Published in PLOS One on 2026-08-19, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Haruna Moshi, Betwel J. Msugupakulya, Mahnaz Vahedi, Franklin N. Glozah
Source: PLOS One • DOI 10.1371/journal.pone.0348920
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Schistosomiasis remains a significant neglected tropical disease of public health concern, particularly in Sub-Saharan African countries, including Ghana. For decades, school-based preventive chemotherapy (PC) has been the mainstay of schistosomiasis elimination in Ghana; however, implementation fidelity across districts falls below WHO recommendations, leading to persistent transmission. This study explores contextual factors that influence the implementation fidelity of school-based preventive chemotherapy for schistosomiasis in endemic districts.
A phenomenological qualitative study design using a maximum-variation purposive sampling technique was conducted in two endemic districts (Gomoa East and Awutu Senya East) in Ghana, with 21 participants, six key informant interviews with district Neglected Tropical Diseases (NTDs) coordinators and School Health Education Program (SHEP) coordinators, and 15 in-depth interviews with head teachers and SHEP teachers. Recruitment of participants and data collection were conducted from 20/06/2025 to 30/07/2025 using semi-structured interview techniques and were thematically analyzed in NVivo version 15, guided by Braun & Clarke framework. The thematic analysis blended inductive and deductive coding techniques; inductive allowed themes to emerge from the data, while deductive was guided by the Consolidated Framework for Implementation Research (CFIR), and a framework for implementation fidelity.
Implementation fidelity was shaped by the interplay of sociocultural, organizational, and health system factors. Key barriers included socio-cultural beliefs and perceptions on treatment uptake, drug-related fears and adverse reactions, logistical constraints and resource limitations, lack of training and incentives for frontline implementers, inadequate community sensitization and engagement, and gaps in coverage and adherence to program protocols. Conversely, fidelity was much better in situations where awareness had been raised, the community was effectively engaged, frontline implementers were motivated, and collaboration was strong among the health and education sectors, suggesting that high fidelity can be achieved through a systemic response.
Implementation fidelity of school-based preventive chemotherapy is a context-dependent, system-driven process shaped by the complex interaction of socio-cultural and structural factors. Moving forward, to enhance fidelity and achieve sustained schistosomiasis control requires a shift toward a community-centered delivery approach that emphasizes community sensitization and engagement, reliable logistical support, effective training and motivation for frontline implementers, and intersectoral collaboration.
Background
Schistosomiasis is a neglected tropical disease caused by parasitic trematodes of the genus Schistosoma. It remains a significant public health problem in many low- and middle-income countries, particularly in sub-Saharan Africa. In Africa, Schistosoma mansoni and Schistosoma haematobium are the predominant species, responsible for intestinal and urogenital schistosomiasis, respectively [1]. Transmission occurs through contact with freshwater contaminated with cercariae released by infected freshwater snails, which penetrate human skin and mature into adult worms within the host [2]. Because transmission is strongly linked to routine water contact and inadequate water, sanitation, and hygiene infrastructure, schistosomiasis persists in communities with frequent exposure and limited environmental control. These characteristics make preventive chemotherapy (PC) delivered at schools and the community level a cornerstone of schistosomiasis control strategies [3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Haruna Moshi, Betwel J. Msugupakulya, Mahnaz Vahedi, Franklin N. Glozah. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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