Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso

Abstract

Background: Taeniasis and cysticercosis are two diseases caused by Taenia solium, a parasite transmitted between humans and pigs, leading to considerable economic loss and disabilities. Transmission of the parasite is linked to environmental and behavioural factors such as inadequate sanitation and hygiene, poor pig management, and consumption of infected pork. This study used implementation research method to design a health education intervention strategy for reducing T. solium infections in Burkina Faso, a country endemic for the parasite.

Methods: Eighteen group discussions were conducted with 8-18 participants each in three villages. In addition, structured interviews were conducted among 4 777 participants and 2 244 pig owners, who were selected through cluster random sampling in 60 villages of three provinces of Burkina Faso. Both approaches assessed knowledge and practices related to T. solium. The information obtained was used to develop a community-adapted health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso.

Results: The group discussions revealed that participants had a poor quality of life due to the diseases as well as inadequate access to latrines, safe water, and healthcare services. In addition, it was found that pig production was an important economic activity, especially for women. Furthermore, financial and knowledge constraints were important limitations to improved pig management and latrine construction. The survey data also showed that open defecation and drinking unboiled water were common behaviours, enhanced by a lack of knowledge regarding the transmission of the parasite, perceived financial barriers to the implementation of control measures, lack of public sensitization, as well as a lack of self-efficacy towards control of the parasite. Nevertheless, the perceived financial benefits of controlling porcine cysticercosis could be emphasized by an education program that discourages open defecation and encourages drinking safe water. The final intervention strategy included a Participatory Hygiene and Sanitation Transformation (PHAST) approach, as well as a 52-min film and an accompanying comic booklet.

Conclusions: The main problem in the study communities regarding the transmission of T. solium cysticercosis is the random disposal of human faeces, which can be contaminated with parasite eggs. Prevention of open defecation requires the building of latrines, which can be quite problematic in economically challenged settings. Providing the community with the skills to construct durable latrines using low-cost locally available materials would likely help to resolve this problem. Further studies are required to implement and evaluate the T. solium control strategy developed in this study.

Keywords: Burkina Faso; Cysticercosis; PHAST; Taenia solium control plan; Taeniasis.

Fig. 1

Villages used in the pilot study, GDs, and questionnaire survey during the planning of the health education intervention strategy to control taeniasis and cysticercosis in Burkina Faso, 2007–2012. One village (green star) was involved in both the pilot and the main study

Fig. 2

PRECEDE model for controlling T. solium taeniasis and cysticercosis in Burkina Faso planned using an implementation research method, 2007–2012. The PRECEDE phases can be read from right to left. Phases 1 and 2: The quality of life of the study community is compromised by the prevalence of human and porcine cysticercosis. The community desires access to safe water, latrines, and healthcare services, all of which can be linked to diseases. An intervention to reduce prevalence of not only cysticercosis but other diseases is linked to poor sanitation, and safe water is desired. Phase 3: Significant and sustainable improvements in the behavioural and environmental factors are necessary to reduce the frequency of human and porcine cysticercosis. Construction and use of latrines needs to be promoted to stop open defecation. Prevention of consumption of undercooked pork could be managed by an education intervention. Phase 4: Cysticercosis is predisposed by a lack of knowledge on T. solium and the advantages of its control. Lack of self-efficacy can be the reason why households are not constructing latrines or pigpens. Health extension services are important in the initiation and maintenance of behavioural and environmental factor changes. Phase 5: A health promotion program in the study area should focus on improving knowledge and enhancing self-efficacy in implementing T. solium control measures. The developed intervention strategy consists of a 52-min film and accompanying comic booklet to improve knowledge and PHAST to enhance self-efficacy. Water and sanitation policy for the Burkina Faso government and that of NGOs are consistent with the initiative of this study. For example, several organizations, including UNICEF, WaterAid, Plan International and World Bank have been supporting initiatives focusing on improving community access to safe water, sanitation and hygiene in Burkina Faso for many years. The health education strategy is expected to improve knowledge on T. solium and self-efficacy in the construction of pit latrines. These in turn will reduce risk behaviours related to T. solium transmission. Consequently, the prevalence of taeniasis and cysticercosis will be reduced. This will contribute to the improvement of quality of life of the community