title: A mixed-methods approach to understanding water use and water infrastructure in a schistosomiasis-endemic community: case study of Asamama, Ghana.
abstract: BACKGROUND
  Surface water contaminated with human waste may transmit urogenital schistosomiasis (UGS). Water-related activities that allow skin exposure place people at risk, but public health practitioners know little about why some communities with access to improved water infrastructure have substantial surface water contact with infectious water bodies. Community-based mixed-methods research can provide critical information about water use and water infrastructure improvements.
  
  
  METHODS
  Our mixed-methods study assessed the context of water use in a rural community endemic for schistosomiasis.
  
  
  RESULTS
  Eighty-seven (35.2 %) households reported using river water but not borehole water; 26 (10.5 %) reported using borehole water but not river water; and 133 (53.8 %) households reported using both water sources. All households are within 1 km of borehole wells, but tested water quality was poor in most wells. Schistosomiasis is perceived by study households (89.3 %) to be a widespread problem in the community, but perceived schistosomiasis risk fails to deter households from river water usage. Hematuria prevalence among schoolchildren does not differ by household water use preference. Focus group data provides context for water preferences. Demand for improvements to water infrastructure was a persistent theme; however, roles and responsibilities with respect to addressing community water and health concerns are ill-defined.
  
  
  CONCLUSIONS
  Collectively, our study illustrates how complex attitudes towards water resources can affect which methods will be appropriate to address schistosomiasis.
authors.affiliation: Department of Community Health, Tufts University, 574 Boston Avenue, Medford, Massachusetts, 02155, USA. karen.kosinski@tufts.edu.
authors.forename: Karen Claire
authors.initials: KC
authors.lastname: Kosinski
authors.affiliation: Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, 02155, USA.
authors.forename: Alexandra V
authors.initials: AV
authors.lastname: Kulinkina
authors.affiliation: , Annapolis, Maryland, 21401, USA.
authors.forename: Akua Frimpomaa Atakora
authors.initials: AF
authors.lastname: Abrah
authors.affiliation: , P.O. Box 399, Teshie-Accra, Ghana.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Adjei
authors.affiliation: , Springfield, Massachusetts, 01129, USA.
authors.forename: Kara Marie
authors.initials: KM
authors.lastname: Breen
authors.affiliation: Mayo Medical School, Rochester, Minnesota, 55905, USA.
authors.forename: Hafsa Myedah
authors.initials: HM
authors.lastname: Chaudhry
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, 98112, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Nevin
authors.affiliation: , Somerville, Massachusetts, 02155, USA.
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: Warner
authors.affiliation: Department of Community Health, Tufts University, 574 Boston Avenue, Medford, Massachusetts, 02155, USA.
authors.forename: Shalini Ahuja
authors.initials: SA
authors.lastname: Tendulkar
mesh_terms: D000293:Adolescent; D000328:Adult; D019353:Endemic Diseases; D005191:Family Characteristics; D005260:Female; D017144:Focus Groups; D005869:Ghana / Q000453:epidemiology; D006417:Hematuria / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D045483:Rivers; D012424:Rural Population / Q000706:statistics & numerical data; D012553:Schistosomiasis haematobia / Q000453:epidemiology*; D014871:Water Microbiology; D014881:Water Supply; D060986:Water Wells; D055815:Young Adult
keywords: Borehole; Improved water source; Mixed-methods; River; Schistosoma haematobium; Surface water; Urogenital schistosomiasis; Water infrastructure