Wilson, Christina2025-07-152025-07-152024https://www.suaire.sua.ac.tz/handle/123456789/6845PhD ThesisTaenia solium taeniasis/cysticercosis (TSTC) is a parasitic zoonotic disease that is endemic in several developing countries in sub- Saharan Africa, Latin America, and East and Southeast Asia. Tanzania is one of the developing countries where the parasite has major negative effects on the economy and public health. Based on previous reports in Tanzania, the disease is widespread in the central region,the northern and southern highland regions. Several studies on disease control have been conducted in Tanzania. Interventions for health education have been conducted with promising results. However, prior health education was characterized by limited community engagement, which could lead to limited sustainability. This study used a health education package (HEP), which was co- created with community participation to ensure knowledge uptake and sustainability for controlling porcine cysticercosis in Kongwa and Songwe Districts in the central and southern highland regions of Tanzania, respectively. Three phases of data collection were used in the study: first, a baseline survey was conducted between June and September 2019 in 42 villages (28 in Kongwa and 14 in Songwe districts), followed by a community health education intervention between October and December 2020 in 21 villages (14 in Kongwa and 7 in Songwe district). The second survey of data collection was conducted one year after a community health education intervention between October and December 2021 in all 42 villages. A cross-sectional study was conducted in a baseline survey to assess farmers’ knowledge, attitudes, and practices (KAP) related to the transmission, prevention, and control of PCC and also assess the seroprevalence of porcine cysticercosis (PCC). The survey was administered using a Kobo toolbox. The interview was conducted in the village office, followed by a household survey to evaluate and verify hygiene and sanitary practices. A total of 692 smallholder pig farmers were interviewed. To assess the seroprevalence of PCC, about 5 ml of blood samples were collected from 692 pigs through a jugular vein using a plain vacutainer tube. Later, the sera were harvested, and using a cysticercosis Ag-ELISA kit, the parasite's circulating antigens were detected. The villages were then stratified into three strata based on the comparability of the PCC seroprevalence measured at baseline using Ag-ELISA. The first stratum consisted of 10 villages with zero seroprevalence. The second stratum consisted of 13 villages with a seroprevalence of 4.5% to 9.5%. The third stratum consisted of 19 villages with a seroprevalence of 10.5% to 33.3%. Half of the selected villages in each stratum were randomly assigned to either the intervention or control groups. Twenty-one villages with 361 households were allocated to the intervention (treatment) group, whereas the other 21 villages with 331 households were allocated to the control group. After the baseline study, a community health education intervention trial was administered to the intervention group using leaflets, posters, and booklets. The health education was conducted in two phases. Phase one involved a two-day training of the trainers (ToT), which included village and ward leaders, livestock, and human health professionals. Phase two involved a one-day training of the pig farmers by the selected ToT. A second survey was conducted one year following the community health education intervention using the same data collection instruments as in the baseline survey. The baseline survey showed that 72% (n = 692) of respondents had heard about porcine cysticercosis (PCC), approximately half (42% (n = 692) of the respondents had little knowledge regarding PCC, and only 34% (n = 692) were aware that pigs can acquire PCC by ingesting human faeces with T. solium eggs. Approximately 36% (n = 692) of the respondents could identify cyst-infected pigs. About 72% had a positive attitude toward PCC prevention and control measures. Approximately 64% (n = 692) of the respondents believed that cyst- infected pork should be outlawed. In addition, 59% of respondents (n = 692) thought that using latrines with functional doors might reduce the occurrence of PCC. The majority of smallholder pig farmers (73%) acknowledged consistently deworming their pigs; 85% of respondents admitted to deworming themselves and their family members each year. The two drugs that are frequently used to treat worms in humans and pigs are albendazole and ivermectin, respectively. In addition, 92% of households in the districts had latrines, and around 28% (n = 692) of the pigs were raised in free-range environments. Ag-ELISA results showed that 67 (9.7%) pigs had PCC. In Kongwa and Songwe districts, the seroprevalence was 7.3% and 14.0%, respectively. In addition, the baseline seroprevalence of PCC was 10.2% and 9.1% in the intervention and control groups, respectively. Twelve months after community health education, the differences in difference analysis found that health education increased the knowledge level (β = 1.779, p = 0.004), attitude level (β = 1.024, p =0.038), and practice level (β = 0.719, p = 0.023) over time. In addition, the study found an increase in knowledge of the transmission of porcine cysticercosis by 41.5% (p <0.001) and 11.3% (p = 0.011) in pig farmers in the intervention group and control group, respectively. Further, the study found improvements of 14.5% (p <0.001) and 3.5% (p = 0.034) in farmers’ desire to condemn cysticerci-infected pork in both the intervention and control groups, respectively. Furthermore, the study observed that PCC seroprevalence decreased to 0.5% and 3.9% in the control and intervention villages, respectively, although the decrease was not statistically significant in both groups. The study showed that PCC was still prevalent in the area and that farmers’ knowledge about the disease was poor, and risky practices were present. The community health education intervention using the HEP has improved the knowledge, attitudes, and practices of smallholder pig farmers toward PCC transmission and control; however, the short observation period compromised the power of the study to definitively attribute the reduction of PCC seroprevalence to the interventions. Therefore, the study recommends that, future research to integrate health education interventions with treatment of human taeniosis, which could be an important step to immediately interrupt the lifecycle of T.solium which may have helped to see the larger short-term effects of health education interventionshealth education interventionporcine cysticercosisKongwa districtSongwe districtTanzania