Parasitic Worms: Knowledge, Attitudes, and Practices in Western Côte d’Ivoire with Implications for Integrated Control

There is a need to better understand communities' knowledge, attitudes, and practices (KAP) of neglected tropical diseases to improve prevention and control efforts. We studied the socio-cultural aspects of parasitic worm infections in two villages (Mélapleu and Zouatta II) of western Côte d'Ivoire, where research and control activities have been implemented. Zouatta II was exposed to a community-based approach, while school-based interventions were implemented in Mélapleu. KAP surveys were carried out using qualitative and quantitative methods. Although there was some knowledge of parasitic worm infections in both villages, we found important differences between the two villages regarding intestinal schistosomiasis: there was a better understanding of this disease in Zouatta II. However, even the community-based research and control efforts implemented in Zouatta II were ineffective in transforming the information conveyed into preventive behavior related to water contact. Our results suggest that KAP of parasitic worm infections conveyed by research and control activities targeting only school-aged children have shortcomings as older population groups are left out. Hence, for effective control of parasitic worms, children and adults must be educated and interventions should include access to deworming drugs, clean water and sanitation

Effect of an integrated intervention package of preventive chemotherapy, community-led total sanitation and health education on the prevalence of helminth and intestinal protozoa infections in Côte d'Ivoire

Preventive chemotherapy with donated anthelminthic drugs is the cornerstone for the control of helminthiases. However, reinfection can occur rapidly in the absence of clean water and sanitation coupled with unhygienic behaviour. The purpose of this study was to assess the effect of an integrated package of interventions, consisting of preventive chemotherapy, community-led total sanitation (CLTS) and health education, on the prevalence of helminth and intestinal protozoa infections and on participants' knowledge, attitude, practice and beliefs (KAPB) towards these diseases including water, sanitation and hygiene (WASH).; A cross-sectional survey was carried out in nine communities of south-central Côte d'Ivoire to assess people's infection with helminths and intestinal protozoa and KAPB. Subsequently, interventions were targeted to five communities, while the remaining communities served as control. The intervention encouraged latrine construction and an evaluation was done 6-7 months later to determine open defecation status of the respective communities. Anthelminthic treatment was provided to all community members. A follow-up cross-sectional survey was conducted approximately one year later, using the same procedures.; Overall, 810 people had complete baseline and follow-up data and were given anthelminthic treatment. The baseline prevalence of hookworm, Schistosoma haematobium, Trichuris trichiura, Schistosoma mansoni and Ascaris lumbricoides was 31.1%, 7.0%, 2.0%, 1.0% and 0.3%, respectively. Four of the five intervention communities were classified open-defecation free. For hookworm infection, we observed higher negative changes in terms of proportion of decrease (-0.10; 95% confidence interval (CI): - 0.16, -0.04) and higher egg reduction rate (64.9 vs 15.2%) when comparing intervention with control communities. For intestinal protozoa, prevalence reduction was higher in intervention compared to control communities (8.2 vs 2.6%) and WASH indicators and intervention outcomes associated with lower odds for infection at follow-up. The intervention significantly impacted on reported latrine use (before: 15.5%, after: 94.6%), open defecation in the community surroundings (before: 75.0%, after: 16.7%) and awareness for environmental contamination through open defecation (before: 20.4%, after: 52.2%).; An integrated package of interventions consisting of preventive chemotherapy, health education and CLTS reduces the prevalence of helminth and intestinal protozoa infection. Additional studies in other social-ecological settings are warranted to confirm our findings

Dynamics of Socioeconomic Risk Factors for Neglected Tropical Diseases and Malaria in an Armed Conflict

Armed conflict and war and infectious diseases are globally among the leading causes of human suffering and premature death. Moreover, they are closely interlinked, as an adverse public health situation may spur violent conflict, and violent conflict may favor the spread of infectious diseases. The consequences of this vicious cycle are increasingly borne by civilians, often as a hidden and hence neglected burden. We analyzed household data that were collected before and after an armed conflict in a rural part of western Côte d'Ivoire, and investigated the dynamics of socioeconomic risk factors for neglected tropical diseases (NTDs) and malaria. We identified a worsening of the sanitation infrastructure, decreasing use of protective measures against mosquito bites, and increasing difficulties to reach public health care infrastructure. In contrast, household crowding, the availability of soap, and the accessibility of comparatively simple means of health care provision (e.g., traditional healers and community health workers) seemed to be more stable. Knowledge about such dynamics may help to increase crisis-proofness of critical infrastructure and public health systems, and hence mitigate human suffering due to armed conflict and war

