], whereby the desired absolute precision (d) =5%, z= standard normal deviation corresponding to the level of significance of 1.96 at the 95% confidence interval (CI). We provided a non-response rate of 20%. Sampling and data collection methods The study districts and villages were selected purposively based on the known or suspected presence of schistosomiasis and fascioliasis in the human and domesticated ruminant populations, as described in previous reports from the respective District Veterinary and Medical Offices. A total of three villages were selected. From these villages, twenty-three individuals were purposively sampled for in-depth interviews (IDIs) based on their experience with the community concerning fascioliasis, schistosomiasis, and climate change issues. Another 348 individuals were sampled for the structured questionnaire interview, and six focus group discussion (FGD) sessions were arranged considering age groups and gender balance. In total, 444 individuals participated in this study. Quantitative data were collected via a structured questionnaire, and qualitative data were collected via IDIs and FGDs. An interviewer-administered questionnaire was used to collect quantitative data related to sociodemographic characteristics and KAP from the participants. In contrast, IDIs and FGDs were used to gather participants’ opinions and perspectives regarding fascioliasis, schistosomiasis, and the impact of climate change on the transmission of fascioliasis and schistosomiasis. Two FGDs were conducted in each village, one for men and the other for women, due to cultural and gender sensitivity. The questionnaire, IDI, and FDG tools were prepared in English, translated into Swahili, and translated back to English before being administered by research team members. Ethical approval The Medical Research Coordinating Committee of the National Institute for Medical Research in the United Republic of Tanzania reviewed and approved this study with the approval number NIMR/HQ/R.8a/Vol. IX/3860). An informed consent process was followed before the study commenced to obtain written informed consent from the study participants to participate in the research and for their data to be published. Participants for IDIs and FGDs and verbal consent for audio, video, and photo taking were requested. The participants were assured that all the information collected was confidential and would not be shared by third parties, only those eligible to see the results. Anonymity was confirmed by the questionnaire, which had no participants' identities. Data analysis Qualitative data were analyzed thematically via an inductive approach. The interviews were transcribed, and themes were generated from the transcripts. These themes were carefully reviewed to ensure accuracy and relevance to the study objectives. The data were compared against the identified themes to confirm that they accurately reflected the participants’ responses. Once finalized, the themes were named, and the writing process commenced, guided by the study objectives [31]. The data were reviewed multiple times to ensure consistency, and the study participants' actual words (verbatim) were reported to capture their lived experiences. Quotations were included to support the findings and provide a deeper understanding of the participants' perspectives [32]. The quantitative data collected were entered into a database via EpiData Version 3.1. The data were analyzed via STATA Version 15.1 (Stata Corporation, Texas, USA) and summarized via descriptive statistics. Results Demographic characteristics A total of 344 out of the 348 questionnaires, representing a 98.9% response rate, were fully completed and considered for analysis. Additionally, six FGDs and 23 IDIs were carried out and included in the analysis. The majority of the respondents were female, 219 (63.7%), aged between 26 and 35 years, 59 (71.1%), and aged older than 46 years, 56 (66.7%) (Table 1). Table 1. Demographic characteristics of the study participants Variable Sex Total n (%) Male n (%) Female n (%) Age group (Years) 18-25 19(39.6) 29(60.4) 48(100) 26-35 24(28.9) 59(71.1) 83(100) 36-45 30(47.6) 33(52.4) 63(100) 46-55 24(36.4) 42(63.6) 66(100) >46 28(33.3) 56(66.7) 84(100) Education level No formal education 26(21.0) 98(79.0) 124(100) Primary 86(44.1) 109(55.9) 195(100) Secondary 11(50.0) 11(50.0) 22(100) College/University 2(66.7) 1(33.3) 3(100) Tribe Hehe 31(29.2) 75(70.7) 106(100) Sukuma 87(40.5) 128(59.5) 215(100) Bena 6(35.3) 11(64.7) 17(100) Nyaturu 0(0.0) 2(100.0) 2(100) Nyantuzu 0(0.0) 1(100.0) 1(100) Gogo 1(33.3) 2(66.7) 3(100) Overall awareness of the presence or absence of disease in the community Among the 344 respondents, 341 (99.1%) were aware of the presence or absence of the disease in their community. The KAP survey revealed that the most common human diseases in the community were malaria, at 255 (74.1%), and schistosomiasis, at 172 (50%) (Table 2). Fascioliasis was the most common animal disease in the community (141 [41%]). The KII and FGD interviewed participants were aware of the presence of diseases affecting people in their communities. The most frequently mentioned diseases were malaria, worms, fever, stomach diseases, diarrhea, cough, urinary tract infection (UTI), typhoid, pneumonia, and amoebiasis. Many more diseases were listed during focus group discussions than during KII interviews. “The common diseases affecting humans here are malaria, typhoid, UTI, diabetes, and pneumonia” (FGD no. 2, Women, Misungwi). The qualitative findings revealed that few participants (26, 27.4%) mentioned schistosomiasis, and after probing, schistosomiasis was among the diseases that affect people in their community. The participants mentioned that everyone (both adults and children) in their community is affected by schistosomiasis and fascioliasis. “From what I see, it affects everyone. Sometimes, even children are affected. For example, I have children, so there are times when I see them coughing, and we go to the dispensary to get medicine (KII no 07 Iringa). “ All people can suffer from schistosomiasis. You will find your husband is suffering from schistosomiasis, and after that, as his wife, you will start to experience the same…... I mean, men and women can all contract the disease.” (FGD no. 04, Women, Bariadi) Apart from human diseases, almost all participants were also aware of diseases that commonly affect animals in their communities. The most frequently mentioned diseases/parasites were worms (fasciolosis and other nematodes), tsetse flies, and ticks. Table 2: Overall awareness of the presence or absence of disease in the community Presence or absence of disease variable Frequency Percentage Awareness of any diseases in your community (n=344) Yes 341 99.1 No 3 0.9 Common human diseases in your community (n=344) Schistosomiasis 177 51.5 Fascioliasis 19 5.5 Malaria 285 82.9 UTI 137 39.8 Diarrhea 130 37.8 Other (diabetes, typhoid, pneumonia, and amoeba) 197 57.3 Common animal diseases in the community (n=344) Fascioliasis 141 41.0 Theileriosis 16 4.7 Anaplasmosis 9 2.6 Trypanosomiasis 10 2.9 Rift Valley Fever 31 9.0 Other helminths 201 58.4 The most affected group by diseases in the community (n=344) Children 74 21.5 Adults 51 14.8 Both children and adults 214 62.2 Don’t know 5 1.4 Respondents’ knowledge of schistosomiasis and fascioliasis Among the 344 individuals interviewed, 314 (91.3%) and 158 (45.9%) reported having heard about schistosomiasis and fascioliasis, respectively. Surprisingly, only 37.2% of the respondents knew snails as intermediate hosts of zoonotic fascioliasis and schistosomiasis. Most respondents mentioned health facilities as a source of information on schistosomiasis and fascioliasis. Through IDIs and FGDs, participants were aware of schistosomiasis and fascioliasis in their communities. However, the majority of participants stated that, compared with other diseases such as malaria, schistosomiasis was no longer a major problem in their communities because of the ongoing school-based MDA program. One FGD participant remarked, " Thanks to the facilitator, I believe that schistosomiasis was widespread but has declined. This decrease occurred after health workers visited schools to provide medication (MDA). (FGD no. 4 Men, Misungwi) Another interviewee elaborated by saying, “ Now it (schistosomiasis) is not there that is why you will find even the red urine is not coming out” (KII no.08, Misungwi). Even though most respondents said that schistosomiasis has decreased, a few respondents admitted that the disease is present in a few people in the community. The affected group consists of children and youth because they tend to come into contact with infested water. “Previously, schistosomiasis was indeed very common here…However, a few years ago, it’s like now schistosomiasis has been controlled ” (KII, CHW, Iringa) “Children get that disease because of water. You know children mostly do their sports in the ponds, and when it rains, they prefer running water” (KII no 05 Bariadi). The quantitative findings revealed that the sources of information about schistosomiasis included public announcements (344, 100%), health facilities (202, 58.2%), schools (96, 27.9%), and radio (38, 11.1%). Concerning fascioliasis, 112 (32.6%), 37 (10.8%), 18 (5.2%), and 6 (1.7%) participants mentioned health facilities, public announcements, and sources of information, respectively. All IDI and FGD interviewees mentioned at least one source from which they received information about schistosomiasis and fascioliasis. When asked if they had an idea about the disease, they all stated that they were aware of it and that they received information from health facilities, i.e., hospitals, health centers, and dispensaries, when they visited health facilities for treatment or had taken a family member for treatment. Few respondents reported having received information from their primary school children. W e obtain information about schistosomiasis and fascioliasis disease when we visit health facilities for treatment (FGD no. 2). Men, Misungwi) The participants mentioned the consumption of contaminated raw vegetables 180 (57.3%), uncooked livers 89 (28.3%), and water contact 38 (12.1%) as ways in which fascioliasis can be transmitted from one person to another. Approximately half of the participants said fascioliasis could be transmitted from animals to humans by eating raw