Precision mapping of hybrid schistosomes in urogenital schistosomiasis: Research lessons learned from stakeholder dialogue, community engagement and household access in two study communities in southern Malawi.

Conducting health research in rural settings of sub-Saharan Africa presents unique challenges and we present our experiences and lessons learned from stakeholder dialogue, community engagement and household mapping strategies for precision mapping of hybrid schistosomes in two study communities of southern Malawi. Targeting to recruit a total sample size of 2400 individuals aged 2 to 45 years, in 2022 we carried out stakeholders’ engagement at district, area and village levels through meetings with representatives from governmental and non-governmental organizations and communities. Community sensitization was achieved through village meetings and public address systems, facilitating local buy-in for a successful Global Positioning System mapping of 1214 households leading to recruitment of a total of 2319 (96.6 %) participants of the 2400 target within a 20-days period. Follow-up surveys in 2023 and 2024 retained 2006 (86.5 %) and 2014 (86.8 %) participants, respectively. Stakeholders and communities were supportive of the study activities and assisted with in kind support. Main challenges in cohort retention were recalcitrant beliefs about disease aetiologies and community displacement following cyclonic flooding. The unfamiliar concept of parasite hybridization and zoonosis in urogenital schistosomiasis required repeated, carefully tailored messaging to build understanding and trust. Our study's experience demonstrates that engaging key stakeholders and community members builds trust, promotes acceptability and ownership, and increases the likelihood of successful implementation of health research activities.