Disparities of Plasmodium falciparum infection, malaria-related morbidity and access to malaria prevention and treatment among school-aged children : a national cross-sectional survey in Côte d'Ivoire

There is limited knowledge on the malaria burden of school-aged children in Côte d'Ivoire. The aim of this study was to assess Plasmodium falciparum infection, malaria-related morbidity, use of preventive measures and treatment against malaria, and physical access to health structures among school-aged children across Côte d'Ivoire.; A national, cross-sectional study was designed, consisting of clinical and parasitological examinations and interviews with schoolchildren. More than 5,000 children from 93 schools in Côte d'Ivoire were interviewed to determine household socioeconomic status, self-reported morbidity and means of malaria prevention and treatment. Finger-prick blood samples were collected and Plasmodium infection and parasitaemia determined using Giemsa-stained blood films and a rapid diagnostic test (RDT). Haemoglobin levels and body temperature were measured. Children were classified into wealth quintiles using household assets and principal components analysis (PCA). The concentration index was employed to determine significant trends of health variables according to wealth quintiles. Logistic and binomial negative regression analyses were done to investigate for associations between P. falciparum prevalence and parasitaemia and any health-related variable.; The prevalence of P. falciparum was 73.9% according to combined microscopy and RDT results with a geometric mean of parasitaemia among infected children of 499 parasites/μl of blood. Infection with P. falciparum was significantly associated with sex, socioeconomic status and study setting, while parasitaemia was associated with age. The rate of bed net use was low compared to the rate of bed net ownership. Preventive measures (bed net ownership, insecticide spray and the reported use of malaria treatment) were more frequently mentioned by children from wealthier households who were at lower risk of P. falciparum infection. Self-reported morbidity (headache) and clinical morbidity (anaemia) were more often reported by children from less wealthy households.; Seven out of ten school-aged children in Côte d'Ivoire are infected with P. falciparum and malaria-related morbidity is considerable. Furthermore, this study points out that bed net usage is quite low and there are important inequalities in preventive measures and treatment. These results can guide equity-oriented malaria control strategies in Côte d'Ivoire

Effects of hygiene and defecation behavior on helminths and intestinal protozoa infections in Taabo, Côte d'Ivoire

Effect of community-led total sanitation and hygiene education to reduce the transmission of helminthiases and intestinal protozoa infections

Significant associations between parasitic infections and household assets, hygiene, and defecation behavior.

<p>The study was carried out among 431 households in the Taabo health demographic surveillance system in south-central Côte d’Ivoire in July 2011. Logistic regression analysis was used with village level exchangeable random effects. Variables included as potential confounders were age groups (<5, 5–14, 15–24, 25–40, and >40 years), wealth quintiles and sex whenever age, sex, and socioeconomic status were significantly associated with a given parasitic infection.</p><p>No significant associations for <i>E. histolytica/E. dispar</i> and <i>G. intestinalis</i> with household assets, hygiene, and defecation behavior have been found after correction for potential confounders (sex, age group, or wealth quintile).</p>a<p><i>P</i>-value based on Wald test.</p

Helminth infection prevalence and intensity among 1,992 participants in Taabo, south-central Côte d’Ivoire, in July 2011.

<p>Infection intensities (mean egg count) were split into light, moderate, and heavy infections using WHO guidelines <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065722#pone.0065722-WHO1" target="_blank">[10]</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0065722#pone.0065722-WHO2" target="_blank">[11]</a>.</p>a<p>Number of infected participants stratified by infection intensities (values in brackets as percentage, %).</p><p>n.d., not defined.</p

Age-prevalence curves of investigated parasites.

<p>The results of the intestinal protozoa and helminth infections arise from the baseline cross-sectional survey carried out in July 2011 among community members of two villages and seven hamlets in the Taabo health demographic and surveillance system, south-central Côte d’Ivoire. <i>Trichuris trichiura</i>, <i>Schistosoma mansoni</i> and <i>Ascaris lumbricoides</i> are not displayed due to very low prevalence.</p

Map of the study area in Taabo, situated in south-central Côte d’Ivoire.

<p>The study was carried out in two villages (Sahoua, Katchénou) and seven hamlets (1 = Beh N’Guessankro, 2 = Allah Thérèsekro, 3 = Yobouékro, 4 = Ouattafouékro, 5 = Kouadio Kouamékro, 6 = Boussoukro, 7 = Amani Kouadiokro) that are part of the Taabo health demographic surveillance system. Results presented here pertain to the baseline cross-sectional parasitological and questionnaire surveys conducted in July 2011.</p