GOT WORMS?: Planning and Evaluation of a Culturally Appropriate Health Education Pilot Program for the Control of Soil-Transmitted Helminth Infections in Rwandan Village Children

Infections with parasitic intestinal worms known as soil-transmitted helminthes (STH) are endemic in most poor countries in Africa, Asia and Latin America. In Rwanda, the prevalence of helminth infections among school-age children was found to be nearly 70%. Chronic STH infections are associated with malnutrition and anemia, which cause physical and cognitive developmental problems. These morbidities negatively affect educational attainment and vocational productivity and thereby perpetuate the cycle of poverty in affected communities. Control of STH requires both regular deworming treatments and changes in health behaviors relevant to transmission, including personal hygiene and sanitation practices. In Rwanda, a nationwide program to treat all children has successfully been implemented twice-yearly since 2009. However, health education to promote changes in relevant health behaviors has not been successful to date. The objective of this pilot program was to determine whether culturally appropriate methods of health education could increase knowledge of STH infections, improve attitudes toward control, and support changes in preventive health behaviors. The Health Belief Model (HBM) was used as the theoretical basis. Published results from a local NGO served as the epidemiological assessment. Unpublished findings from focus groups in Rwandan villages served as the community assessment, which guided the planning of the content and format of the lessons. The program was implemented in the two villages where the Thomas Jefferson University student organization JeffHEALTH works. Six group lessons were held with a total of 61 female participants who have children or who are otherwise involved in childcare. Per the HBM, a pre- and post-lesson questionnaire was created to evaluate perceived risk and severity of infection, and perceived benefits of and barriers to control. The data was analyzed using descriptive statistics. Results show that participants demonstrated improved knowledge of STH transmission and symptoms, and improved knowledge of preventive health behaviors. Participants also demonstrated an intention to practice these health behaviors. Results also indicate that teaching methods that mimic the Rwandan tradition of drama were more effective than others. Recommendations for future health education programs include greater use of traditional teaching methods, development of culturally appropriate visual aids, hands-on demonstrations of preventive health behaviors, utilization of other behavioral theories, and observational research to confirm that changes in relevant health behaviors actually occur