Effectiveness of an education-based control option for human cysticercosis
Authors: Kabemba Evans Mwape
Journal: The Lancet Global Health (2018)

Taenia solium is a zoonotic parasite affecting resource-poor communities in developing countries, and ranks high on the list of neglected tropical diseases. The parasite causes human cysticercosis, which is a major cause of epilepsy in endemic countries.1Ndimubanzi PC Carabin H Budke CM et al.A systematic review of the frequency of neurocysticercosis with a focus on people with epilepsy.PLoS Negl Trop Dis. 2010; 4: e870Crossref PubMed Scopus (296) Google Scholar Poor knowledge about the parasite in affected communities remains a major risk factor for infection since it leads to continuation of risky behaviours that contribute to transmission of the parasite. Factors such as consumption of infected pork, which in most cases is undercooked and not inspected, deliberate use of human faeces for fertilising fields or feeding pigs, open defaecation, and poor sanitation in affected communities remain important risk factors.2Murrell KD WHO/OIE/FAO guidelines for the surveillance, prevention and control of taeniosis/cysticercosis.in: World Health Organization for Animal Health (OIE), Paris2005: 27-43Google Scholar Traditional taboos have also been reported to contribute to practices, such as avoidance of latrine use.3Thys S Mwape KE Lefèvre P et al.Why latrines are not used: communities' perceptions and practices regarding latrines in a Taenia solium endemic rural area in Eastern Zambia.PLoS Negl Trop Dis. 2015; 9: e0003570Crossref PubMed Scopus (72) Google Scholar Although the zoonotic disease caused by T solium has been described as potentially eradicable,2Murrell KD WHO/OIE/FAO guidelines for the surveillance, prevention and control of taeniosis/cysticercosis.in: World Health Organization for Animal Health (OIE), Paris2005: 27-43Google Scholar its control still remains problematic. Drugs and vaccines for control of cysticercosis in pigs are either expensive, not readily available, or not registered in endemic countries.4Gabriël S Dorny P Mwape KE et al.Control of Taenia solium taeniasis/cysticercosis: the best way forward for sub-Saharan Africa?.Acta Trop. 2017; 165: 252-260Crossref PubMed Scopus (40) Google Scholar Affected communities do not always have the necessary knowledge to recognise cysticercosis in pigs as a zoonotic disease and are therefore not prompted to adopt behaviours that could prevent disease transmission. Sanitation programmes that have been implemented have shown little improvement in T solium control. The community-led total sanitation approach evaluated in Zambia showed no significant reduction in occurrence of cysticercosis in pigs, nor did it improve the behavioural practices of inhabitants.5Bulaya C Mwape KE Michelo C et al.Preliminary evaluation of community-led total sanitation for the control of Taenia solium cysticercosis in Katete District of Zambia.Vet Parasitol. 2015; 207: 241-248Crossref PubMed Scopus (28) Google Scholar Furthermore, a community reported to be open defaecation-free for over a decade reported a porcine cysticercosis prevalence of about 10% (unpublished results). These reports indicate that a sanitation programme without a specific message for controlling a disease is ineffective. Another important factor hindering control of T solium is the absence of cheap and reliable diagnostic tools in affected communities.6Mwape KE Gabriël S The parasitological, immunological, and molecular diagnosis of human taeniasis with special emphasis on Taenia solium taeniasis.Curr Trop Med Rep. 2014; 1: 173-180Crossref Scopus (10) Google Scholar Many reports have shown that the control of T solium requires a One Health approach bringing together the health and veterinary sectors. Control of T solium infections remains important in reducing the burden of human cysticercosis on affected communities. Since it is a neglected parasite, governments in endemic countries do not have the resources to implement expensive interventions such as mass drug administration for both human beings and pigs or vaccinations of pigs. Breaking the transmission of T solium requires changing people's attitudes towards the parasite. This approach involves changing health-related behaviours and practices by identifying important and potentially modifiable factors.7Ngowi H Ozbolt I Millogo A et al.Development of a health education intervention strategy using an implementation research method to control taeniasis and cysticercosis in Burkina Faso.Infect Dis Poverty. 2017; 6: 95Crossref PubMed Scopus (12) Google Scholar Health education has been shown to reduce the incidence of T solium infections in both human beings and pigs, and is thus a cheaper control option than drug-based and vaccine-based interventions. However, the effectiveness of this control option requires thorough scientific evaluation with sound study designs. Studies that explore the effectiveness of health education as a control option for T solium with robust study designs are needed. The cluster-randomised controlled trial by Hélène Carabin and colleagues,8Carabin H Millogo A Ngowi HA et al.Effectiveness of a community-based educational programme in reducing the cumulative incidence and prevalence of human Taenia solium cysticercosis in Burkina Faso in 2011–14 (EFECAB): a cluster-randomised controlled trial.Lancet Glob Health. 2018; 6: e411-e425Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar which aimed to estimate the effectiveness of a community-based educational intervention in reducing human cysticercosis frequency in Burkina Faso, is one such report that provides empirical evidence that a participatory intervention can be an effective and cheap option for control of human T solium cysticercosis. The intervention tended towards a reduction in the cumulative incidence and prevalence of active human cysticercosis overall, although it was more effective in two of three provinces studied, with almost no effect in the third. The report contributes to the available knowledge on the effectiveness of control options for this parasite. The use of innovations such as the community-level model PHAST (Participatory Hygiene and Sanitation Transformation) applied via the SARAR (Self-esteem, Associative strengths, Resourcefulness, Action planning, Responsibility) approach, and adaptation of these models to human cysticercosis, is important in assisting communities to adopt behaviours that can break the life cycle of the parasite. Such an approach can empower communities to drive the intervention measures and thus achieve improved results. The use of a cluster-randomised controlled trial is the most appropriate approach for evaluation of health promotion and educational interventions. Since cost is a huge hindrance to control measures in developing countries, the actual total cost of undertaking this community-based educational programme requires evaluation. However, if the intervention is provided and implemented at a large scale, as stated by the authors, the cost could be minimal. Possibilities of integration of this type of intervention with educational interventions for other diseases should also be considered to make the intervention even more cost-effective. Our knowledge of infections caused by T solium has substantially increased in the past decades, even in sub-Saharan Africa. Areas of endemicity, risk factors, burden of diseases, and control options have been reported. It is imperative that the focus now moves towards control. There is, therefore, a need for complete evaluation of the cost-effectiveness of the various options available, either as single stand-alone options or in various combinations to identify those that are most cost-effective. I declare no competing interests. Effectiveness of a community-based educational programme in reducing the cumulative incidence and prevalence of human Taenia solium cysticercosis in Burkina Faso in 2011–14 (EFECAB): a cluster-randomised controlled trialCommunity-engaged participatory interventions can be effective at reducing the incidence and prevalence of cysticercosis in some low-resource settings. Full-Text PDF Open Access