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

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.

Fig 1. Flow of primary school participants during a cluster randomised health-education intervention trial in Mbulu District, Tanzania, 2010–2012.

A random sample of 30 primary schools (1126 students) was randomised into either an intervention (health education) or control (monitoring alone) group and reassessed twice after the health education. During the intervention together with second reassessment, three schools from the control group were not accessible due to heavy rains. In addition, one school from the control group was accidentally educated. Throughout the follow up, there were some losses of students for various reasons. This flow diagram is based on initial randomisation, which resulted into 27 schools analysed.

Fig 2. Flow of secondary school participants during a cluster randomised health-education intervention trial in Mbulu District, Tanzania, 2010–2012.

A random sample of 30 secondary schools (1224 students) was randomised into either an intervention (health education) or control (monitoring alone) group and reassessed three times after the health education. During the intervention together with second reassessment, one school from the intervention group was not accessible due to heavy rains and one had fewer than 8 pupils. Throughout the follow up, there were some losses of students for various reasons. Thus a total of 28 schools were analysed.