Adherence to diagnosis followed by selective treatment of schistosomiasis mansoni and related knowledge among schoolchildren in an endemic area of Minas Gerais, Brazil, prior to and after the implementation of educational actions

Abstract

Introduction Brazilian guidelines for schistosomiasis elimination recommend regular search of infection carriers and their timely treatment. This study evaluates the effect of educational actions (EAs) among schoolchildren on adherence to diagnosis and treatment, as well as on knowledge of the disease. Methods In April/2013, a questionnaire was applied to 6th-to-8th-grade pupils of eight public schools to evaluate prior knowledge of disease and self-reported risk behavior. Baseline parasitological survey (PS) was done in May/2013, followed by selective treatment and cure assessment. The schools were then randomly allocated to experimental (EG) and control (CG) groups, with and without EAs, respectively. EAs were conducted for 3 months from August/2013. Questionnaire was reapplied in November/2013, April/2014, October/2014, and October/2015 to evaluate changes in knowledge about the disease and self-reported risk behavior. Two further annual PSs (May/2014 and May/2015), each followed by treatment of positives, allowed to evaluate between-group differences and intra-group changes in adherence to diagnosis and treatment, and to follow-up prevalence and intensity of infection. Results Adherence to diagnosis did not differ significantly between EG (84.1%) and CG (81.1%) at baseline but was significantly higher in EG in subsequent PSs. Overall, adherence to treatment was higher than 90% in all three PSs; cure was 98.4%, egg-reduction was 99.8% and reinfection, 2.8%. Prevalence fell significantly in EC (from 23.5% to 6.8%) and CG (from 21.8% to 2.4%), the same occurring with intensity (from 54.2 to 4.6 epg in EG and from 38.4 to 1.3 epg in CG). Disease knowledge increased significantly in EG and CG; knowledge about disease transmission increased significantly more in the EG. Self-reported risk behavior remained above 67% and did not differ significantly between EG and CG. Conclusion EAs increased adherence of schoolchildren and improved knowledge about the disease, confirming that EAs are an important tool to enhance schoolchildren participation in control campaigns.

Teachers as multipliers of knowledge about schistosomiasis: a possible approach for health education programmes

“…The school has traditionally been used as a place for learning by formal teaching. However, many studies in Brazil and other endemic countries have shown a broader role for schools as a space for health promotion, non-formal teaching and addressing issues relating to schistosomiasis (10,(16)(17)(18)(19).…”

“…That scenario contributed strongly to the teachers determined engagement in conducting the educational activities with their pupils, making them key components of the endeavour to control the disease. Several studies have suggested that teachers can facilitate and motivate pupils' adherence to diagnosis and treatment, in addition to mobilising educational activities to develop a clearer understanding of the disease, thus making pupils and their families more willing to participate in activities led by teams of local health workers (10,13,(27)(28)(29)(30).…”

“…For that reason, they are the main target for WHO recommendations and preventive chemotherapy programmes in several endemic countries (8). Children's adherence to diagnosis, treatment and other control measures implemented by local health teams has been demonstrated to be a key factor in the success of programmes directed to schistosomiasis and dracunculiasis (9,10). The various schistosomiasis control strategies can be made more successful and sustainable if they are combined with continued health education programmes able to engage the target population and address speci c local features of the infection both in the school environment and in the wider community (11,12).…”

“…The school has traditionally been used as a place for learning by formal teaching. However, many studies in Brazil and other endemic countries have shown a broader role for schools as a space for health promotion, non-formal teaching and addressing issues relating to schistosomiasis (10,(16)(17)(18)(19).This study evaluated whether, when applied to schistosomiasis, two educational approaches directed to primary and lower secondary school teachers and tailored to epidemiological conditions in the endemic municipality where they lived had contributed to improving knowledge of the endemic, and whether that improvement was re ected positively in the level of knowledge acquired by their pupils.…”

Reliability of point-of-care circulating cathodic antigen assay for diagnosing schistosomiasis mansoni in urine samples from an endemic area of Brazil after one year of storage at -20 degrees Celsius

“…This study was conducted in Jaguaritira (17°54’00.0” S; 42°13’58.8” W), a rural district in the municipality of Malacacheta with a population of approximately 900, located in the endemic area of Minas Gerais, Brazil 11 . The prevalence of schistosomiasis estimated by the KK (single sample, two slides) among schoolchildren (6-15 years-old) was 13% in 2015 12 . In May-June 2019, all children aged 11-13 years attending the middle years of upper secondary school in Jaguaritira, together with their families, were invited to participate in the multicenter study, the findings of which will be published in good time.…”