liver (88 (47.3%)) and vegetables contaminated by animal feces (72 (45.5%)). The study participants (57%) also underlined that schistosomiasis is transmitted through water contact (55.7%), for example, by swimming in contaminated water, ponds, or wells. The quantitative findings that schistosomiasis is transmitted through water contact were also confirmed by the participants’ narratives through IDIs and FGDs, as illustrated below: "Indeed, it is true that schistosomiasis is contracted during activities such as fetching unsafe water from the river" (KII no. 06 Iringa). “ Some school children defecate in the same water. Therefore, urine, feces, and other dirt enter the water and contaminate it. If you come into contact with the contaminated water, you can get the disease” (FGD no. 03, Men, Bariadi). In the IDI and FGD interviews, the participants reported that fascioliasis is a disease that affects animals but not humans and that most animals are domestic, such as cows, goats, and sheep. A few participants reported that the disease is zoonotic, affecting animals first, and then it spreads to human beings through the consumption of raw meat. The animals develop disease through drinking dirty water in ponds and other water sources. According to most participants, the animal liver is the most affected part, and when eaten by a person, he/she become infected. Other participants reported that they had no knowledge of fascioliasis, and it was difficult for them to recognize whether the animal had fascioliasis. One FGD participant stated: “Regarding livestock, sometimes cows get very weak for unknown reasons, but I have realized that the problem is the liver. You will find that the liver is affected, even when the cow dies. When you slaughter it, you find that the liver has already been affected” (FGD no. 02, Women, Misungwi). The participants added that the symptoms of fascioliasis in animals are visible; when the animals develop the disease, they become weak, and they die later. However, human symptoms are not visible until a person is clinically examined. One interviewee explained: "I think it is important for people to get regular checkups to determine if they have liverworms. Since the symptoms are not well known, my child might have liver worms, and I would not even realize it." ( KII no.05, Iringa). The results from the quantitative data revealed that blood in the urine of 227 patients (66%), burning urine of 165 patients (48%), abdominal pain of 105 patients (30.5%), and vomiting of 67 patients (19.5%) were the major signs/symptoms of schistosomiasis. The other symptoms are diarrhea, fatigue, and fever. For fascioliasis, the participants mentioned liver abnormalities in 126 (36%), swelling of the liver in 86 (25%), and nausea in 56 (16.3%) as significant signs and symptoms of the disease; however, vomiting, skin rashes, fever and diarrhea were also mentioned. Community attitudes and practices regarding schistosomiasis and fascioliasis Findings from quantitative data revealed that 176 (51.7%) of the respondents used tap water, and 177 (51.5%) used uncovered well water at home in their daily activities. The type of toilet mentioned by most of the respondents was a pit latrine 170, 49.4%), and 296 (86.0%) respondents frequently used toilets. The majority of the respondents mentioned watering livestock 271 (78.8%), bathing 308 (89.5%), and washing dishes 266 (77.3%) as activities involving the use of water from open sources or making contact with water. Almost 308 (89.5%) of the respondents were in frequent contact with water during their daily activities. Both schistosomiasis and fascioliasis were mentioned as dangerous diseases by 153 (48.7%) and 158 (76.5%) respondents, respectively. These findings are also consistent with the qualitative findings, as most of the participants mentioned swimming in ponds and activities for collecting water as a source of contracting the disease. The participants’ narratives depicted the sources of water used for domestic purposes as unsafe because it is shared with animals, hence hindering their efforts to prevent themselves from becoming infected. “ We are getting the disease by swimming in the ponds and by fetching water…. When you go there to take bath or fetch water, then you find that the infected animal has to urinate in that water so you become contaminated” (KII no. 07, Misungwi). Children’s tendency to play in open-water ponds and sometimes pass urine inside them was also cited as a risk factor for schistosomiasis. This is particularly true because the same water is used in the community for different purposes, such as irrigation and bathing. “In all open water ponds, you will find children playing and urinating there; when you come to fetch that water, you find the parasites inside ” (KII no. 04, Bariadi). The quantitative findings revealed that approximately half of the participants, 74 (46.5%), sought treatment from health facilities when they fell sick. On the other hand, in the qualitative analyses, 60 (37.7%) of the respondents reported using traditional medicine for fascioliasis and schistosomiasis treatment. In this context, they consider using drugs from nearby pharmacies/drug shops (self-medication) when traditional drugs fail. “When a person suspects he is infected, he buys medicines from the nearby drug shop and uses them (KII no. 04, CHW, Bariadi). “During that age, I don’t remember, but I went to the hospital and was given medication. (KII no 07, Iringa) Toward zoonotic fascioliasis and schistosomiasis prevention and control Among the 344 respondents, only 19.2% (66/344) were aware of the presence of national programs for snail-borne disease control, and approximately half (50%, 33/66) mentioned reducing snail abundance as one of the main interventions for snail-borne disease control. Among the respondents, 22.4% (77/344) mentioned implementing snail-borne disease control activities in their area. A lack of coordination among key sectors and stakeholders 57.3%, 197/344) was a common problem affecting the implementation of control activities for snail-borne diseases. The participants in the qualitative studies (IDIs and FGDs) stated that efforts to control and eliminate snail-borne diseases should focus on community engagement and education, since most people are unaware of how these diseases are transmitted. One FGD participant stated: “ I am suggesting that health education has to be provided, but along with education, we should engage in dialogs with community members, health service providers, and the government” ( FGD no. 8, Men, Iringa). Furthermore, participants mentioned the importance of clean and safe water as one solution for controlling snail-borne diseases. Most participants stated that using dirty and unsafe water sources was the main challenge that could lead to people being infected with schistosomiasis and fascioliasis. “ The government should plan to provide clean and safe water to communities. The government can dig water wells to provide clean and safe water for people and animals; this will also prevent people from going to rivers and ponds” (KII no. 02, Bariadi). Climate change and zoonotic fascioliasis and schistosomiasis The results from the quantitative survey revealed that 198 (57.6%) of the respondents had already heard about climate change from various information sources, such as radio 132 (43.8%), school 34 (11.3%), and health workers 34 (11.3%). The majority of the respondents, 165 (83.00%), thought that climate change had occurred in their area through drought (96, 33.5%), increased/irregular seasons of rainfall and floods (45, 15.7%), increased temperature (64, 22.3%), irregular air movement/winds (18, 6.3%), and other factors (55, 20.2%). Approximately 63 (31.8%) of the participants were aware of the link between climate change and schistosomiasis and fascioliasis. There are climate change issues, drought, and floods, but currently, drought is the most extreme. Initially, we used to hear about Kenya, Mozambique, and Somalia...but now, it has reached Tanzania (FGD NO.03, Men, Bariadi) The respondents mentioned deforestation at 100 (37.3%), pollution from industries at 29 (10.82%), population growth at 23 (8.58%), and other causes at 110 (41.01%) as the leading causes of climate change in their areas (Table 3). Approximately 155 (78.3%) of the respondents were affected by climate change, which affects 72.2% of livestock production. Approximately 72.7% of the respondents reported changes in livestock and agricultural production systems over the past ten years (Table 3). This finding is similar to the qualitative results, which show that most respondents narrate deforestation as a source of climate change and other causes. “ I think due to the increase in population, …. Additionally, the activities\mostly agricultural, pastoralism and deforestation” (KII no.04, CHW, Iringa) Approximately 61 (42.4%) of the respondents agreed that climatic changes affect vector-borne diseases; however, only 49 (24.8%) thought that there might be more or fewer snails, i.e., as a result of more/less rain or higher temperatures. Moreover, 99 (50%) of the respondents mentioned that changes in the occurrence of other vectors, such as mosquitoes and ticks, were affected by climate change. Approximately 139 (70.2%) people suffer from schistosomiasis/fascioliasis during the rainy season. The qualitative results indicate that the government and other stakeholders somehow fulfill their responsibility in combating climate change by using their professionalism to provide education on environmental conservation, assist in planting trees, and enact and manage laws to address climate change. “ First and foremost, we should educate the community, especially about environmental conservation, which leads to significant climate change mitigation. Second, owing to climate change, we must educate people about proper food conservation and timely farming.” (KII no. 7, Iringa) “ Other institutions also have the same responsibility as the government, as I said earlier, to mobilize the community so that the community would know the advantages of trees and the disadvantages of not having trees as one of the climate change mitigation strategies (KII no.07, Misungwi) “Our national leaders or even the leaders in our neighborhood advise us not to cut firewood recklessly, not to farm near water sources, and not to cut down trees. If you have your land, when you