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

Abstract

In the developing world where parasitic worm infections are pervasive, preventive chemotherapy is the key strategy for morbidity control. However, local knowledge, attitudes, and practices (KAP) of parasitic worms are poorly understood, although such information is required for prevention and sustainable control. We carried out KAP surveys in two rural communities of Côte d'Ivoire that were subjected to school-based and community-based research and control activities. We used qualitative and quantitative methods. The former included observations, in-depth interviews with key informants, and focus group discussions with school children and adults. Quantitative methods consisted of a structured questionnaire administered to household heads. Access to clean water was lacking in both communities and only a quarter of the households had functioning latrines. There was a better understanding of soil-transmitted helminthiasis than intestinal schistosomiasis, but community-based rather than school-based interventions appeared to improve knowledge of schistosomiasis. In the villages with community-based interventions, three-quarters of household interviewees knew about intestinal schistosomiasis compared to 14% in the village where school-based interventions were implemented (P<0.001). Whereas two-thirds of respondents from the community-based intervention village indicated that the research and control project was the main source of information, only a quarter of the respondents cited the project as the main source. Preventive chemotherapy targeting school-aged children has limitations, as older population segments are neglected, and hence lack knowledge about how to prevent and control parasitic worm infections. Improved access to clean water and sanitation is necessary, along with health education to make a durable impact against helminth infections. 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.