Assessing the Knowledge, Attitudes, and Practices (KAP) towards deworming of community health workers and teachers, and the experiences and perspectives of local leaders in the national deworming program in Nyamagabe and Rutsiro Districts in Rwanda

Background: Worm infections are among the most prevalent neglected tropical diseases (NTDs)
worldwide. In Rwanda, Schistosomiasis and Soil-Transmitted Helminths (STH) are the most
common worm infections, mostly affecting school aged children. Since 2014, the government of
Rwanda through the Ministry of Health (MOH), supported by World Health Organization (WHO)
and World Food Program (WFP), adopted a nation-wide deworming program to address worm
infections. This study was conducted to assess the KAP of Community Health Workers (CHWs)
and teachers on deworming, and to explore the perspectives and experiences of local leaders who
are primary implementers in this program.
Methods: This was a cross-sectional study consisting mainly of a quantitative survey with
complementary in-depth interviews (IDIs). The study settings were Nyamagabe and Rutsiro
districts in Rwanda. Cluster sampling was used to acquire CHWs and teachers for the survey, and
purposive sampling was used to acquire local leaders for the IDIs. Quantitative data was analyzed
using univariate, bivariate and multivariate techniques while qualitative data was analyzed
thematically.
Results: A total of 852 CHWs and teachers completed the KAP survey on worm infections, among
which 63.6% were female. A total of 54.1% of the respondents had a good knowledge score,
estimated at ≥80%. The mean knowledge score was 78.04%. From the multivariate analysis, lack
of training was shown to increase the odds of having poor knowledge (OR 0.487, 95% CI: 0.328
– 0.722, p <0.001). One attitude statement was associated with knowledge: “I am an important
contributor to the prevention of Schistosomiasis in my community”, as participants who had poor
knowledge were less likely to agree with the statement (OR 0.215, 95% CI: 0.0079-0.580, p
<0.001). With regards to practice, participants with good knowledge, were more likely to swim in
rivers/lakes (OR 2.187, 95% CI: 1.242-3.850, p=0.006)
A total of 17 local leaders were interviewed. The 5 emerging themes were: (1) Community
mobilization and sensitization by local leaders and CHWs improved the outreach of the deworming
program, (2) Community members appeared to appreciate the decentralized deworming program
and expressed the desire for expansion, (3) Complementary interventions to the deworming
program, (4) Resistance and hesitance from caregivers were perceived as challenges to the
deworming program, (5) Poor water access was identified as a drawback in the prevention of worm
infections.
Conclusion: The findings from this study signify the importance of training CHWs and teachers
on worm infections as they are the key personnel in the deworming program. Furthermore, the
deworming program must be expanded to cover adults as they are also at risk of acquiring worm
infections. There is a critical need to strengthen Water Sanitation and Hygiene (WASH) programs
as complementary activities to deworming, which play a vital role in curbing worm infections.
Intensified health education of community members on misconceptions towards deworming can
help improve the outcome of the deworming program.