KNOWLEDGE AND PERCEPTION OF SOIL-TRANSMITTED HELMINTH INFECTIONS AMONG RESIDENTS IN NASARAWA STATE
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PUBLIC HEALTH PROJECT TOPICS AND MATERIALS ON KNOWLEDGE AND PERCEPTION OF SOIL-TRANSMITTED HELMINTH INFECTIONS AMONG RESIDENTS IN NASARAWA STATE
- Background of the study
Worm infection has plagued humans for centuries now (World Health Organization, 2015). This predates the era of our earliest recorded history and still poses a great threat to global health. Ova of intestinal helminths can be found in the mummified feces of humans dating back thousands of years (Cox, 2016). The ancient writings of Hippocrates, Egyptian medical papyri, as well the Bible abound with many of the characteristic clinical features of helminth infestations (Hotez, 2018).
Soil-transmitted helminths (STH) are intestinal worms whose immature stages require a period of incubation in the soil before becoming infective (Chukwuma and Ekejindu and Agbakoba, 2019). The most common are Ascaris lumbricoides, Trichuris trichiura, the hookworms (Ancylostoma duodonale and Necator americanus) and Strongyloides stercoralis (W.H.O, 2016). They are transmitted by eggs present in infected human faeces, which contaminate the soil in areas where sanitation is poor. STH infections are included in the list of the world’s neglected tropical diseases, NTDs, and are the most common infections among the poorest and most deprived communities (Ekundayo and Aliyu, 2017). Transmission of A. lumbricoides and T. trichiura is primarily through oral-faecal route (usually by ingestion of parasite eggs in faeces), whereas hookworm species and S. stercoralis are through active skin penetration of infective larva. STH infections are among the most common chronic human infections in most regions of the world; with approximately 1.5 billion people infected globally (Gazzinelli and Yang, 2014). It accounts for a global burden of 3.3 million of disability-adjusted life years (Cox, 2016). Approximately 270 million preschool-aged children (PSAC) and 600 million schoolage children (SAC) are at risk of infection. They live in areas where transmission of these parasites are intense and in need of treatment and preventive interventions (Vandemark and Zhou, 2017).
Nigeria has the highest burden and endemicity (Odinaka, Nwolisa and Mbanefo, 2015). A larger fraction of those affected are young children of ages 5 to 14 years, living in rural areas and urban slums (Oluwole, Isiyaku, Okoronkwo and Saka, 2015). The major contributors to persistence of infections are cultural, socioeconomic and environmental factors [6, 7] . Unhygienic and common practice of indiscriminate defecation or dumping excrement have persisted in Nigeria (Eke, Omalu, Otuu and Hassan, 2018). There has been little success in the introduction of latrines to rural Nigeria. A temporal data available from 1990 through 2015 indicate a marginal decrease in the use of improved sanitation facilities from 38% to 29%, and small increase in open defecation from 24% to 25%. Currently, Nigeria is ranked as one of the nations in the world with the highest number of people practicing open defecation, estimated at over 46 million people (Otti, 2016).
In Nigeria, there are still states where there are limited to no epidemiological information on STH infections; Nasarawa state is one of those with limited information. Majority of the communities in Nasarawa state are farming communities where children and adults are fully exposed to risks of helminth infection. In agrarian communities, practices such as walking on bare feet, open defecation, eating of fallen fruits and raw unwashed vegetables with unwashed hands in farmlands could predispose individuals to STH infections (Naish, 2014). Majority of the agrarian communities are warm and moist for most of the year, creating a good environment for the parasites to develop all year round. However, the mapping was only vulnerable adults. Scholars believed that the importance of water, sanitation and hygiene (WASH) in control of STH could be assessed in relation to socio-economic status. Therefore, socio-economic status of the study population was assessed using an asset-based approach, which involved classification of individuals into wealth quintiles in relation to possession of arbitrary but systematically chosen assets.
