Eradication of schistosomiasis in Guangxi, China. Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future

Reported are the results of a community-based assessment of maintenance of schistosomiasis eradication in Guangxi, a large autonomous region of China with a population of 44 million. Eradication of the disease was acheived in 1989 in Guangxi but maintenance costs are rising. We focused on three coun ties that had the most intense transmission in the past: Binyang, Jingxi, a nd Yishan. Four instruments were used: in-depth interviews, focus group dis cussions, a knowledge, attitudes and practices survey and subsequent commun ity feedback. In the past, schistosomiasis had serious consequences in Guangxi, decreasin g work capacity and restricting marriage and occupational mobility. Since i fs eradication there have been clear benefits in terms of increased agricul tural output and improved farming conditions. Personal habits and tradition al manual farming activities in Guangxi would continue to expose a large pr oportion of the population to environmental risk if the disease were to ret urn. Ignorance about control programme achievements is increasing and is re lated to youth and inexperience. There was a universal desire in the study counties for more local education about the history of the programme and ab out the risk of schistosomiasis returning. Snail surveillance is considered important, but people are not willing to volunteer for such work. Our study methods were novel for Guangxi and community feedback was helpful . Snail checking procedures have been modified to make them more efficient and no snails have been found since 1992. The animal and human stool examin ations have ceased and vigilance now concentrates on snails and children (s kin tests). The long-term strategy is to make the population invulnerable t o future schistosomiasis transmission if the snail vectors return. This mea ns continuing education and making the former endemic counties a high prior ity for wafer and sanitation improvements.