MGHD 2022

Background: Tenia solium (T. solium) parasite is a tapeworm that causes taeniasis and cysticercosis when ingested as viable cysts and eggs respectively. A greater burden of T. solium infection is felt in low and middle-income countries, within which it accounts for 80% of all cases of acquired epilepsy. In Rwanda, available reports suggest that T. solium cysticercosis is endemic and affect both humans and pigs. In addition, neurocysticercosis has been documented in people with Epilepsy (PWE) in the southern province of Rwanda where there is extensive pig husbandry. As a neglected disease, neuro/cysticercosis requires a multidisciplinary and multisectoral approach to be addressed. Health education has been shown to be one of the effective measures to inspire positive change in behavior and promote desired attitudes towards the eradication of neuro/cysticercosis. Methods: A cross-sectional mixed-methods study was carried out with the aim of evaluating the baseline knowledge and knowledge acquisition and retention of community health workers (CHWs) on different aspects of T. solium using a multiple-choice questionnaire. The knowledge was assessed with the same questionnaire at different time intervals in relation to a health education intervention which was conducted using “The Vicious Worm” education tool. In addition, a semi-structured interview guide was used to determine the perceptions of the participants regarding the health education tool used. The quantitative data was collected at three-time intervals, pre-intervention, immediately post-intervention and four weeks post intervention, and was analyzed using IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics were used to describe the sociodemographic characteristics of the participants while Wilcoxon Signed Rank and logistic regression tests were used to determine the association among variables considering a confidence interval of 95% and a p value of < 0.05. Finally, a thematic analysis was carried out to analyze the qualitative data. Results: A total of 217 participants were recruited for this study. The participants were from Tare (40%) and Kibirizi (60%) sectors of Nyamagabe district in the southern province of Rwanda. Participants were composed of males (32%) and females (68%), aged between 22 and 68 years (median:45, IQR= 15 years). The participants came from three levels of educational background and most (71%) of them were those who had at least completed primary school. The baseline knowledge score showed a lower and significantly different overall median score (76.19%, IQR=14.28%) than both the immediate post-intervention median score (95.14%, IQR=9.52%) (p value < .001) and the median score four weeks after the intervention (95.14%, IQR=9.52%) (p value < .001). Immediately post-intervention, the participants from Kibirizi had a median score of 100%, an increase of 23.8% from their baseline (p value < .001), while those from Tare scored 95.2%, an increase of 23.8% (p value < .001). At follow-up, 4 weeks later, the overall median score was the same for both Kibirizi and Tare, 95.2% with no significant difference from the immediate post score (p value 0.119 and 0.212 respectively). There was performance improvement across all question categories, however, performance on neurocysticercosis was lower compared to other categories of questions. There was no independent variable found significant to influence the participants’ short-term knowledge acquisition and retention. The participants reported the tool to be user-friendly and educative. They expressed that they were challenged by the digital skills required to use the soft tool and recommended to be equipped with digital literacy and provided with digital devices to access the tool or else be provided with booklet forms of the tool. Conclusion: This study has shown gaps in knowledge regarding T. solium infections within rural Rwanda. The gap is wider in knowledge regarding neurocysticercosis than other T. solium infections knowledge. Health education using “The Vicious Worm” education tool has proven effective to provide short-term T. solium knowledge acquisition and retention to CHWs. If CHWs were digitally equipped or provided with a hard version of the tool, they would be more comfortable learning and transferring knowledge from it.