cut down a tree, you must plant another one” ( FGD no. 04, Women, Iringa ). Table 3: Climate change and zoonotic fascioliasis and schistosomiasis Your area/community has been affected by climate change, N=198 Numbers Percent Yes 155 78.3 No 33 16.7 Don’t know 10 5.1 Observed any changes in agriculture and livestock production systems over the past ten years, N=198 Yes 144 72.7 Think livestock production has been affected by climate change (N=144) Yes 104 72.2 Does climate change have any effect on vector-borne diseases (N=144) Yes 61 42.4 I think there have been changes in the number of snails, which have been caused by climate change Yes 49 24.8 Think there are changes in the occurrence of other vectors (e.g. mosquitoes, ticks) which have been affected by climate change (N=198) Yes 99 50.00 Think climate change has increased the transmission of schistosomiasis/fascioliasis in your area (N=198) Yes 63 31.8 Time of the year during which the majority of people suffer from schistosomiasis/fascioliasis (N=198) Rain season 139 70.2 Dry season 26 13.1 Don’t know 33 16.7 Who do you think is responsible for the mitigation of climate change (N-198) Government 102 39.5 Nongovernmental/environmental organizations 25 9.7 Individuals 75 29.1 Other 56 21.7 Think the community in your area is responsible for the mitigation of climate change (N=198) Yes 45 22.7 Have your community ever taken any action to mitigate climate change (N=198) Yes 36 18.2 Have your government ever taken any action to mitigate climate change (N=198) Yes 62 31.3 Discussion The present study explored KAP regarding zoonotic schistosomiasis and fascioliasis in the context of climate change around Lake Victoria and the southern highlands ecological zones of Tanzania. The study findings show that the majority of respondents were aware of schistosomiasis; however, knowledge of fascioliasis was relatively low. Surprisingly, only a few respondents, 37.2%, knew the role of snail intermediate hosts in transmitting these diseases. High awareness of schistosomiasis has been reported in other schistosomiasis-endemic areas in Zimbabwe [33], Kenya [34, 35], and Nigeria [36]. Similarly, a study conducted in Brazil revealed that people were reasonably familiar with schistosomiasis [37]. Most respondents in the present study were aware of schistosomiasis because of the ongoing MDA campaign through the NTD program under the Ministry of Health in Tanzania. The findings of the present study regarding poor knowledge of fascioliasis in an African context were also reported in South Africa by Olaogun et al. [38]. Similarly, poor knowledge regarding zoonotic transmission, prevention, and control was mentioned among farmers [26, 39]. The general lack of knowledge concerning fasciolosis among the participants observed in this study might also be due to the asymptomatic nature of the disease in cattle or because it is not routinely diagnosed in our healthcare settings. The consumption of contaminated raw vegetables and raw meat/liver was mentioned as a transmission route of fascioliasis. At the same time, schistosomiasis is considered to be transmitted through water contact, for example, by swimming in contaminated water ponds or wells. This finding is in line with a study in Thailand, which revealed that more than half of the participants had a good understanding of how fascioliasis is transmitted [40]. The same findings were reported in a study conducted in Ethiopia, where most respondents believed that the transmission of fascioliasis was caused by consuming raw meat [41]. A study in Ethiopia reported that most respondents mentioned fascioliasis, transmitted by eating raw meat and vegetables [15]. Moreover, no one was aware of the role of snails in transmitting the disease [15]. Although it is important to defecate in latrines and avoid contact with contaminated water sources, participants reported that it is impossible to avoid defecating in the water because they spend most of their time on farms where there are no latrines. A KAP study along the Lake Victoria region of Uganda [42] and a systematic review of KAP regarding schistosomiasis in Uganda [43] also revealed that avoiding contact with water was impossible since it is linked to the community’s livelihoods. Providing clean and safe water sources and raising awareness of latrine use in the community are considered important interventions. Quantitative and qualitative findings revealed that schistosomiasis and fascioliasis are generally considered dangerous diseases. Stigma and long-term adverse effects are the primary causes of disease severity. Indeed, research has demonstrated that in addition to anemia, liver problems, and numerous other adverse effects, chronic schistosomiasis and fascioliasis may cause stunting and hinder cognitive development [44]. Similarly, a previous study conducted in Kenya, parts of Uganda, and other places revealed that the community believed fascioliasis and schistosomiasis to be harmful illnesses. [34, 45, 46, 26]. The negative effects of these zoonotic diseases on both humans and animals might be the reason why they are perceived by the community to be dangerous. Concerning health-seeking behavior regarding fascioliasis and schistosomiasis, most participants reported seeking treatment from health facilities when they fell sick. In contrast, few respondents reported traditional medicine as their first line of treatment. A study conducted in the Magu district of Tanzania revealed that in endemic areas, patients refer to traditional healers as care-seeking behavior [47]. A similar finding was reported in a study by [48] in Côte d’Ivoire and southern Mauritania, which showed that the community relies on self-medication and various herbal remedies to treat schistosomiasis. Moreover, the results of this study revealed that changes in climatic conditions, such as rainfall and floods, have led to a shift in the number of intermediate snail hosts, resulting in increased transmission of schistosomiasis and fascioliasis, with most people suffering during the rainy season. These findings align with those of [16, 17, 2], which showed that rising temperatures and changing patterns of precipitation associated with climate change could strongly impact the distribution and abundance of various species of IHS and their trematode parasites, resulting in a shift in the dynamics and transmission of these parasites to both humans and animals. The study revealed that approximately 31.8% of the participants were aware of the link between climate change and schistosomiasis and between climate change and fascioliasis transmission . A similar study conducted in Ghana on quantitative analysis of changes in the interannual total rainfall showed that the total rainfall and number of rainy days positively correlated with the prevalence of schistosomiasis/fascioliasis in the area [49]. In another related study conducted in Ethiopia by Xue et al . [50], rainfall was considered a prominent climatic factor responsible for increased incidence of snail-transmitting schistosomiasis by supplying sufficient water in ponds as breeding sites for snail intermediate hosts. Conclusions The findings from this study provide some baseline information for understanding zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania. This study revealed knowledge gaps, risk practices, and a lack of coordination across sectors and stakeholders. This calls for a multidisciplinary approach to controlling and preventing zoonotic schistosomiasis and fascioliasis, and the need for proper climate change mitigation initiatives. This study suggests the adoption of a comprehensive one-health approach that considers the interconnectedness of human, animal, and environmental health (climate change mitigation) to effectively mitigate zoonotic fascioliasis and schistosomiasis burdens and increase community well-being. Abbreviations FGD Focus group discussion KAP Knowledge, Attitude, and Practice IDI In-depth interview IHS Intermediate host snail MDA Mass drug administration NIMR National Institute for Medical Research NTD Neglected tropical disease SSA Sub-Saharan Africa Declarations Acknowledgments: The authors would like to thank the Regional Commissioners of the Mwanza, Simiyu, and Iringa regions; the District Executive Directors of the Bariadi, Misungwi, and Iringa Rural districts; the Regional and District Veterinary Officers; and the Village and Subvillage leaders for their cooperation during fieldwork. We are grateful to Coleman Kishamawe and Yasinta Sylivester for their technical assistance during the fieldwork. Authors’ contributions GSM, SK, JN, AK, and BJV conceptualized and designed the study; GSM, SK, JM, RN, and JN planned and conducted the fieldwork; GSM, RN, and JM analyzed the data and drafted the manuscript; and GSM, JN, AK, SK, RN, JM, MEV AS and BJV revised and improved the final version of the manuscript. The authors read and approved the final version of the manuscript. Funding This work was supported by the PREPARE4VBD project, which has received funding from the European Unionʼs Horizon 2020 Research and Innovation Programme under grant agreement No. 101000365. Availability of data and materials All data generated or analyzed during this study are included in this published article. Ethics approval and consent to participate Ethical approval was obtained from the Medical Research Coordinating Committee of the National Institute for Medical Research in the United Republic of Tanzania, (Ref. NIMR/HQ/R.8a/Vol. IX/3860). Support letter was obtained from Sokoine University of Agriculture. Permission letter was obtained from study region/districts and from village leaders. An informed consent process was followed before the study commenced to obtain written informed consent from the study participants to participate in the research and for their data to be published Consent for publication Permission to publish this paper was obtained from the Director General of the Tanzanian National Institute for Medical Research (NIMR). Competing interests The authors declare that they have no competing interests. References Angeles JMM, Leonardo LR, Goto Y, Kirinoki M, Villacorte EA, HHakimi H, et al. Water buffalo as sentinel animals for schistosomiasis surveillance. Bull World Health Organ. 93 (2015) 511–2. Mas-Coma S, Valero MA, Bargues MD. Climate change effects on trematodiases, with emphasis on zoonotic fascioliasis and schistosomiasis. Vet Parasitol. 