Knowledge, Attitudes and Practice Related to Soil-Transmitted Helminthes in Rwandan Villages

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Committee Members: Dr. Rickie Brawer and Dr. James Plumb, Thomas Jefferson University.


The current prevalence of intestinal helminthiasis in Rwandan school-aged and preschool-aged children is over 70%. Chronic infection can lead to problems including malnutrition, anemia and delayed development, and there is evidence that these diseases promote poverty as well. Recently the Rwandan government instituted programs to medicate all children twice yearly as per the recommendations of the World Health Organization. The goal of this project was to understand the factors that are involved in people’s decisions to participate in the mass drug administrations as well as to engage in health behaviors that reduce transmission rates. In order to explore these issues we used mixed methods investigation. A total of 3 focus groups were held in the two villages, in addition to conduction of surveys and interviewing of key informants. Focus group results were analyzed using qualitative methods, and survey results analyzed using descriptive statistics. Challenges to conducting focus groups in Rwanda include working through a translator, lack of familiarity with the process and possible interference from the Hawthorne effect. Results showed that there was a considerable amount of misinformation regarding the causes, transmission and prevention of intestinal worms, and a strong belief that the conditions of poverty made prevention of transmission impossible. Parents who had to work lacked feelings of self-efficacy in their ability to promote health behaviors in their children while they were away, including hand washing, latrine usage and wearing shoes. Sentiments toward the mass drug administrations and prophylactic medicine usage were positive, although it was not commonly known that this is available. Recommendations were made using the Health Belief Model for future interventions. An educational module using these recommendations will be designed in conjunction with students from Jefferson planning to travel to Rwanda next summer, and will be used to further the public health initiatives of the Jeff HEALTH student organization in Rwanda.