Development and rapid assessment of community based health educational package for control of taenia solium cysticercocis/taeniasis in Tanzania
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Date
2024-05
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Sokoine University of Agriculture
Abstract
aenia solium taeniasis/cysticercosis is a neglected parasitic zoonosis with
significant economic and public health impacts worldwide. Food and
Agriculture Organization of the United Nations (FAO) and the World Health
Organization ranked it first on the global scale of food-borne parasites. Taenia
solium cysticercosis/taeniasis (TSCT) impacts is more in developing countries,
including Tanzania, where social, economic, and cultural conditions favour its
endemicity. Community knowledge is central in successful disease control in
endemic areas. For control intervention to be effective and sustainable it
should engage the community from planning stage. The study addressed the
gap on knowledge, attitude and practices related to the disease, developed
and conducted rapid assessment of a community-based health educational
package (CHEP) for the prevention and control of TSCT in Tanzania. The
study employed a community-based mixed methods approach involving
different qualitative and quantitative approaches, using questionnaire for the
household survey from 483 selected households, in addition, household
infrastructure observations were conducted to the same 483 randomly
selected households, Focused Group Discussions (FGD) and Key Informants
Interviews (KII) were also conducted in Mbulu, Rungwe, Mbinga and
Mpwapwa districts. The information collected led to the formulation of key
messages for the development of a health education package, which
comprises four components including; a training manual for the training of
trainers (TOTs), a booklet with illustrations and instructions on how to perform
small doable actions, brochure with key messages and poster with a
tapeworm life cycle indicating the areas which can be targeted to interrupt the
transmission. The formative research method was used in the development of
the package. It is expected that the CHEP will be sustainable as it is
development engaged the community in all stages of development.
The CHEP developed was assessed in Babati district. This was done to
assess the effectiveness of the package towards improvement of community
knowledge attitude and practices towards control of TSCT. Qualitative data
were analysed using thematic analysis. Descriptive statistics and chi-square
test were used to analyse quantitative data including data on knowledge,
attitude, and practices. Binary logistic regression was used to examine factors
influencing socio demographic factors on knowledge and related practices,
both independent and dependent variables were used. Socio demographic
factors assessed were sex, age, district/location, education level, age group,
main source of income, period of residence in years, and Savings and Credit
Cooperative Society. The results revealed good knowledge about porcine
cysticercosis, particularly among pig keepers across the districts. Majority of
participants (48%) had heard about the pork tapeworm and the knowledge
about clinical signs/symptoms and treatment was fair, but the means of
transmission and prevention measures were often unknown. The risk
perception of the infection with the pork tapeworm was low too and a similar
trend is reflected in the attitudes toward the low-risk perception of
cysticercosis infection. Hand washing practices was also low, many
participants reported not washing their hands before eating or after using the oilet which highlights potential risks for the transmission of human
cysticercosis. Almost all participants reported using the toilet always, however,
household observations revealed that toilets were either lacking or had no
complete walls, with others showing the sign of not being used for some time.
Generally, household observations revealed a discrepancy between
responses to the questionnaire on one hand and the availability of toilet and
handwashing facilities, and the confinement of pigs on the other hand. This
highlights the importance of including household observation during data
collection. Respondents with tertiary education were more likely to have heard
of tapeworm, be aware of T. solium transmission, be aware of T. solium health
effects, and be aware of human cysticercosis transmission. Male respondents
were more likely to be knowledgeable about porcine cysticercosis
transmission. Lack of standardised education materials about the disease
might influence the quality of health education in different infected
communities. Using the gathered information, the health education package
on knowledge, attitude, and practices reported a statistically significant
improvement in knowledge regarding the link between epilepsy and
cysticercosis and in the practice of washing fruits and vegetables, however,
the long-term effect of the health educational package on knowledge, attitude,
and practices and the disease parameter need to be evaluated. This study has
revealed poor knowledge of T. solium Cysticercosis/Taeniasis with generally
better knowledge about its effects on porcine than on human health. The
limited overall knowledge, together with negative attitudes and practices may
represent an important barrier to TSCT control and elimination efforts. It is
therefore recommended to scale up the efforts of knowledge sharing with the
general population on transmission, TSCT clinical signs/symptoms, control,
treatment, and prevention in Tanzania, preferably adopting one health
approach, to improve favourable knowledge, attitude for control and eventual
eradication of TSCT. The study shows that socio-demographic factors have a
direct influence on knowledge and practices related to TSCT. Education was
the most important factor among the others and contributed significantly to the
overall models that determined knowledge and practices related to TSCT. It is
therefore, recommended that studies that include health education
interventions also consider socio-demographic factors. Another area covered
by this study was the development and rapid assessment of the health
educational package which revealed an improvement in knowledge regarding
tapeworm treatment from 61 (81.3%) pre-intervention to 76 (95.0%) post-
intervention, while the knowledge regarding condemnation of infected pork
increases from 65 (83.3%) pre-intervention to 73 (90.1%) post-intervention.
Practices about washing vegetables and fruits significantly improved
(P=0.025), while, that of pigs’ confinement increased from 45 (77.6%) pre-
intervention to 54 (88.5%) post-intervention. It is recommended that to achieve
the maximum impact of the intervention, the educational package should be
combined with other existing control strategies as well as other intervention
methods such as video, cartoons for school children, and a computer-based
health-education tool such as the vicious worm. It is also recommended that
the interventions preventing TSCT reinfection, such as improvements in
hygiene achieved through health education, are urgently required to augment
the effect of other control strategies as part of an integrated approach.
Description
PhD Thesis
Keywords
Rapid Assessment, Community Based Health Educational, aenia Solium Cysticercocis, Taeniasis, Tanzania