Behaviour change interventions for the control and elimination of schistosomiasis: A systematic review of evidence from low- and middle-income countries

Modifying people’s risk practices through behaviour change (BC) interventions can strengthen schistosomiasis control. Disease transmission can be interrupted by controlling peoples’ exposure to infected water, open defaecation practices, and by fostering treatment acceptance. We reviewed peer-reviewed publications released before June 2021 to assess the effectiveness of BC projects in decreasing risk practices and disease prevalence. 32 publications reporting on 31 projects based in Low- and Middle-Income countries were fully examined. Projects used four approaches: health education (HEIs), social-environmental (SEIs), physical-environmental (PEIs), and incentives-centred interventions (ICIs). Available data could not assert which approach was most effective in reducing risk behaviour. Structural barriers limited HEIs’ effects, whilst community social and material conditions affected those of SEIs. Both demanded comprehensive infrastructure investments. The cost-effectiveness of ICIs, in turn, remain unclear. Limited evidence of independent epidemiological impacts from BC was found. Indicative evidence, however, shows that BC projects could sustain gains attained through treatment activities. Overall, investment in integrated interventions appear needed to address exposure and transmission behaviour, whilst a context-driven strategic use of HEIs or SEIs appears useful to prompt treatment uptake. Despite BC’s potential, treatment activities appear essential for epidemiological effects.