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Spencer SA, Andriamasy EH, Linder C, Penney JMS, Henstridge-Blows J, Russell HJ, Hyde K, Sheehy C, Young IL, Sjoflot B, Rakotomampianina DAL, Nandimbiniaina AM, Raderalazasoa GU, Ranaivoson TN, Andrianiaina A, Michèle RSM, Rohe ZA, Bustinduy AL, Stothard JR, Cruickshank SM, Edosoa GT, Rahetilahy AM. Impact of a Novel, Low-Cost and Sustainable Health Education Program on the Knowledge, Attitudes, and Practices Related to Intestinal Schistosomiasis in School Children in a Hard-to-Reach District of Madagascar. Am J Trop Med Hyg 2022; 106:685-694. [PMID: 35008056 PMCID: PMC8832942 DOI: 10.4269/ajtmh.21-0220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/01/2021] [Indexed: 11/22/2022] Open
Abstract
Schistosomiasis control requires multisectoral approaches including praziquantel treatment, access to safe water, sanitation and hygiene, and health education. Community input can help ensure health education programs are culturally appropriate to effectively direct protective behavior change. This study reports on the three-stage development of an education program for Malagasy children, with an impact evaluation on their knowledge, attitudes, and practices (KAP) related to intestinal schistosomiasis. A cross-sectional study took place in 2017 with follow-up in 2018 in the hard-to-reach Marolambo district, Madagascar. A novel schistosomiasis education program (SEP) was designed in collaboration with researchers, stakeholders, and local community and included cartoon books, games, songs, puzzles, and blackboard lessons, costing $10 USD per school. KAP questionnaires were completed by 286 children pre-SEP and 273 children post-SEP in 2017, and by 385 and 337 children pre-SEP and post-SEP, respectively, in 2018. Improvements were observed in responses to all questions between pre- and post-education answers in 2017 (53–77%, P < 0.0001) and 2018 (72–98%, P < 0.0001) and in the pre-education answers between years (53–72%, P < 0.0001). Praziquantel mass drug administration attendance improved, rising from 64% to 91% (P < 0.0001), alongside improved latrine use, from 89% to 96% (P = 0.005). This community-consulted and -engaged SEP resulted in substantial improvements in children’s understanding of schistosomiasis, with improvements in praziquantel uptake and latrine use. Socioculturally tailored education programs can help gain schistosomiasis control. Continued investment in SEP will help promote the future well-being of children through increased participation in control and treatment activities.
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Affiliation(s)
- Stephen A Spencer
- North Bristol NHS Trust, Bristol, United Kingdom.,The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Emmanuel H Andriamasy
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar.,Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Cortland Linder
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - James M StJ Penney
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Jemima Henstridge-Blows
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Hannah J Russell
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Kate Hyde
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Caitlin Sheehy
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Isla L Young
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Benedicte Sjoflot
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | | | | | | | | | - Antsa Andrianiaina
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar
| | | | - Zafera A Rohe
- Faculté de Médecine, Université d'Antananarivo, Antananarivo, Madagascar
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J Russell Stothard
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sheena M Cruickshank
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Glenn T Edosoa
- World Health Organization, Madagascar Country Office, Antananarivo, Madagascar.,Ministère de la Santé Publique de Madagascar, Antananarivo, Madagascar
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Spencer SA, Linder C, Penney JMS, Russell HJ, Hyde K, Sheehy C, Reid A, Andriamasy EH, Raderalazasoa GU, Rakotomampianina DAL, Nandimbiniaina AM, Ranaivoson TN, Andrianiaina A, Cruickshank SM, Bustinduy AL, Stothard JR, Edosoa GT, Rahetilahy AM. Five-Year Follow-Up on the Prevalence and Intensity of Infections of Schistosoma mansoni in a Hard-to-Reach District of Madagascar. Am J Trop Med Hyg 2021; 104:1841-1850. [PMID: 33684064 PMCID: PMC8103437 DOI: 10.4269/ajtmh.20-1433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/10/2021] [Indexed: 01/15/2023] Open
Abstract
