Development and rapid assessment of community based health educational package for control of taenia solium cysticercocis/taeniasis in Tanzania

PhD Thesis

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.

Germany Federal Ministry of Education and Research