163 (2009)264–80. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6576554","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":454189059,"identity":"d9e081a2-5927-428e-95b5-3c2d8750747a","order_by":0,"name":"Godlisten Shedrack Materu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYHCD5IYDIIqfgYGNgEpmGCMRqCWBgUGygRQtDCAtBgcIaNFtP3/wcWUbg10/e2LjwZ8/bPKMbyQ/e/ChgkGeX+wAVi1mZ5KZDc+2MSTP7HnYcJgnIa3Y7EaaueGMMwyGM2cnYNdyIJlNshGoxeBGYsNhhoTDidtuJJhJ87YxJBjcxqHl/GP2nzAtB38k/E/cPCP9G34tN5LZGIFa7EBaDvAkHEjcIJFDwJYbj40lG85JJEiC/ZKWnDjjzJsyyRlnJHD75Xziw48NZTb2/OzJhz/+sLFL7G9P3ybxocJGnl8auxYokABFChQIgFVK4FMOBvYIJv8BgqpHwSgYBaNgZAEAGJFlnF2H9VQAAAAASUVORK5CYII=","orcid":"","institution":"Sokoine University of Agriculture","correspondingAuthor":true,"prefix":"","firstName":"Godlisten","middleName":"Shedrack","lastName":"Materu","suffix":""},{"id":454189060,"identity":"73c40795-bd65-45fd-8c39-6315df35f0de","order_by":1,"name":"Jahashi Nzalawahe","email":"","orcid":"","institution":"Sokoine University of Agriculture","correspondingAuthor":false,"prefix":"","firstName":"Jahashi","middleName":"","lastName":"Nzalawahe","suffix":""},{"id":454189061,"identity":"b6092885-caf6-459f-87e2-8d72b81a3b75","order_by":2,"name":"Mita Eva Sengupta","email":"","orcid":"","institution":"University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Mita","middleName":"Eva","lastName":"Sengupta","suffix":""},{"id":454189062,"identity":"c82f1c49-865f-43eb-a5f5-df8c9f7e8be3","order_by":3,"name":"Anna-Sofie Stensgaard","email":"","orcid":"","institution":"University of Copenhagen","correspondingAuthor":false,"prefix":"","firstName":"Anna-Sofie","middleName":"","lastName":"Stensgaard","suffix":""},{"id":454189063,"identity":"e816bf07-4248-47e3-98b2-e1d945a75d5c","order_by":4,"name":"Abdul Katakweba","email":"","orcid":"","institution":"Sokoine University of Agriculture","correspondingAuthor":false,"prefix":"","firstName":"Abdul","middleName":"","lastName":"Katakweba","suffix":""},{"id":454189064,"identity":"cba662b4-60e5-406b-b995-13f1b7cca49f","order_by":5,"name":"Birgitte J. 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Fascioliasis and schistosomiasis are widespread in tropical and subtropical regions where climatic, ecological, and hygienic conditions favor their transmission [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In addition to their considerable public health burden [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], fascioliasis and schistosomiasis are responsible for economic loss in livestock, mainly through reduced fertility and productivity, liver dysfunction and condemnation, stunted growth, and premature death [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSchistosomiasis and fascioliasis infect more than 2.4\u0026nbsp;million and 200\u0026nbsp;million people, respectively, with 850\u0026nbsp;million at risk of both infections [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In Tanzania, the prevalence of schistosomiasis in humans ranges from 12.7\u0026ndash;87.6% and ranks second to Nigeria for the country with a high prevalence of schistosomiasis in sub-Saharan Africa (SSA) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Previous studies in Tanzania reported a prevalence of human fascioliasis of 21% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], whereas for animals, the prevalence ranges from 17.8\u0026ndash;94% in live animals. Liver condemnations due to fasciolosis may reach up to 100% in some slaughter slabs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In Tanzania, it is estimated that the annual direct economic loss due to bovine fascioliasis is US\u003cspan\u003e$\u003c/span\u003e42,191.9, equivalent to US\u003cspan\u003e$\u003c/span\u003e3,515.9 per month [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eClimate change and zoonotic fascioliasis and schistosomiasis\u003c/h2\u003e \u003cp\u003eClimatic factors, such as temperature, can affect the transmission of snail-borne zoonotic diseases such as fascioliasis and schistosomiasis, primarily by affecting the intermediate host snail (IHS) growth, survival, reproduction, dispersal, and parasite development inside the snail. Therefore, rising temperatures and changing patterns of precipitation associated with climate change could strongly impact the distribution and abundance of various species of IHS and their trematode parasites, resulting in a shift in the dynamics and transmission of these parasites to both humans and animals [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe free-living stages of the parasite thrive in warm, moist conditions, promoting the reproduction and survival of IHS, such as \u003cem\u003eG. truncatula\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Because temperature and moisture influence multiple lifecycle stages, changing climatic conditions may affect the timing, intensity, and distribution of fascioliasis outbreaks [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Climate variability, such as precipitation, floods, drought, and pH, among other factors, has been predicted as a potential factor that may influence schistosomiasis transmission [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePeople's culture, norms, and KAP can contribute to the spread, control, and elimination of various diseases, including zoonotic diseases [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Evidence shows that people\u0026rsquo;s perceptions of disease risks, such as transmission and health consequences, influence their attitudes, practices, and behaviors toward the diseases of concern [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The use of raw dairy products, such as butter, buttermilk, and even raw milk without boiling, has been mentioned as one of the practices associated with zoonotic schistosomiasis and fascioliasis transmission [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In Tanzania, there is a lack of information about the community KAP concerning the effects of climate change on zoonotic schistosomiasis and fascioliasis. Based on this background, we aimed to assess community perceptions and practices regarding zoonotic schistosomiasis and fascioliasis transmission in the study area, community perceptions/knowledge of climate change in general and specifically in the context of schistosomiasis and fascioliasis transmission and control, to design local, effective, and accepted control interventions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eStudy area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in Itubukilo village of Bariadi District, Kanyelele village of Misungwi District in the Lake Zone, and Lupembelenga village of the Iringa rural District in the southern highlands of Tanzania.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design and sample size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA mixed-methods KAP survey was carried out using both quantitative and qualitative methods concurrently, giving each method an equal weight [27]. In this regard, the study triangulated quantitative and qualitative research methods of sampling, data collection, analysis, and discussions, enhancing the completeness of the results. This approach helped us explain the findings and answer the research questions [28], i.e., community perceptions and practices regarding zoonotic schistosomiasis and fascioliasis transmission in the study area, community perceptions/knowledge of climate change in general and specifically in the context of schistosomiasis and fascioliasis. The concurrent use of qualitative and quantitative methods has enabled broader coverage and in-depth topic exploration [29].\u003c/p\u003e\n\u003cp\u003eFor the quantitative data, we used a total sample size of 348 individuals calculated via the formula n = (Z\u003csup\u003e2\u003c/sup\u003e * p * (1-p))/d\u003csup\u003e2\u003c/sup\u003e and an expected incidence (p) of human\u0026nbsp;schistosomiasis of 21% [30], whereby the desired absolute precision (d) =5%, z= standard normal deviation corresponding to the level of significance of 1.96 at the 95% confidence interval (CI). We provided a non-response rate of 20%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling and data collection methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study districts and villages were selected purposively based on the known or suspected presence of schistosomiasis and fascioliasis in the human and domesticated ruminant populations, as described in previous reports from the respective District Veterinary and Medical Offices. A total of three villages were selected. From these villages, twenty-three individuals were purposively sampled for in-depth interviews (IDIs) based on their experience with the community concerning fascioliasis, schistosomiasis, and climate change issues. Another 348 individuals were sampled for the structured questionnaire interview, and six focus group discussion (FGD) sessions were arranged considering age groups and gender balance. In total, 444 individuals participated in this study.\u003c/p\u003e\n\u003cp\u003eQuantitative data were collected via a structured questionnaire, and qualitative data were collected via IDIs and FGDs. An interviewer-administered questionnaire was used to collect quantitative data related to sociodemographic characteristics and KAP from the participants. In contrast, IDIs and FGDs were used to gather participants’ opinions and perspectives regarding fascioliasis, schistosomiasis, and the impact of climate change on the transmission of fascioliasis and schistosomiasis. Two FGDs were conducted in each village, one for men and the other for women, due to cultural and gender sensitivity. The questionnaire, IDI, and FDG tools were prepared in English, translated into Swahili, and translated back to English before being administered by research team members.