Effectiveness of community based health education intervention on the control of human taenia solium taeniasis / cysticercosis in Kongwa and Songwe Districts, Tanzania
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Date
2024
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Sokoine University of Agriculture
Abstract
Taenia solium taeniasis/cysticercosis are neglected tropical diseases
and infections transmitted between humans and pigs, causing
economic and public health impact in affected communities. The
diseases and infections have received great attention in recent years
and now are included in the global agenda of neglected tropical
diseases. However, little efforts are in place for the control in sub-
Saharan Africa (SSH), a highly endemic region. Tanzania is among
the SSH countries where the diseases and infections are endemic
especially in districts that keep high number of pigs. Control
measures recommended to combat these diseases and infections
include improvements in hygiene, sanitation and pig management,
mass taeniacidal chemotherapy and health education. Health
education is the cornerstone of health promotion and has been
defined as the lifelong process by which individuals acquire
knowledge, attitudes and behaviour that promote health and foster
wise decisions for solving personal, family and community health
problems. However, there are limited studies to evaluate community-
based health education interventions in endemic areas of the country.
The current study on community health education on T. solium
taeniasis / cysticercosis was conducted between July 2019 and
December 2021 in Kongwa and Songwe Districts, Tanzania. The
general aim of this study was to determine the effectiveness of a
developed community based health education intervention to
increase community knowledge, improve preventive measures and
reduce incidences of human T. solium taeniasis/cysticercosis in the
study area. To achieve this, all villages from Kongwa and Songwe
Districts were assessed for their eligibility to participate in the study
targeting on selecting 42 villages and estimated sample size of 872
people. Randomized controlled trial design was used, where villages
were randomly assigned into two groups, 21villages as control group
and other 21 villages as intervention group. The study was conducted
in three key phases, including the baseline phase whereby the
baseline data were assessed, health education intervention phase
whereby the education intervention was performed and the post
intervention phase whereby the education intervention was assessed for its effectiveness. The study recruited the same participants in all
the three phases.
At baseline phase which was conducted between June and
September in 2019, a questionnaire survey was conducted in both
village groups to assess community knowledge and practices
associated with transmission of human T. solium infections. In each
village, 20 to 25 households were randomly selected to participate,
and in each household, one person was randomly selected to
represent the household. The respondent was consented, interviewed
and sampled 5 mls of blood from the cephalic or median cubital vein
(median basilic vein) by a medical laboratory technician for T. solium
cysticercosis detection. The sera were examined for presence of
excretory secretory circulating antigens of the metacestode of T.
solium using enzyme-linked immunosorbent assay (Ag-ELISA) and
Western blot IgG kit (WB-IgG), which is an immunological method for
detection of exposure to T. solium. During the second phase which
was conducted between July and August 2020, community based
health education intervention trial was implemented using the health
education package. The health education was implemented by first
training livestock/agricultural extension officers, school teachers,
health workers and village leaders to serve as local trainers for
knowledge sustainability purpose. Subsequently, the local trainers
and the researcher trained a total of 440 participants from 21
intervention villages and 432 participants from the 21 control villages
were not trained. The third phase was conducted between September
and December in 2021 a year after intervention, whereby the
questionnaire survey and blood sampling were repeated in selected
study households of the 42 selected villages and was planned to use
the same respondents of phase one. The purpose was to assess the
same factors that were assessed during the baseline phase.
However, only 320 respondents were available in the control villages
and 342 in the intervention villages. A total of 210 participants were
lost during the follow up period that constituted 98 participants from
the intervention villages and 112 participants from control villages.
At baseline, the knowledge of respondents was analysed using the
scoring method whereby a respondent was considered to have high level of knowledge/safety practice or low level of knowledge/safety
practice on a particular variable when his/her total responses scores
were 6-10 points and 0-5 points, respectively. Also, binary logistic
regression model was used to test for associations between
categorical variables. The results indicated that, community level of
knowledge on human T. solium taeniasis/cysticercosis was limited in
the study area, whereby a total of 539 (61.8%) participants had low
knowledge. Regarding preventive practices, it was found that, a total
of 653 (74.9%) participants had low level of practices related to T.
solium taeniasis/ cysticercosis transmission. A total of 572 (65.6%)
participants had low level of knowledge and preventive practices
related to human T. solium taeniasis/cysticercosis in the study area.
However, it was further revealed that participants from Kongwa
District were likely to have higher level of knowledge and preventive
practices than those from Songwe District (OR=2.4). Also,
participants with at least primary level of education were likely to have
higher level of knowledge and preventive practices than those with
informal level of education (OR=3.3). Further descriptive analysis and
regression analysis were used, whereby at baseline a total of 12
(1.4%) individuals tested positive by Ag-ELISA indicating the
presence of circulating antigen of T. solium cysticercosis (active
infection). A total of 21 (2.4%) individuals were tested positive by WB-
IgG assay indicating the presence of circulating IgG antibodies
(exposure to infection). The seropositivity of both tests varied
considerably across demographic, behavioural and clinical factors.
Further analysis found that, participants who were above 45 years of
age were more likely to be infected (OR=6.7) and among this group,
10 (2.8%) and 14 (3.9%) individuals were detected by Ag-ELISA and
WB-IgG assay, respectively.
The effectiveness of the intervention was evaluated by comparing
changes in knowledge, preventive practices related to human T.
solium transmission and cumulative incidence of human T. solium
cysticercosis between intervention and control villages using
Sharpiro-Wilk test, T-test and Wilcoxon test. In addition, the
cumulative incidences of HCC were compared between the
intervention and control groups taking into account that all detected
cases at the baseline were subjected to further clinical management and were not included in the third phase of the study. At baseline, the
study revealed no significant difference in knowledge and practices
mean scores between the control and intervention villages (1.45
±0.94 vs 1.54±1.02, p= 0.24). In addition, no significant difference
was observed in the prevalence of human T. solium cysticercosis
between intervention and the control villages (1.4% vs.1.4%, p =
0.97) by Ag-ELISA. At one year post intervention, the study revealed
a significantly higher knowledge mean scores in the intervention
villages compared to the control villages (2.06 ±1.45 vs 0.94 ±1.18, p
< 0.001). However, there was no significant difference in the mean
practice scores and cumulative incidences of human T. solium
cysticercosis at the intervention compared to the control villages. A
lack of improved preventive practices might be attributed by limited
time to evaluate the effect and the observed insufficient supply of safe
and clean water.
This study reveals that the community based health education
intervention is effective in increasing knowledge on control of human
T. solium infections. However, improvement in preventive practices
and reduction in incidences of human T. solium cysticercosis are a
gradual process, they may require sanitary and hygienic improvement
and more time after the intervention to see the desired effect.
Therefore, the study recommends implementation of this community
based health education intervention to the general public for broader
and permanent effect.
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Thesis
Keywords
Health education intervention, Human taenia solium, Human taeniasis-cysticercosis, Kongwa-Songwe Districts, Tanzania