Browsing by Author "Kajuna, Flora Francis"

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Digital health education on epidemiology of taenia solium cysticercosis in Iringa-Tanzania
(Sokoine University of Agriculture, 2024) Kajuna, Flora Francis
Taenia solium cysticercosis (TSC) is a parasitic disease caused by larvae of the pork tapeworm, Taenia solium. It is common in low- and middle-income countries. The disease is transmitted through ingestion of food or water contaminated with the tapeworm's eggs or through direct contact with contaminated objects or the worm infected individuals. One effective approach to raise community awareness about the disease is digital health education, the technology disseminates health information and services to a wider audience. Digital health technology provides an opportunity for communities to engage with physicians for consultation, access medical care, follow-up on treatments, and report health emergencies. In Tanzania, digital health education suggested the strategy for endemic T. solium cysticercosis (TSC) control. The disease cause human disabilities even death, also it affects pig industry by causing unsafe and unwholesome pork. The digital health education technology can potentially improve socio-cultural settings and lifestyles influencing TSC epidemiology in endemic communities. However, utilization of digital health in Tanzania is inconsistent. This study aimed at assessing the impact of digital health education intervention on porcine cysticercosis prevalence and on associated household factors in endemic rural communities for management decisions. A baseline cross-sectional study was carried at Izazi, Migoli, and Mlowa wards of Iringa District Council, in April-May, 2018, to evaluate the practices promoting porcine cysticercosis transmission. The survey was a quasi-controlled field trial with pre- and post- intervention assessments for porcine cysticercosis and the associated household practices. The focus was on socio-cultural practices and lifestyles related to the life cycle of T. solium, such as household pig management, sanitation and hygiene practices, pork preparation and consumption. Upon visits, respondents provided information guided with questionnaire, observational checklist used for observation study. Pigs were bleed for Enzyme-Linked Immunosorbent Assay (ELISA) analysis to detect the parasite antigen glycoprotein that indicated T. solium cysticercosis prevalence. Immediately after the baseline study, digital health intervention conducted at Migoli and Izazi wards. A door-to-door video show of animations on T. solium cysticercosis and taeniosis educational messages presented using tablets. The tablets were then left in the intended ward offices for voluntary learning. Furthermore, free internet access was provided in designated offices for unsupervised community access to online health education using smartphones or tablets. Post-intervention assessment was then conducted 25 months after commencement of the intervention study in July, 2021. The intervention effect was analysed based on the post-intervention and the baseline data collected with the same procedures described earlier. Digital health technology adoption in health information, health learning, and managing health issues, was also investigated as a cross-sectional study involving 78 public service health offices in the 26 regions of Tanzania's mainland. The survey involved a face-to-face visit and through questionnaire. In places researchers couldn't afford to visit, an electronic questionnaire was distributed via email. The gathered information concerned the experience and the use of digital technologies in health services. The survey showed 33 (37.9%) households had latrines without restrictions to entrance and with limited water supply for handwashing, 42 (57.5%) pigpens didn‟t maintain pigs indoors, and 52 (15%) households allowed pigs to roam freely. Averagely, 22.3 ± 3.44% pigs were tested positive for porcine cysticercosis, and 53.4% households surveyed had at least one seropositive pig. Porcine cysticercosis was significantly associated with free-roaming pigs (OR=2.426; p≤0.05) and poor-quality pens (OR=1.75; p≤0.05). The digital health intervention significantly increased pig confinement (p=0.026) and improved the quality of pigpens (p=0.025), but it didn‟t improve the quality of household latrines (p=0.453) nor the prevalence of porcine cysticercosis (p=0.231). The survey also found Tanzanians (n=191, 91.0%) were preferring digital mobile and internet-enabled tools for personal and official health services. The adoption of digital health services was determined by the availability (n=137, 65.2%), accessibility (n=75, 35.7%), internet connection (n=196, 93.3%), affordability (n=198, 94.3%), and interest of using social media (n=189, 90.0%). Digital health services use was associated with individual's primary occupation (p=0.002, 95% CI), availability of digital health materials (p=0.001, 95% CI), affordability of internet use (p=0.006, 95% CI), and preference of internet, short message system (SMS), and phone calls on health information search (p=0.020, 95% CI). It was also associated with living in areas having reliable electricity (p=0.049, 95% CI). Persistent seropositive pigs suggest traditional lifestyle promotes T. solium worm life cycle. The latrines without entrance restrictions and with limited water supply for hand-washing after toilet, indicate lack of knowledge about safe and hygiene latrine use, hence neglect of safety. It implies community lacks skills to construct and properly use of good latrines made with locally available materials. Sensitization on proper construction and sanitary use of latrines is required. The free-roaming pigs or kept in poorly constructed pens indicates lack of information on benefits of raising pigs under total confinement. Training on good pig management practices is crucial to improve the situation. The practices in the studied community perpetuate Taenia solium life cycle and risk them to infection. Unrestricted entrances latrines, limited water for hand-washing, free-roaming scavenging pigs, and/or pigs escape from confinement poses for TSC infection. Pigs are coprophagous, they become exposed to T. solium eggs by eating feces of human tapeworm carriers who contaminate land with T. solium eggs. The uncomfortable constructed latrines prompt people to less or not use them, resulting defecation in bushes that favor T. solium eggs dispersal. The digital health education was effective in improving pig confinement (p=0.026) and quality pigpens, as pigs were kept indoors during post-intervention study visits. Therefore, digital health intervention is recommended among important strategies in disseminating knowledge aimed at T. solium and other related diseases control in wider communities. Remote communities in mainland Tanzania hardly practice digital health services due to electricity, network, and internet constraints. Marginalized communities can‟t afford costs associated with the necessary hardware and internet access. Therefore, digital health applicability in such communities requires public and private sector partnership. In Tanzania, digital health services are preferred for learning and addressing health problems; however, availability, accessibility, affordability, and internet connection hinder. Thus, socio-cultural practices surveillance and sustainable health education are mandatory when planning for TSC control.