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Religious practices and Neglected Tropical Diseases: What is the connection?

News article 26 Feb 2019
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Figure 2: Full immersion Christian water baptism. Credit: DailyAdvent

By Dr Samuel Armoo 

On a warm and humid Sunday afternoon during a COUNTDOWN field trip on schistosomiasis related to our implementation research on expanding the mass drug administration treatment against schistosomiasis and soil-transmitted helminthiasis,  I observed 20 individuals performing the Christian practice of baptism by full-water-immersion in Manheam - a community along the Weija dam where schistosomiasis remains highly endemic.

My interaction and discussions with the people revealed that participants were not local to the community but had travelled from afar to baptise or be baptised in the dam. I also found out that this was a common practise among many churches in Accra, as Weija dam was within easy commute. So how could I ignore this observation as my COUNTDOWN team had revealed active on-going transmission of schistosomiasis, a parasitic disease also known as bilharzia, being highly endemic in the local community. This meant that many of these unsuspecting individuals, living in areas further away with no risk of infection, could now be exposed to a disease in the process of practising this religious act. The Weija dam is within a day’s trip to millions of Ghanaian Christians, so the significance of this observation should not be overlooked. Moreover, Ghana is a deeply religious country, with about 70% of the population being Christians.

Infection occurs when the larval forms of the parasite are deposited by freshwater snails which can penetrate the skin when it comes into contact with the infested water. The parasitic worms that cause schistosomiasis can live up to 40 years within the system of an infected individual if left untreated. As a result of a single water baptism in an infested water source, this can lead to contracting this disease, with unfortunate life changing experiences. 

Figure 1: Several activities at Manheam that bring people in contact with schistosomiasis- infected water.

The World Health Organisation estimates that over 200 million people around the world are infected with the Schistosoma parasites, with most of the burden of prevalence in sub-Saharan Africa. Ghana is one of the top five countries (Nigeria, Tanzania, Ghana, the Democratic Republic of Congo, Mozambique) on the continent with high prevalence rates of schistosomiasis.

In sub-Saharan Africa the disease presents in two forms: intestinal schistosomiasis, which is caused by S. mansoni, and urinary schistosomiasis, which is caused by S. haematobium. Urinary schistosomiasis known as urogenital schistosomiasis also affects women’s reproductive health leading to infertility, social stigma and an increased rate of abortion. The lesions associated with retained S. haematobium eggs in the female urogenital tract have been associated with an increased risk of HIV infection. For male genital schistosomiasis, the most common symptoms include blood in semen, inflammation of one or both testicles, and prostate inflammation. Both intestinal and urinary schistosomiasis results in anaemia and impaired childhood development, with the risk of reduced intellectual function.

The current control strategies for schistosomiasis is mainly based in identified endemic communities, who usually have close proximity to dams, lakes and other still water bodies. Despite the many successes against the disease in Ghana, it still remains a public health threat. Many areas in Accra are not within the control radar for the national control programme with regards to schistosomiasis. The frequent water baptism in the infested Weija dam area could mean a large cohort of infected individuals living outside the targeted intervention communities. And the most concerning issue is that many of these individuals may not be aware of their infection status and may relate the symptoms of schistosomiasis to other diseases, and wrongly treat them. This calls for an urgent need to inform, communicate and ultimately educate those largely oblivious to the risks of schistosomiasis, in a professional manner allowing them to seek better alternatives.

My suggested way forward is for the churches to create safer places for water baptism, without losing its religious significance and connection or to educate about the risks of infected water sources. The national or district disease control programmes could help advise and collaborate with churches to set up safer ponds with treated water, since people should not be prevented from exercising their Christian faith. Environmental control of schistosomiasis has a long history of local water engineering schemes but is sadly often forgotten. Despite the dangers of drowning in the lake during baptism activities – like was reported a few weeks after my observation, the risks of contracting schistosomiasis during baptism needs to be mitigated and addressed as part of the national NTD control programme.

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Dr Samuel Armoo is the Head of the Biomedical and Public Health Research Unit at the Council for Scientific and Industrial Research – Water Research Institute (CSIR-WRI) in Accra, Ghana. You can reach him via his email: Samuel.k.armoo@gmail.com