Digital health education on epidemiology of taenia solium cysticercosis in Iringa-Tanzania
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Date
2024
Authors
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Publisher
Sokoine University of Agriculture
Abstract
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.
Description
Dissertation
Keywords
Digital health education, Epidemiology, Taenia solium cysticercosis, Iringa, Tanzania