Effects of Public Health Interventions on Intestinal Parasitic Infections among School-Going Children in Murang’a County, Kenya

Intestinal parasitic infections have been found to form at least a quarter of all human infections globally. School-going children are the worst affected by these infections as it impairs their growth and cognitive development. Following the WHO recommendation, the Government of Kenya rolled out a school deworming programme under the School Health Programme in 2009. The study was embedded in the School Health Programme. The main objective of the study was to investigate the effects of public health interventions against intestinal parasitic infections among school going children in Murang’a County. It was a quasi-experimental study with schools assigned to intervention and control groups. The schools were selected through multi-stage sampling. Data was collected in three phases: baseline, intervention and post intervention evaluation. A total of 446 pupils from six primary schools provided stool samples for examination of intestinal parasitic infections. Structured interview guides and observation were used to collect more information on school sanitation, pupils’ hygiene practices and their level of knowledge of intestinal parasites. Qualitative data was collected through Key Informants Interviews and observations of school sanitation and hygiene practices compared with School Health Policy. Installation of tippy taps, provision of soap and water, and health education were some of the public health interventions which were implemented in intervention group. A post intervention evaluation was conducted to determine the effect of these interventions. Data was analyzed using SPSS version 20. Association of variables was tested using chi-square while t-test was used to compare means. At the baseline phase the overall prevalence of intestinal protozoan infections was 51.2% and 55.1% in the intervention and control group respectively. Prevalence of intestinal helminthic infections was 12% and 16.5% in intervention and control groups respectively. A comparison of mean percentage of infected pupils at baseline revealed that there was no statistically significant difference in the prevalence of intestinal parasites between intervention and control groups (t =0.32, P = 0.37). Level of knowledge of intestinal parasites was 52.3% and 48.8% in the intervention and control group respectively. The difference between the two was not statistically significant ( 2 = 3.4, df = 5, P=0.13). There was a statistically significant relationship between protozoan infections and school sanitation ( 2 = 10.3, df = 1, P = 0.001). Association between helminthic infections and school sanitation was also found to be significant ( 2 = 2.4, df = 1, P=0.01). Key informants interview revealed that there were no health clubs at schools through which health promotion would be propagated among the pupils. After intervention a comparison of mean percentage of infected pupils revealed that there was a statistically significant reduction in intestinal protozoan infections in intervention group from 55.1% to 6.0% (t=12.6, P=0.001). There was also a statistically significant reduction in the prevalence of helminthic infections in the intervention group from 12.4% to 0.0% (t = -3.78, P<0.001). This has led to the conclusion that public health interventions influenced the reduction of the prevalence of intestinal parasites. The findings of this study are useful to the ministry of Education in formulating policies that will shape the future of the School Health Programme in Kenya. There is a suggestion to conduct a community based study to rule out the infections from the home environment.