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Medical Research Coordinating Committee of the National Institute for Medical Research in the United Republic of Tanzania reviewed and approved this study with the approval number NIMR/HQ/R.8a/Vol. IX/3860). An informed consent process was followed before the study commenced to obtain written informed consent from the study participants to participate in the research and for their data to be published. Participants for IDIs and FGDs and verbal consent for audio, video, and photo taking were requested. The participants were assured that all the information collected was confidential and would not be shared by third parties, only those\u0026nbsp;eligible to see the results. Anonymity was confirmed by the\u0026nbsp;questionnaire, which had no\u0026nbsp;participants' identities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative data were analyzed thematically via an inductive approach. The interviews were transcribed, and themes were generated from the transcripts. These themes were carefully reviewed to ensure accuracy and relevance to the study objectives. The data were compared against the identified themes to confirm that they accurately reflected the participants’ responses. Once finalized, the themes were named, and the writing process commenced, guided by the study objectives [31]. The data were reviewed multiple times to ensure consistency, and the study participants' actual words (verbatim) were reported to capture their lived experiences. Quotations were included to support the findings and provide a deeper understanding of the participants' perspectives [32].\u003c/p\u003e\n\u003cp\u003eThe quantitative data collected were entered into a database via EpiData Version 3.1. The data were analyzed via STATA Version 15.1 (Stata Corporation, Texas, USA) and summarized via descriptive statistics.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 344 out of the 348 questionnaires, representing a 98.9% response rate, were fully completed and considered for analysis. Additionally, six FGDs and 23 IDIs were carried out and included in the analysis. The majority of the respondents were female, 219 (63.7%), aged between 26 and 35 years, 59 (71.1%), and aged older than 46 years, 56 (66.7%) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic characteristics of the study participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eMale \u0026nbsp; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eFemale \u0026nbsp; n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (Years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e18-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e19(39.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e29(60.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e48(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e26-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e24(28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e59(71.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e83(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e36-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e30(47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e33(52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e63(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e46-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e24(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e42(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e66(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026gt;46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e28(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e56(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e84(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e26(21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e98(79.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e124(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e86(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e109(55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e195(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e11(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e11(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e22(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eCollege/University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTribe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eHehe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e31(29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e75(70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e106(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eSukuma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e87(40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e128(59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e215(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eBena\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e17(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eNyaturu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e2(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e2(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eNyantuzu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eGogo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e3(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eOverall awareness of the presence or absence of disease in the community\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 344 respondents, 341 (99.1%) were aware of the presence or absence of the disease in their community. The KAP survey revealed that the most common human diseases in the community were malaria, at 255 (74.1%), and schistosomiasis, at 172 (50%) (Table 2). Fascioliasis was the most common animal disease in the community (141 [41%]).\u003c/p\u003e\n\u003cp\u003eThe KII and FGD interviewed participants were aware of the presence of diseases affecting people in their communities. The most frequently mentioned diseases were malaria, worms, fever, stomach diseases, diarrhea, cough, urinary tract infection (UTI), typhoid, pneumonia, and amoebiasis. Many more diseases were listed during focus group discussions than during KII interviews.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The common diseases affecting humans here are malaria, typhoid, UTI, diabetes, and pneumonia\u0026rdquo;\u003c/em\u003e (FGD no. 2, Women, Misungwi).\u003c/p\u003e\n\u003cp\u003eThe qualitative findings revealed that few participants (26, 27.4%) mentioned schistosomiasis, and after probing, schistosomiasis was among the diseases that affect people in their community.\u003c/p\u003e\n\u003cp\u003eThe participants mentioned that everyone (both adults and children) in their community is affected by schistosomiasis and fascioliasis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;From what I see, it affects everyone. Sometimes, even children are affected. For example, I have children, so there are times when I see them coughing, and we go to the dispensary to get medicine\u0026nbsp;\u003c/em\u003e(KII no 07 Iringa).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eAll people can suffer from schistosomiasis. You will find your husband is suffering from schistosomiasis, and\u0026nbsp;after that, as his wife, you will start to experience the same\u0026hellip;... I mean, men and women can all contract the disease.\u0026rdquo;\u003c/em\u003e (FGD no. 04, Women, Bariadi)\u003c/p\u003e\n\u003cp\u003eApart from human diseases, almost all participants were also aware of diseases that commonly affect animals in their communities. The most frequently mentioned diseases/parasites were worms (fasciolosis and other nematodes), tsetse flies, and ticks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Overall awareness of the presence or absence of disease in the community\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence or absence of disease variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eAwareness of any diseases in your community\u0026nbsp;(n=344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e99.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCommon human diseases in your community (n=344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eSchistosomiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e51.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFascioliasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eMalaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e82.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eUTI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e39.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eOther (diabetes, typhoid, pneumonia, and amoeba)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eCommon animal diseases in the community (n=344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eFascioliasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTheileriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eAnaplasmosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eTrypanosomiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eRift Valley Fever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eOther helminths\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eThe most affected group by diseases in the community (n=344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eChildren\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eAdults\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eBoth children and adults\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents\u0026rsquo; knowledge of schistosomiasis and fascioliasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 344 individuals interviewed, 314 (91.3%) and 158 (45.9%) reported having heard about schistosomiasis and fascioliasis, respectively. Surprisingly,\u0026nbsp;only 37.2% of the respondents knew snails as intermediate hosts of zoonotic fascioliasis and schistosomiasis. Most respondents mentioned health facilities as a source of information on schistosomiasis and fascioliasis.\u003c/p\u003e\n\u003cp\u003eThrough IDIs and FGDs, participants were aware of schistosomiasis and fascioliasis in their communities. However, the majority of participants stated that, compared with other diseases such as malaria, schistosomiasis was no longer a major problem in their communities because of the ongoing school-based MDA program. One FGD participant remarked,\u003c/p\u003e\n\u003cp\u003e\u0026quot;\u003cem\u003eThanks to the facilitator, I believe that schistosomiasis was widespread but has declined. This decrease occurred after health workers visited schools to provide medication (MDA).\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e(FGD no. 4 Men, Misungwi)\u003c/p\u003e\n\u003cp\u003eAnother interviewee elaborated by saying, \u0026ldquo;\u003cem\u003eNow it (schistosomiasis) is not there that is why you will find even the red urine is not coming out\u0026rdquo;\u003c/em\u003e (KII no.08, Misungwi).