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

Abstract

SummaryBackgroundThe effectiveness of drug-free interventions in controlling human cysticercosis is not well known. We aimed to estimate the effectiveness of a community-based educational intervention in reducing the frequency of human cysticercosis in Burkina Faso.MethodsWe did a cluster-randomised controlled trial between 2011 and 2014. 60 eligible villages from three provinces (Boulkiemdé, Sanguié, and Nayala) were randomly allocated to the intervention or control group. Villages raising pigs, that were not a regional capital or located on a main road, that were more than 20 km from Ouagadougou or 5 km from one another, were eligible. In each village, 60 participants were asked for blood samples at baseline, 18 months later (before randomisation), and 18 months after randomisation. Villages were block randomised (1:1) by pig-raising department immediately after the pre-randomisation visit. The intervention aimed to improve knowledge of Taenia solium transmission and control through screening and structured discussion of a 52-min movie, and to increase community self-efficacy through a Self-esteem, Associative strengths, Resourcefulness, Action planning, Responsibility (SARAR) approach via the Participatory Hygiene and Sanitation Transformation (PHAST) model. The primary outcome was active cysticercosis, defined as the presence of circulating antigens detected by use of B158/B60 ELISA. Effectiveness measured at the village level was estimated by use of three Bayesian hierarchical models. This study is registered with ClinicalTrials.gov, number NCT0309339.FindingsTwo villages in the same randomisation block were excluded, resulting in a final sample size of 58 villages. Overall, the intervention tended towards a decrease in the cumulative incidence of active cysticercosis from baseline to after randomisation (adjusted cumulative incidence ratio 0·65, 95% Bayesian credible interval [95% CrI] 0·39–1·05) and a decrease in active cysticercosis prevalence from baseline to after randomisation (adjusted prevalence proportion ratio 0·84; 95% CrI 0·59–1·18). The intervention was shown to be effective in Nayala and Sanguié but not in Boulkiemdé.InterpretationCommunity-engaged participatory interventions can be effective at reducing the incidence and prevalence of cysticercosis in some low-resource settings.FundingUS National Institutes of Health (National Institute of Neurological Disorders and Stroke, Fogarty International Center, and National Institute of General Medical Sciences).

Factors Associated with the 18-Month Cumulative Incidence of Seroconversion of Active Infection with Taenia solium Cysticercosis: A Cohort Study among Residents of 60 Villages in Burkina Faso

“…This cohort study used data from the 18-month pre-randomization period of a cluster-randomized controlled trial (CRCT) aimed at estimating the effectiveness of an educational program to reduce human and porcine CC. 19 …”

“…Reasons for province inclusion and selection procedures for study villages, households, concessions (i.e., a group of households living in a compound), and participants were previously described. 9 , 19 , 20 Briefly, the three provinces were selected based on their large pig population (Boulkiemde and Sanguie) or neighboring location (Nayala). Departments where there was a record of some pig raising were selected (30 of 31 departments in the three provinces) and two villages per department with at least 1,000 inhabitants and pig raising, present on official maps and separated from other study villages by at least 5 km, were randomly selected for future blocked randomization in the CRCT.…”

“…As described elsewhere, 19 potential participants were first asked if they were willing to provide a blood sample on three occasions over the next 3 years until 60 participants in each village consented to the serological component of the study. Participants refusing to participate to the serological follow-up were included in the general follow-up to measure knowledge attitudes and practices toward T. solium and development of epilepsy and severe chronic headaches.…”

“…The villages were visited in the same order and 18 months apart. Because of unforeseen circumstances (see Carabin et al 19 for more details), the phlebotomist was not available when the villages in Nayala were visited and some participants were absent during the initial pre-randomization sampling period. To reduce the number of missing samples, a physician was sent to collect all blood samples in Nayala and to villages with a high number of participants absent during the initial phlebotomist visit.…”

Overview of Taenia solium cysticercosis in West Africa

“…Gap; Recently effectiveness of community-based (EFECAB) educational programme carried out in Burkina Faso showed a reduction in the cumulative incidence of active cysticercosis (adjusted cumulative incidence ratio 0ꞏ65, 95% Bayesian credible interval [95% CrI] 0ꞏ39-1ꞏ05)and a reduction in active cysticercosis prevalence adjusted prevalence proportion ratio 0ꞏ84; 95% CrI 0ꞏ59-1ꞏ18) both from baseline to after randomisation (Carabin et al, 2018).Such studies can be repeated in other countries of West Africa so that health education can be used as a control tool for T. solium cysticercosis in West Africa.…”