Makingi George Isdory2026-01-262026-01-262024https://www.suaire.sua.ac.tz/handle/20.500.14820/7260ThesisTaenia 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.enHealth education interventionHuman taenia soliumHuman taeniasis-cysticercosisKongwa-Songwe DistrictsTanzaniaThesis