Knowledge, perceptions and behaviour of mothers toward intestinal helminths in Upper Egypt: implications for control

Abstract

Operational research was conducted in Qena Governorate, Upper Egypt, to gather the information needed to design an integrated control programme for intestinal helminths in the area. To this aim, qualitative and quantitative techniques were used on a sample representative of the entire governorate. Mothers were questioned about their knowledge and perception of intestinal helminths, their hygienic habits and health-seeking behaviour. At the same time, a coprological survey was conducted on all the children 2 to 12 years of age living in the selected households (n = 2657) to provide baseline data on the prevalence of infection with these parasites. The survey results showed that intestinal helminth infections were more prevalent in rural areas and in three of the 12 Governorate districts. Almost all the respondents considered worms harmful and were aware of the need for treatment. More than adequate knowledge was present on ways to prevent infection. Good hygienic practices were associated with a low prevalence of infection in the household. Practical recommendations were formulated to design a helminth control programme tailored to the local situation and to prioritize allocation of resources. Passive case detection appeared to be appropriate to the level of infection in Qena (< 15%). The intervention should target areas and districts where prevalence of infection was higher, and all children below 12 years of age. Health education, besides encouraging mothers to refer their children to the health units for treatment, should focus on improving hygienic behaviour. While schools might be the best channel to contact children, the use of informal channels of communication, such as television, should be promoted to reach the mostly illiterate mothers. The research highlights the importance of gathering information on mothers' perceptions and behaviour in the design and implementation of a community-based intestinal helminths control programme.

PIP: Until community sanitation can be improved, community treatment by chemotherapy and improvements in personal hygiene through health education remain the most affordable, effective strategies for controlling helminth infections in Egypt. To facilitate the design of an appropriate intestinal helminths control program in Upper Egypt, operations research was conducted in the Governorate of Qena. 768 mothers or other caretakers of 2657 children 2-12 years old were interviewed. 35.5% of households had at least 1 child harboring worms and 13.5% of children were infected with 1 or more parasites. Although 88.8% of households had a latrine, 22.5% of children were reported to defecate anywhere. Knowledge of the sources of infection and ways to prevent transmission was generally good. One-third of mothers of children with worms in their stools did not seek any treatment for their children, however, in part due to drug shortages in the area. Two-thirds of mothers reported they were unable to pay for the health services they needed. The majority of mothers treated intestinal worms with lupine juice prepared at home. Bivariate analysis identified the following significant correlates of reduction in risk of infection: hand washing after defecation, maternal literacy, household use of public health care facilities, and maternal attendance at health education sessions. Given the relatively low level of infection in the area, passive case detection may be a sufficient control measure if drugs are made available at health units and priority is given to children living in areas with a high prevalence of infection. Health education should seek to improve hygienic behavior, rather than knowledge of the disease, and use of television should be considered to reach illiterate mothers.