In Adasawase, a rural Ghanaian town, 36% of girls (n=43/119) and 51% of boys (n=69/134) who were screened three times were infected with S. haematobium as of 2008. Praziquantel was administered by Ghana Health Services. In 2009, schoolchildren were screened three or more times and prevalence was estimated to be 13% (n=13/98) among girls and 24% (n=29/122) among boys, indicating ongoing transmission of S. haematobium. In 2009, children again received praziquantel. Children in Adasawase contract schistosomiasis in the Tini River where they play, bathe, and collect water. An intervention in the form of a novel water recreation area (WRA) was designed and implemented to function as an effective, sustainable form of primary prevention. It consists of a concrete pool supplied by two hand-pumped boreholes and a rainwater collection system. Adasawase was selected for the study based on the relatively high prevalence of urogenital schistosomiasis, strong support of the project by community leaders, and water availability. Concrete structural elements were constructed in 2008 and waterproofing and aesthetic touches were completed in 2009. The WRA was opened for public use after praziquantel treatment in 2009. Community members operate and maintain the WRA. Local children were encouraged by community leaders to use the WRA instead of the Tini River for recreation.

In 2010, one year after opening the WRA, children were screened at least three times for S. haematobium eggs; only 2% of girls (n=2/105) and 5% of boys (n=7/141) were positive, reflecting annual incidence after WRA construction. Risk factors associated with infection also changed significantly during the course of the study. Age, sex, and observed river use in 2009 correlated with 2008 infection status. Observed river use and previous infection status were the only significant risk factors in 2009. Statistical analysis of positive children in 2010 was not possible due to the small number of positive children. The WRA should be evaluated in other water-rich regions to determine whether it is effective and sustainable in other settings. Continued praziquantel administration is still necessary for morbidity control and should be promoted in conjunction with WRAs.