Re-assessing disability: The impact of schistosomal infection on daily activities among women in Gezira Province, Sudan

Schistosoma mansoni is often perceived by governments and international aid agencies to present a major public health problem in the tropical and sub-tropical world. This perception persists in spite of the fact that biomedical practitioners and research workers disagree about the nature and extent of disease and disability caused by schistosomes. This paper raises the question of whether S. mansoni should continue to be given priority as a public health problem in Gezira Province, Sudan. Biomedical and continuous observational data are blended with ethnographic information in order to develop a more integrated picture of the impact of S. mansoni on daily activity patterns among women. Research took place in one village in the Gezira/Managil irrigation scheme. The study is characterized by a small sample and a paired design. That is, 11 infected women were paired with 11 uninfected women. These women were engaged in agricultural activities in the cotton picking season and they were matched for a wide range of social and economic factors that might otherwise have affected their working activities. Observations were conducted on a minute by minute basis in the cotton fields. These data, in combination with ethnographic information and data indicating female productive output, showed that infection with S. mansoni significantly altered activity patterns in the cotton fields. That is, infected women (with an arithmetic mean egg output of 1958 eggs/g) attempted to pick as much cotton as possible in the shortest time period feasible in the morning. This pattern was partially repeated by infected women who returned to the fields in the afternoon. However, a significant number of infected women felt too weak to sustain this work regime and the economic implications of this finding are discussed. Finally, Fisher's exact probability test showed that infected women were significantly less likely to undertake personal care activities between cotton picking sessions and this result suggests they may have been too tired and/or had a diminished perception of their own well-being. The implications of these results for public health policy in Gezira Province are discussed.