\u003c/p\u003e\n\u003cp\u003eEven though most respondents said that schistosomiasis has decreased, a few respondents admitted that the disease is present in a\u0026nbsp;few people in the community. The affected group consists of children and youth because they tend to come into contact with infested water.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Previously, schistosomiasis was indeed very common here\u0026hellip;However, a few years ago, it\u0026rsquo;s like now schistosomiasis has been controlled\u003c/em\u003e\u0026rdquo; (KII, CHW, Iringa)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Children get that disease because of water. You know children mostly do their sports in the ponds, and when it rains, they prefer running water\u0026rdquo;\u003c/em\u003e (KII no 05 Bariadi).\u003c/p\u003e\n\u003cp\u003eThe quantitative findings revealed that the sources of information about schistosomiasis included public announcements (344, 100%), health facilities (202, 58.2%), schools (96, 27.9%), and radio (38, 11.1%). Concerning fascioliasis, 112 (32.6%), 37 (10.8%), 18 (5.2%), and 6 (1.7%) participants mentioned health facilities, public announcements, and sources of information, respectively.\u003c/p\u003e\n\u003cp\u003eAll IDI and FGD interviewees mentioned at least one source from which they received information about schistosomiasis and fascioliasis. When asked if they had an idea about the disease, they all stated that they were aware of it and that they received information from health facilities, i.e., hospitals, health centers, and dispensaries, when they visited health facilities for treatment or had taken a family member for treatment. Few respondents reported having received information from their primary school children.\u003c/p\u003e\n\u003cp\u003eW\u003cem\u003ee obtain information about schistosomiasis and fascioliasis disease when we visit health facilities for treatment\u0026nbsp;\u003c/em\u003e(FGD no. 2). Men, Misungwi)\u003c/p\u003e\n\u003cp\u003eThe participants mentioned the consumption of contaminated raw vegetables 180 (57.3%), uncooked livers 89 (28.3%), and water contact 38 (12.1%) as ways in which fascioliasis can be transmitted from one person to another. Approximately half of the participants said fascioliasis could be transmitted from animals to humans by eating raw liver (88 (47.3%)) and\u0026nbsp;vegetables contaminated by animal feces (72 (45.5%)).\u003c/p\u003e\n\u003cp\u003eThe study participants (57%) also underlined that schistosomiasis is transmitted through water contact (55.7%), for example, by swimming in contaminated water, ponds, or wells. The quantitative findings that schistosomiasis is transmitted through water contact were also confirmed by the participants\u0026rsquo; narratives through IDIs and FGDs, as illustrated below:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;Indeed, it is true that schistosomiasis is contracted during activities such as fetching unsafe water from the river\u0026quot;\u003c/em\u003e (KII no. 06 Iringa).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eSome school children defecate in the same water. Therefore, urine, feces, and other dirt enter the water and contaminate it. If you come into contact with the contaminated water, you can get the\u003c/em\u003e disease\u0026rdquo; (FGD no. 03, Men, Bariadi).\u003c/p\u003e\n\u003cp\u003eIn the IDI and FGD interviews, the participants reported that fascioliasis is a disease that affects animals but not humans and that most animals are domestic, such as cows, goats, and sheep. A few participants reported that the disease is zoonotic, affecting animals first, and then it spreads to human beings through the consumption of raw meat. The animals develop disease through drinking dirty water in ponds and other water sources. According to most participants, the animal liver is the most affected part, and when eaten by a person, he/she become infected. Other participants reported that they had no knowledge of fascioliasis, and it was difficult for them to recognize whether the animal had fascioliasis. One FGD participant stated:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Regarding livestock, sometimes cows get very weak for unknown reasons, but I have realized that the problem is the liver. You will find that the liver is affected, even when the cow dies. When you slaughter it, you find that the liver has already been affected\u0026rdquo;\u003c/em\u003e (FGD no. 02, Women, Misungwi).\u003c/p\u003e\n\u003cp\u003eThe participants added that the symptoms of fascioliasis in animals are visible; when the animals develop the disease, they become weak, and they die later. However, human symptoms are not visible until a person is clinically examined. One interviewee explained:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;I think it is important for people to get regular checkups to determine if they have liverworms. Since the symptoms are not well known, my child might have liver worms, and I would not even realize it.\u0026quot;\u003c/em\u003e\u003cem\u003e\u0026nbsp;(\u003c/em\u003eKII no.05, Iringa).\u003c/p\u003e\n\u003cp\u003eThe results from the quantitative data revealed that blood in the urine of 227 patients (66%), burning urine of 165 patients (48%), abdominal pain of 105 patients (30.5%), and vomiting of 67 patients (19.5%) were the major signs/symptoms of schistosomiasis. The other symptoms are diarrhea, fatigue, and fever. For fascioliasis, the participants mentioned liver abnormalities in 126 (36%), swelling of the liver in 86 (25%), and nausea in 56 (16.3%) as significant signs and symptoms of the disease; however, vomiting, skin rashes, fever and diarrhea were also mentioned.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommunity attitudes and practices regarding schistosomiasis and fascioliasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings from quantitative data revealed that 176 (51.7%) of the respondents used tap water, and 177 (51.5%) used uncovered well water at home in their daily activities. The type of toilet mentioned by most of the respondents was a pit latrine 170, 49.4%), and 296 (86.0%) respondents frequently used toilets. The majority of the respondents mentioned watering livestock 271 (78.8%), bathing 308 (89.5%), and washing dishes 266 (77.3%) as activities involving the use of water from open sources or making contact with water.\u003c/p\u003e\n\u003cp\u003eAlmost 308 (89.5%) of the respondents were in frequent contact with water during their daily activities. Both schistosomiasis and fascioliasis were mentioned as dangerous diseases by 153 (48.7%) and 158 (76.5%) respondents, respectively.\u003c/p\u003e\n\u003cp\u003eThese findings are also consistent with the qualitative findings, as most of the participants mentioned swimming in ponds and activities for collecting water as a source of contracting the disease. The participants\u0026rsquo; narratives depicted the sources of water used for domestic purposes as unsafe because it is shared with animals, hence hindering their efforts to prevent themselves from becoming infected.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eWe are getting the disease by swimming in the ponds and by fetching water\u0026hellip;. When you go there to take bath or fetch water, then you find that the infected animal has to urinate in that water so you\u0026nbsp;\u003c/em\u003ebecome contaminated\u0026rdquo; (KII no. 07, Misungwi).\u003c/p\u003e\n\u003cp\u003eChildren\u0026rsquo;s tendency to play in open-water ponds and sometimes pass urine inside them was also cited as a risk factor for schistosomiasis. This is particularly true because the same water is used in the community for different purposes, such as irrigation and bathing.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;In\u003cem\u003e\u0026nbsp;all open water ponds, you will find children playing and urinating there; when you come to fetch that water, you find the parasites inside\u003c/em\u003e\u0026rdquo; (KII no. 04, Bariadi).\u003c/p\u003e\n\u003cp\u003eThe quantitative findings revealed that approximately half of the participants, 74 (46.5%), sought treatment from health facilities when they fell sick. On the other hand, in the qualitative analyses, 60 (37.7%) of the respondents reported using traditional medicine for fascioliasis and schistosomiasis treatment. In this context, they consider using drugs from nearby pharmacies/drug shops (self-medication) when traditional drugs fail. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When a person suspects he is infected, he buys medicines from the nearby drug shop and uses them\u0026nbsp;\u003c/em\u003e(KII no. 04, CHW, Bariadi).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During that age, I don\u0026rsquo;t remember, but I went to the hospital and was given medication.\u0026nbsp;\u003c/em\u003e(KII no 07, Iringa)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eToward zoonotic fascioliasis and schistosomiasis prevention and control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 344 respondents, only 19.2% (66/344) were aware of the presence of national programs for snail-borne disease control, and approximately half (50%, 33/66) mentioned reducing snail abundance as one of the main interventions for snail-borne disease control. Among the respondents, 22.4% (77/344) mentioned implementing snail-borne disease control activities in their area.\u0026nbsp;A lack of coordination among key sectors and stakeholders 57.3%, 197/344) was a common\u0026nbsp;problem affecting the implementation of control activities for snail-borne diseases.\u003c/p\u003e\n\u003cp\u003eThe participants in the qualitative studies (IDIs and FGDs) stated that efforts to control and eliminate snail-borne diseases should focus on community engagement and education, since most people are unaware of how these diseases are transmitted. One FGD participant stated:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eI am suggesting that health education has to be provided, but along with education, we should engage in dialogs with community members, health service providers, and the government\u0026rdquo; (\u003c/em\u003eFGD no. 8, Men, Iringa).\u003c/p\u003e\n\u003cp\u003eFurthermore, participants mentioned the importance of clean and safe water as one solution for controlling snail-borne diseases. Most participants stated that using dirty and unsafe water sources was the main challenge that could lead to people being infected with schistosomiasis and fascioliasis.