A school based cluster randomised health education intervention trial for improving knowledge and attitudes related to Taenia solium cysticercosis and taeniasis in Mbulu district, northern Tanzania.

Sylvester A Mwidunda,Hélène Carabin,Helena A Ngowi,Andrea S Winkler,William B M Matuja,Don Operario

doi:10.1371/journal.pone.0118541

Abstract

Taenia solium causes significant economic and public health impacts in endemic countries. This study determined effectiveness of a health education intervention at improving school children’s knowledge and attitudes related to T. solium cysticercosis and taeniasis in Tanzania. A cluster randomised controlled health education intervention trial was conducted in 60 schools (30 primary, 30 secondary) in Mbulu district. Baseline data were collected using a structured questionnaire in the 60 schools and group discussions in three other schools. The 60 schools stratified by baseline knowledge were randomised to receive the intervention or serve as control. The health education consisted of an address by a trained teacher, a video show and a leaflet given to each pupil. Two post-intervention re-assessments (immediately and 6 months post-intervention) were conducted in all schools and the third (12 months post-intervention) was conducted in 28 secondary schools. Data were analysed using Bayesian hierarchical log-binomial models for individual knowledge and attitude questions and Bayesian hierarchical linear regression models for scores. The overall score (percentage of correct answers) improved by about 10% in all schools after 6 months, but was slightly lower among secondary schools. Monitoring alone was associated with improvement in scores by about 6%. The intervention was linked to improvements in knowledge regarding taeniasis, porcine cysticercosis, human cysticercosis, epilepsy, the attitude of condemning infected meat but it reduced the attitude of contacting a veterinarian if a pig was found to be infected with cysticercosis. Monitoring alone was linked to an improvement in how best to raise pigs. This study demonstrates the potential value of school children as targets for health messages to control T. solium cysticercosis and taeniasis in endemic areas. Studies are needed to assess effectiveness of message transmission from children to parents and the general community and their impacts in improving behaviours facilitating disease transmission.

Highlights

Taenia solium is an intestinal and tissue parasite that causes taeniasis and cysticercosis, respectively
The intervention and control groups were similar in their baseline average knowledge and attitudes related to epilepsy, taeniasis and cysticercosis, ranging from 0.1–94.6% and 0.2–92.1% in the intervention and control groups, respectively
To the best of our knowledge, this is the first randomised controlled health education intervention trial conducted in school children for assessment of knowledge and attitudes related to T. solium cysticercosis and taeniasis in an endemic area

Summary

Introduction

Taenia solium is an intestinal and tissue parasite that causes taeniasis and cysticercosis, respectively. The larval stage of T. solium is found primarily in pigs and the condition is referred to as cysticercosis. Human acquires T. solium taeniasis through consumption of raw or undercooked pork that contains larvae of this parasite. Pigs, humans and a few other animals acquire T. solium cysticercosis after ingesting viable eggs of this parasite from feeds or water contaminated with human faeces that contain viable T. solium eggs. Poor hygiene resulting in the contamination of the environment with human faeces put the pigs and people at risk of developing T. solium cysticercosis [1,2], and is suspected to largely explain the high prevalence of porcine cysticercosis in some developing country areas. If the cysts settle in the human brain or spinal cord they cause neurocysticercosis, with epileptic seizures being the most common symptom [3,4]

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