Schistosomiasis is a major public health problem in Madagascar. The WHO recommends preventive chemotherapy by mass drug administration (MDA) with praziquantel as the primary approach to control Schistosoma mansoni-related morbidity in endemic populations, alongside complementary interventions such as health education. The impact of annual MDA and health education programs was assessed in the hard-to-reach Marolambo district of eastern Madagascar, an area endemic for S. mansoni. Repeated cross-sectional studies undertaken 2015-2019 examined between 300 and 381 school-aged children (aged 5-14 years) annually. The prevalence and infection intensity of S. mansoni were assessed by urine-circulating cathodic antigen (CCA) dipsticks and coproscopy using Kato-Katz (KK) methodologies. After four rounds of annual MDA, a reduction in S. mansoni prevalence was seen in CCA (93.9% in year 1-87.7% in year 5; P = 0.007) and KK (73.9% in year 1-59.4% in year 5; P < 0.0001). The prevalence of heavy-intensity infections roughly halved from 23.7% to 10.1% (P < 0.0001), and the mean intensity of infection fell by 55.0% (480.2-216.3 eggs per gram of feces). A malacological survey found Biomphalaria pfeifferi snail intermediate hosts in multiple water contact sites including rice paddies, streams, and Nosivolo River. Despite reductions in infection prevalence and intensity, schistosomiasis still poses a significant public health challenge in Marolambo district. Twice yearly MDA cycles and/or community-wide MDA are suggested to better reduce infections. Expanding health education, improving standards of water, sanitation and hygiene, and attention on snail-related control will also be important, especially in rice paddy irrigated areas.
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Affiliation(s)
- Stephen A. Spencer
- Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom;,The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom;,Address correspondence to Stephen A. Spencer, Post-Graduate Medical Centre, Royal United Hospital, Combe Park, Bath BA1 3NG, United Kingdom. E-mail:
| | - Cortland Linder
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - James M. StJ. Penney
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Hannah J. Russell
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Kate Hyde
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Caitlin Sheehy
- The University of Manchester Faculty of Biology Medicine and Health, Manchester Academic Health Centre, Manchester, United Kingdom
| | - Alice Reid
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Emmanuel H. Andriamasy
- Faculté de Médecine, Université d’Antananarivo, Antananarivo, Madagascar;,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gina U. Raderalazasoa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Anjara M. Nandimbiniaina
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tahiry N. Ranaivoson
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Antsa Andrianiaina
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheena M. Cruickshank
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amaya L. Bustinduy
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - J. Russell Stothard
- Unité d’Epidémiologie et de Recherche Clinique, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Glenn T. Edosoa
- World Health Organization, Madagascar Country Office, Antananarivo, Madagascar;,Ministère de la Santé Publique de Madagascar, Antananarivo, Madagascar
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Spencer SA, Penney JMSJ, Russell HJ, Howe AP, Linder C, Rakotomampianina ALD, Nandimbiniaina AM, Squire SB, Stothard JR, Bustinduy AL, Rahetilahy AM. High burden of Schistosoma mansoni infection in school-aged children in Marolambo District, Madagascar. Parasit Vectors 2017. [PMID: 28646926 PMCID: PMC5483300 DOI: 10.1186/s13071-017-2249-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background A school-based survey was undertaken to assess prevalence and infection intensity of schistosomiasis in school-aged children in the Marolambo District of Madagascar. Methods School-aged children from six purposively selected schools were tested for Schistosoma haematobium by urine filtration and Schistosoma mansoni using circulating cathodic antigen (CCA) and Kato-Katz stool analysis. The investigators did not address soil-transmitted helminths (STH) in this study. Results Of 399 school-aged children screened, 93.7% were infected with S. mansoni based on CCA analysis. Kato-Katz analysis of stool revealed S. mansoni infection in 73.6% (215/ 292). Heavy infections (> 400 eggs per gram) were common (32.1%; 69/ 215), with a mean of 482 eggs per gram of stool. Moderate infection intensities were detected in 31.2% (67/ 215) and light infection intensities in 36.7% (79/ 215) of infected participants. No infection with S. haematobium was detected by urine filtration. Conclusions Intestinal schistosomiasis appears a considerable public health issue in this remote area of Madagascar where there is a pressing need for mass drug administration.
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Affiliation(s)
- Stephen A Spencer
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK. .,The University of Manchester Medical School, Manchester, UK.
| | | | | | - Anthony P Howe
- The University of Manchester Medical School, Manchester, UK
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