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eThe government should plan to provide clean and safe water to communities. The government can dig water wells to provide clean and safe water for people and animals; this will also prevent people from going to rivers and ponds\u0026rdquo;\u0026nbsp;\u003c/em\u003e(KII no. 02, Bariadi).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClimate change and zoonotic fascioliasis and schistosomiasis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results from the\u0026nbsp;quantitative survey revealed that 198 (57.6%) of the respondents had already heard about climate change from various information sources, such as radio 132 (43.8%), school 34 (11.3%), and health workers 34 (11.3%).\u003c/p\u003e\n\u003cp\u003eThe majority of the respondents, 165 (83.00%), thought that climate change had occurred in their area through drought (96, 33.5%), increased/irregular seasons of rainfall and floods (45, 15.7%), increased temperature (64, 22.3%), irregular air movement/winds (18, 6.3%),\u0026nbsp;and other factors (55, 20.2%). Approximately 63 (31.8%) of the participants were aware of the link between climate change and schistosomiasis and fascioliasis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThere are climate change issues, drought, and floods, but currently, drought is the most extreme. Initially, we used to hear about Kenya, Mozambique, and Somalia...but now, it has reached Tanzania\u0026nbsp;\u003c/em\u003e(FGD NO.03, Men, Bariadi)\u003c/p\u003e\n\u003cp\u003eThe respondents mentioned deforestation at 100 (37.3%), pollution from industries at 29 (10.82%), population growth at 23 (8.58%), and other causes at\u0026nbsp;110 (41.01%) as the leading causes of climate change in their areas (Table 3). Approximately 155 (78.3%) of the respondents were affected by climate change, which affects 72.2% of livestock production. Approximately 72.7% of the respondents reported changes in livestock and agricultural production systems over the past ten years (Table 3). This finding is similar to the qualitative results, which show that most respondents narrate deforestation as a source of climate change and other causes.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eI think due to the increase in population, \u0026hellip;. Additionally, the activities\\mostly agricultural, pastoralism and deforestation\u0026rdquo;\u003c/em\u003e (KII no.04, CHW, Iringa)\u003c/p\u003e\n\u003cp\u003eApproximately 61 (42.4%) of the respondents agreed that climatic changes affect vector-borne diseases; however, only 49 (24.8%)\u0026nbsp;thought that there might be more or fewer snails, i.e., as a result of more/less rain or higher temperatures. Moreover, 99 (50%) of the respondents mentioned that changes in the occurrence of other vectors, such as mosquitoes and ticks, were affected by climate change. Approximately 139 (70.2%) people suffer from schistosomiasis/fascioliasis during the rainy season. The qualitative results indicate that the government and other stakeholders somehow fulfill their responsibility in combating climate change by using their professionalism to provide education on environmental conservation, assist in planting trees, and enact and manage laws to address climate change.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;\u003cem\u003eFirst and foremost, we should educate the community, especially about environmental conservation, which leads to significant climate change mitigation. Second, owing to climate change, we must educate people about proper food conservation and timely farming.\u0026rdquo;\u0026nbsp;\u003c/em\u003e(KII no. 7, Iringa)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;\u003cem\u003eOther institutions also have the same responsibility as the government, as I said earlier, to mobilize the community so that the community would know the advantages of trees and the disadvantages of not having trees as one of the climate change mitigation strategies\u003c/em\u003e (KII no.07, Misungwi)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Our national leaders or even the leaders in our neighborhood advise us not to cut firewood recklessly, not to farm near water sources, and not to cut down trees. If you have your land, when you cut down a tree, you must plant another one\u0026rdquo; (\u003c/em\u003eFGD no. 04, Women, Iringa\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003cem\u003e\u0026nbsp;\u003c/em\u003eClimate change and zoonotic fascioliasis and schistosomiasis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYour area/community has been affected by climate change, N=198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003eNumbers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e78.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eObserved any changes in agriculture and livestock production systems over the past ten years, N=198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e144 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e72.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThink livestock production has been affected by climate change (N=144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eDoes climate change have any effect on vector-borne diseases (N=144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e42.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eI think there have been changes in the number of snails, which have been caused by climate change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThink there are changes in the occurrence of other vectors (e.g. mosquitoes, ticks) which have been affected by climate change (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e50.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThink climate change has increased the transmission of schistosomiasis/fascioliasis in your area (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eTime of the year during which the\u0026nbsp;majority of people suffer from schistosomiasis/fascioliasis (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eRain season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eDry season\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eDon\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eWho do you think is responsible for the mitigation of climate change (N-198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eNongovernmental/environmental organizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eIndividuals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eThink the community in your area is responsible for the mitigation of climate change (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eHave your community ever taken any action to mitigate climate change (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e18.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eHave your government ever taken any action to mitigate climate change (N=198)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study explored KAP regarding zoonotic schistosomiasis and fascioliasis in the context of climate change around Lake Victoria and the\u0026nbsp;southern highlands ecological zones of Tanzania. The study findings show that the majority of respondents were aware of schistosomiasis; however, knowledge of fascioliasis was relatively low. Surprisingly, only a few respondents, 37.2%, knew the role of snail intermediate hosts in transmitting these diseases.\u003c/p\u003e\n\u003cp\u003eHigh awareness of schistosomiasis has been reported in other schistosomiasis-endemic areas in Zimbabwe [33], Kenya [34, 35], and Nigeria [36]. Similarly, a study conducted in Brazil revealed that people were reasonably familiar with schistosomiasis [37]. Most respondents in the present study were aware of schistosomiasis because of the ongoing MDA campaign through the NTD program under the Ministry of Health in Tanzania.\u003c/p\u003e\n\u003cp\u003eThe findings of the present study regarding poor knowledge of fascioliasis in an African context were also reported in South Africa by Olaogun et al. [38]. Similarly, poor knowledge regarding zoonotic transmission, prevention, and control was mentioned among farmers [26, 39]. The general lack of knowledge concerning fasciolosis among the participants observed in this study might also be due to the asymptomatic nature of the disease in cattle or because it is not routinely diagnosed in our healthcare settings.\u003c/p\u003e\n\u003cp\u003eThe consumption of contaminated raw vegetables and raw meat/liver was mentioned as a transmission route of fascioliasis. At the same time, schistosomiasis is considered to be transmitted through water contact, for example, by swimming in contaminated water ponds or wells.\u0026nbsp;This\u0026nbsp;finding is in line with a study in Thailand, which revealed that more than half of the participants had a good understanding of how fascioliasis is transmitted [40]. The same findings were reported in a study conducted in Ethiopia, where most respondents believed that the transmission of fascioliasis was caused by consuming raw meat [41]. A study in Ethiopia reported that most respondents mentioned fascioliasis, transmitted by eating raw meat and vegetables [15]. Moreover, no one was aware of the role of snails in transmitting the disease [15].\u003c/p\u003e\n\u003cp\u003eAlthough it is important to defecate in latrines and avoid contact with contaminated water sources, participants reported that it is impossible to avoid defecating in the water because they spend most of their time on farms where there are no latrines. A KAP study along the Lake Victoria region of Uganda [42] and a systematic review of KAP regarding schistosomiasis in Uganda [43] also revealed that avoiding contact with water was impossible since it is linked to the community’s livelihoods. Providing clean and safe water sources and raising awareness of latrine use in the community are considered\u0026nbsp;important interventions.