1.2 Statement of the problem
Soil transmitted helminths is one of the leading Neglected Tropical Diseases due to its low mortality irrespective of its high morbidity even when compared with the so called “the big three,” including HIV/AIDS, tuberculosis, and malaria. The diseases caused by helminths infection receives less than 1% of global research funds (Eke, Omalu, Otuu and Hassan, 2018). The global burden of disease caused by these intestinal nematodes is estimated at 22.1 million disability adjusted life years (DALYs) lost to hookworm, 10.5 million to A. lumbricoides, 6.4 million to T. trichiura, giving a combined total of 39 million DALYs (Vandemark and Zhou, 2017). The disease burden is as great as that due to tuberculosis (34.7 million DALYs) or malaria (46.5 million DALYs) (Hotez and Aruna, 2019). The prevalence of soil transmitted helminth in this study was 45.6% in Asendabo Delta State in Nigeria. In Kwara State, the prevalence of soil-transmitted helminthiasis among the study population was 42.6%. Ascaris lumbricoides (25.7%) was the most common parasites, followed by Trichuris trichiura (10.3%). The male participants had a prevalence of 55.2% compared to the females who had a prevalence rate of 44.8%. It is against this background that the study intends to determine the knowledge and perception of soil-transmitted helminth infections among residents in Nasarawa state.
1.3 Objective of the study
The general objective of this study is to determine the knowledge and perception of soil-transmitted helminth infections among residents in Nasarawa state, with the following specific objectives of the study:
- To determine the knowledge of soil-transmitted helminth infections among residents in Nasarawa state
- To examine the perception of soil-transmitted helminth infections among residents in Nasarawa state
- To assess the attitude of soil-transmitted helminth infections among residents in Nasarawa state
- To assess the practices of soil-transmitted helminth infections among residents in Nasarawa state
1.4 Research questions
- What is the knowledge of soil-transmitted helminth infections among residents in Nasarawa state?
- What is the perception of soil-transmitted helminth infections among residents in Nasarawa state?
- What is the attitude of soil-transmitted helminth infections among residents in Nasarawa state?
- What are the practices of soil-transmitted helminth infections among residents in Nasarawa state?
1.5 Significance of the study
In this socioeconomically disadvantaged community, the poor levels of hygiene and overcrowding, lack of veterinary attention and zoonotic awareness along with uncontrolled population of dogs or cats that exist in close proximity with humans, exacerbate the risks of zoonotic transmission in this community. There is a crucial need for a simple, rapid and highly sensitive and specific technique such as the method reported in this study that can serve as an alternative analytical tool to improve diagnosis and surveillance of hookworm infections. In addition, the complementary use of a more variable locus such as the cox gene as complementary to the ITS-2 gene will provide additional evidence to support the zoonotic exchange of hookworm species particularly A. ceylanicum between humans and animals. For instance, although many surveys have been conducted particularly in endemic areas in Nigeria, an accurate estimation of the total disease burden has not been fully explained. Additionally, these data are rarely in the public domain and available in a form that is accessible to policy makers or relevant authorities for control program intervention. This study also will offer the opportunity to investigate the geographical distribution of infection highlighting where such information is lacking. Such approach has been further enhanced by the used of RS tool that provides proxy to the environmental factors and correlate with the prevalence data in order to identify ecological correlation with infection patterns. The correlations between infection patterns and ecological factors can be used to extrapolate predictive risk map in areas for which no data are available. Likewise, the predictive risk map can serve as a baseline data to estimate number of population at risk, numbers of requiring treatment and cost of delivering anthelminthic. Establishment of such reliable map is essential for the development and implementation of control measures to those populations in greatest need particularly when the recourses for control program are finite and limited. Therefore, findings of the current study will be valuable for the public health authorities to justify and facilitate the reassessment of the existing control measures to reduce the prevalence of STH infections.
1.6 Scope of the study
This study is delimited to the knowledge and perception of soil-transmitted helminth infections among residents in Nasarawa state. Also, this study will assess the practices of soil-transmitted helminth infections among residents in Nasarawa state