THE STUDY OF HUMAN BEHAVIOR AND SCHISTOSOMIASIS TRANSMISSION IN AN IRRIGATED AREA IN MOROCCO S. WATTS, 1 * K. KHALLAAYOUNE, 2 R. BENSEFIA, 3 H. LAAMRANI 2 and B. GRYSEELS 4 1 Social Research Center, American University in Cairo, Box 2511, 11511 Cairo, Egypt, 2 Department of Parasitology, Institut Agronomique et Veterinaire Hassan II, Rabat, Morocco, 3 Faculty of Law, Rabat, Morocco and 4 Director, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium AbstractÐThis paper presents a research strategy for studying water contact, water use and schistoso- miasis transmission in an irrigated area of Morocco. This setting, with many scattered water contact sites, many activities carried out at these sites, and the small number of people involved, was not appro- priate for a conventional water contact study based on the observation of water contact sites, such as had been carried out in the Nile delta. The Moroccan study utilizes three related concepts: the house- hold, time geography, and the gendered use of space. It seeks to understand processes and interrelation- ships underlying the daily mobility pattern of individual households, and seen as part of a larger system of organization and structure in time and space. The preliminary results of the study indicated the complexity and dynamism of water use and water contact, which need to be considered in planning disease control strategies especially in changing settings, such as those associated with environmental interventions in the study area. # 1998 Published by Elsevier Science Ltd. All rights reserved Key wordsÐschistosomiasis, irrigation, water contact, time geography, household, gender INTRODUCTION Next to malaria, schistosomiasis has in recent times been one of the most destructive diseases in tropical and subtropical areas. It weakens and debilitates the suerer, aects people's ability to carry out physical labor and, if untreated, in the long term undermines the functioning of the liver and ulti- mately causes death (Farley, 1991). Irrigation and other water development projects present particu- larly favorable locales for the survival and spread of the disease. The possibility of extremely high rates of infection in newly irrigated areas, or those in which irrigation is being expanded, is demon- strated in the Richard Toll irrigation project near the mouth of the Senegal River. Here, a recent out- break of Schistosoma mansoni in one village recorded an infection rate of almost 100% in people over 5 years of age (Stelma et al., 1993). Schistosomiasis is not a disease threat to be taken lightly. The transmission of schistosomiasis occurs when humans come into contact with water containing schistosomes which penetrate the skin, following the contamination of the water by infected humans who excrete schistosome eggs in feces (in the case of Schistosoma mansoni) or in urine (in the case of S. haematobium). To complete their life cycle, and infect humans, the schistosome requires an inter- mediate snail host in the water source. The disease persists because people in endemic areas continue to contaminate water during excretory activities, and come into contact with potentially infective water sources during domestic, recreational and agricul- tural activities. An understanding of who, where, how, when and why people engage in behavior which puts them at risk of perpetuating or contracting schistosomiasis through water contact activities should be essential input in any integrated schistosomiasis control pro- grams. Answering these questions requires collabor- ation between researchers in the social sciences and those in the ®elds of medicine, biology, parasitology and engineering. Planning and implementation should also involve the sta in various government sectors, including health, irrigation, agriculture, and potable water supply. However, there is frequently a lack of communication among these groups because of dierent professional and sectoral inter- ests (Hunter et al., 1993). This paper presents a strategy for studying water use and water contact which has been devised for use in an interdisciplinary research project in the Tessaout Amont irrigation scheme in the Haouz plain of central Morocco. This setting, with many scattered water contact sites, many activities carried out at these sites, and the small number of people involved, was not appropriate for a conventional water contact study based on the observation of Soc. Sci. Med. Vol. 46, No. 6, pp. 755±765, 1998 # 1998 Published by Elsevier Science Ltd. All rights reserved Printed in Great Britain 0277-9536/98 $19.00 + 0.00 PII: S0277-9536(97)00171-8 *Author for correspondence. 755