\u003c/p\u003e\n\u003cp\u003eQuantitative and qualitative findings revealed that schistosomiasis and fascioliasis are\u0026nbsp;generally\u0026nbsp;considered dangerous diseases. Stigma and long-term adverse effects are the primary causes of disease severity. Indeed, research has demonstrated that in addition to anemia, liver problems, and numerous other adverse effects, chronic schistosomiasis and fascioliasis may cause stunting and hinder cognitive development [44]. Similarly, a previous study conducted in Kenya, parts of Uganda, and other places revealed that the community believed fascioliasis and schistosomiasis to be harmful illnesses. [34, 45, 46,\u0026nbsp;26]. The negative effects of these zoonotic diseases on both humans and animals might be the reason why they are perceived by the community to be dangerous.\u003c/p\u003e\n\u003cp\u003eConcerning health-seeking behavior regarding fascioliasis and schistosomiasis, most participants reported seeking treatment from health facilities when they fell sick. In contrast, few respondents reported traditional medicine as their first line of treatment. A study conducted in the Magu district of Tanzania revealed that in endemic areas, patients refer to traditional healers as care-seeking behavior [47]. A similar finding was reported in a study by [48] in Côte d’Ivoire and southern Mauritania, which showed that the community relies on self-medication and various herbal remedies to treat schistosomiasis.\u003c/p\u003e\n\u003cp\u003eMoreover, the results of this study revealed that changes in climatic conditions, such as rainfall and floods, have led\u0026nbsp;to a shift in the number of intermediate snail hosts, resulting in increased transmission of schistosomiasis and fascioliasis, with most people suffering during the rainy season. These findings align with those of [16, 17, 2], which showed that rising temperatures and changing patterns of precipitation associated with climate change could strongly impact the distribution and abundance of various species of IHS and their trematode parasites, resulting in a shift in the dynamics and transmission of these parasites to both humans and animals.\u003c/p\u003e\n\u003cp\u003eThe study revealed that approximately 31.8% of the participants were aware of the link between climate change and schistosomiasis and between climate change and fascioliasis transmission\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eA similar study conducted in Ghana on quantitative analysis of changes in the interannual total rainfall showed that\u0026nbsp;the total rainfall and number of rainy days positively correlated with the prevalence of schistosomiasis/fascioliasis in the area [49]. In another related study conducted in Ethiopia by Xue et al\u003cem\u003e.\u003c/em\u003e [50], rainfall was considered a prominent climatic factor responsible for increased incidence of snail-transmitting schistosomiasis by supplying sufficient water in ponds as breeding sites for snail intermediate hosts.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings from this study provide some baseline information for understanding zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania. This study revealed knowledge gaps, risk practices, and a lack of coordination across sectors and stakeholders. This calls for a multidisciplinary approach to controlling and preventing zoonotic schistosomiasis and fascioliasis, and the need for proper climate change mitigation initiatives. This study suggests the adoption of a comprehensive one-health approach that considers the interconnectedness of human, animal, and environmental health (climate change mitigation) to effectively mitigate zoonotic fascioliasis and schistosomiasis burdens and increase community well-being.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eFGD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eFocus group discussion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKAP \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eKnowledge, Attitude, and Practice\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIDI\u003c/strong\u003e In-depth interview\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIHS\u003c/strong\u003e Intermediate host snail\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eMass drug administration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNIMR\u003c/strong\u003e National Institute for Medical Research\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNTD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003eNeglected tropical disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSA\u003c/strong\u003e\u0026nbsp; Sub-Saharan Africa\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the Regional Commissioners of the Mwanza, Simiyu, and Iringa regions; the District Executive Directors of the Bariadi, Misungwi, and Iringa Rural districts; the Regional and District Veterinary Officers; and the Village and Subvillage leaders for their cooperation during fieldwork. We are grateful to Coleman Kishamawe and Yasinta Sylivester for their technical assistance during the fieldwork.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGSM, SK, JN, AK, and\u0026nbsp;BJV conceptualized and designed the study; GSM, SK, JM, RN, and JN planned and conducted the fieldwork; GSM, RN, and\u0026nbsp;JM analyzed the data and drafted the manuscript; and GSM, JN, AK, SK, RN, JM, MEV AS and BJV revised and improved the final version of the manuscript. The authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the PREPARE4VBD project, which has received funding from the European Unionʼs Horizon 2020 Research and Innovation Programme under grant agreement No. 101000365.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Medical Research Coordinating Committee of the National Institute for Medical Research in the United Republic of Tanzania, (Ref. NIMR/HQ/R.8a/Vol. IX/3860). Support letter was obtained from Sokoine University of Agriculture. Permission letter was obtained from study region/districts and from village leaders. An informed consent process was followed before the study commenced to obtain written informed consent from the study participants to participate in the research and for their data to be published\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission to publish this paper was obtained from the Director General of the Tanzanian National Institute for Medical Research (NIMR).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAngeles JMM, Leonardo LR, Goto Y, Kirinoki M, Villacorte EA, HHakimi H, et al. Water buffalo as sentinel animals for schistosomiasis surveillance. 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Community knowledge, attitudes and practices related to schistosomiasis and associated healthcare-seeking behaviors in northern C\u0026ocirc;te d\u0026rsquo;Ivoire and southern Mauritania, Infectious Diseases of Poverty (2018) 7:70 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40249-018-0453-0\u003c/span\u003e\u003cspan address=\"10.1186/s40249-018-0453-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCodjoe SNA, Larbi RT. Climate change/variability and schistosomiasis transmission in the Ga district, Ghana. Clim. Dev. 8 (2016) 58\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXue Z, Gebremichael M, Ahmad R, Weldu ML, Bagtzoglou AC, Impact of temperature and precipitation on propagation of intestinal schistosomiasis in an irrigated region in Ethiopia: Suitability of satellite datasets. Trop. Med. Int. Health 16 (2011) 1104\u0026ndash;1111.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fascioliasis, Schistosomiasis, Climate, Trematode, Knowledge, Attitude, Practices, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-6576554/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6576554/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eZoonotic fascioliasis and schistosomiasis, which are transmitted by climate-sensitive freshwater snails, are neglected tropical diseases of medical and veterinary importance. Although zoonotic fascioliasis and schistosomiasis have been reported in both humans and domestic ruminants in Tanzania, little is known about the knowledge, attitudes, and practices (KAP) of local communities concerning the occurrence, transmission, and risk factors for zoonotic schistosomiasis and fascioliasis in Tanzania. To address this knowledge gap, we conducted a KAP survey in Lake Victoria and the southern highlands of Tanzania to investigate community KAP regarding the transmission, risk, and prevention of zoonotic schistosomiasis and fascioliasis. Given that climate change potentially causes increased levels of schistosomiasis and fascioliasis, particularly in highland areas, we also investigated the general knowledge of communities about climate change and how climate change may impact schistosomiasis and fascioliasis.\u003c/p\u003e \u003cp\u003eMost of the study participants (91.3%) had already heard of zoonotic schistosomiasis, 45.9% had ever heard about zoonotic fascioliasis, and 57.6% were aware of climate change. Nevertheless, only 37.2% knew snails as intermediate hosts of zoonotic fascioliasis and schistosomiasis. The consumption of raw vegetables (57.3%), raw liver (28.3%), and contaminated water (12.1%) was mentioned as how fascioliasis can be transmitted. Among the study participants, 55.7% emphasized that schistosomiasis is transmitted through contact with contaminated water. A lack of coordination between sectors and stakeholders was mentioned by 57.3% of the participants as a common constraint affecting the implementation of zoonotic schistosomiasis and fascioliasis control programs. Approximately 31.8% of the participants understood the link between climate change and zoonotic schistosomiasis and fascioliasis. This study reveals knowledge gaps in risk perception and a lack of coordination between sectors and stakeholders, which calls for the adoption of multidisciplinary and multisectoral approaches to control and prevent zoonotic schistosomiasis and fascioliasis, and the need for appropriate climate change awareness and mitigation initiatives.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitudes and practices of zoonotic fascioliasis and schistosomiasis in the context of climate change in Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 18:28:17","doi":"10.21203/rs.3.rs-6576554/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a9d18a8-a3a7-4c4c-9ff9-ea82b324be09","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-11T06:53:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-13 18:28:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6576554","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6576554","identity":"rs-6576554","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}