Bilharzia and the boys: questioning common assumptions

There is insufficient and inadequate information to gauge the impact of schistosomal infection on the health of women. Biomedical research has equated women's health with the study of reproductive performance and reproductive organs and this narrow focus has left a number of important questions unanswered. Attempts to explore the economic and social aspects of schistosomal infection have been minimal and most research has focused on men rather than women. It has two characteristics: first, economists have relied on single performance indicators which are rooted in the cultural traditions of the research workers rather than the participants. Second, questionnaires have been used to elicit perceptions of health and illness; and local, culturally-specific information has not even been used to formulate the questions. Future research assessing the social and economic aspects of infection among women would be enhanced by undertaking inter-disciplinary research, with an ethnographic component; and blending qualitative with quantitative methods. Research assessing the impact of schistosomal infection on daily activities has been undertaken in Omdurman aj Jadida, Sudan. Biomedical and continuous observational data were blended with ethnographic information and the analyses of these data suggest that Schistosoma mansoni exerts a differential impact on female activity patterns. That is, infection by S. mansoni significantly impaired female activities in the agricultural sphere whereas infection by S. mansoni did not have any significant impact on female activities in the domestic sphere. Variations in the nature and extent of work undertaken by these two groups of women as well as differential exposure to solar radiation probably accounts for these recorded differences. The limited and tentative nature of biomedical, economic, sociological and anthropological information assessing the impact of schistosomal infection on the health of women adds to the current controversies about whether schistosomiasis should continue to be given priority as a public health problem. Further research is essential to clarify this important issue.