The Role of Socio-Cultural-Cognition in Disease Prevalence and Risky Behaviour among Children: A Conceptual Framework

Abstract

It is estimated that 93% of the global schistosomiasis prevalence is found in sub-Saharan Africa, with the highest prevalence and intensity rates occurring in children and adolescents. Schistosomiasis infection is associated with detrimental developmental effects. The current study presents a hierarchical conceptual framework for understanding the role of socio-cultural-cognitive factors that influence risk behaviour among children, especially young girls, living in this hyperendemic setting. This study sought to determine the impact of caregiver monitoring on adolescent girl's risk behaviours that may increase their risk of infection, especially with schistosomiasis, a neglected tropical disease that is pandemic in this region and has been associated with increased risk of HIV infection. This was a school-based, cluster, randomised, cross-sectional study conducted among 970 adolescent girls living in KwaZulu-Natal, South Africa. A questionnaire was administered by a trained research counsellor and urine samples were co microscopy. Microscopy results showed a moderate prevalence of schistosomiasis infection (32.2%) among girls. Binary logistic regression revealed social (playing and swimming) and domestic (collecting water, doing laundry and washing blankets) water contact behaviours as significant predictors of infection. Caregiver monitoring was ineffective in reducing risk behaviours. The current study presents a conceptual model for understanding disease acquisition among children living in resource limited settings. The SCC model highlights the role of social and culturally rooted interactions that influence an adolescent girl's capacity to act; subsequently increasing their risk of schistosomiasis and HIV infection.