In , a recent remapping survey using detection of the circulating cathodic antigen CCA from S. This considerably more sensitive diagnostic tool detected S. The role of primary health care is fundamental in sustaining a successful control strategy. Knowledge of the way people live in endemic communities and how they value and utilize the services provided by the primary health care facilities is crucial.
Since then, however, the situation has improved and data for show that Few knowledge, attitude and practices KAP studies have been carried out in Egypt, and no studies looked at the peripheral health services. The main aim of the present study is to create community-based KAP portrays comparing a highly prevalent village to a low-prevalence community in the same region.
In addition, we compared the healthcare service in the two villages and investigated the schistosomiasis transmission using multiple indicators not only limited to human infection, but also including malacological indices such as shedding and sentinel mice [ 42 ]. The data of the present study is part of the microlevel approach of Schistosomiasis Research Project SRP which was funded by the government of the USA and the MoHP aiming to improve control strategy of schistosomiasis [ 43 ].
Part of this project focused on the epidemiology of schistosomiasis using hybrid of cross-sectional prospective study designs, and included governorates in the Nile Delta, Nile Valley and new reclaimed areas [ 44 ]. Due to the the current, sometimes insecure situation, there was an unplanned, relatively long gap between the time of conducting the study and its finalization.
However, this should not have caused any change of the level of transmission [ 40 ], the quality of peripheral healthcare services or the population education profile in the study area inrural Egypt.
Based on previous surveys in this region [ 45 ], two villages were selected: El-Rouse for high schistosomiasis prevalence and Ebiana for low. The village has only two schools; preparatory and mid-level. For water, the inhabitants depend on public taps in addition to canal water, but they lack a proper sanitary sewage disposal system.
Most of the inhabitants are farmers producing mainly rice and vegetables. This village is older and larger than El-Rouse and has a higher socioeconomic standard as well as an overall higher educational level. It has preparatory, mid- and high-level schools. There is a primitive sewage disposal system and most of the houses have access to clean water inside, however not always in adequate amounts, so some people depend partly on public tap water for domestic purposes.
Farming is the main occupation also in this village and rice is the main crop. Each village has a peripheral health centre. In Ebiana, the sample included individuals in houses; in El Rouse, the sample included individuals in 66 houses. The sample size calculation was mentioned in the first report [ 43 ], published in , showing that the sample size was selected by multistage stratified random sample, was calculated to detect a prevalence of Schistosoma sp.
The field examination included three main arms: KAP, parasitology and malacology. The KAP questionnaire was designed by two specialists in health education and behavioural science, and the validity of the contents was confirmed by a panel of experts Supp 1.
Before the study, the questionnaire was piloted in the field to ensure face validity, while necessary modifications were implemented as necessary. Knowledge questions inquired about the disease, mode of transmission and preventive measures. This section included 13 questions with eight questions scored from 0 to 2 and 5 questions from 0 to 3. The attitude scale measured three domains including; perceived danger of canal water included seven items, perceived disease severity included three items, and perceived benefits of treatment included five items.
In total, the scale comprised 15 items measured on a three point-Likert scale, i. The score ranged from 15 to 45, with higher scores indicating good attitudes. Water contact included six items scored from 1 to 3 usually; sometimes; and never , The total score ranged from 6 to 18, where lower scores indicated more water contact. Experience of the study participants with regard to health services was investigated using questions that assessed the utilization of health services provided by the health center: four multiple option questions were designed to inquire about rating of the village health center as a source of care, place of latest stool analysis and treatment, and the principal source of health care.
The standard Kato-Katz methodology [ 35 ] was used for stool examination. Stool samples were collected annually at the end of transmission season and at the same time from the houses. Diagnosis of S. Egg counts from the four slides of the two consecutive samples were averaged and the egg per gram of stool EPG was computed. This approach was used because intensity of infection does not follow the Poisson distribution, which makes the GMEC preferable compared to the arithmetic mean.
The prevalence of infection was determined at the base line with follow-up prevalence, incidence and reinfection rates determined annually comparing two consecutive years.
Incidence was computed as the percentage of positives among those who had tested negative in the previous year whilst reinfection was determined for those who tested positive despite being treated on the previous year [ 47 ].
This part of the study focused on Biomphalaria alexandrina , the intermediate host of S. Mapping of canals and drains in the two villages were performed to locate the transmission foci, i. Only one snail survey per year was conducted in each village during the transmission season May—December at selected stations along a total length of Snails were collected with scoops using three dips from each station.
At the central lab, the snails were identified with respect to species and examined for Schistosome Cercariae using the shedding technique [ 48 ]. The mice were perfused eight weeks after exposure to determine the risk of infection at each station. Data were analyzed using SPSS, version Intensity of infection was expressed as GMEC.
The prevalence of S. Additionally, the intensity of infection in El-Rouse was almost triple that found in Ebiana. Annual application of PZQ treatment for cases testing positive resulted in a significant reduction of prevalence and intensity of infection in both villages after the first intervention.
However, while the prevalence fell faster in Ebiana than in El-Rouse, and continued to decrease there over the whole study period, the prevalence in the latter actually rebounded after the second round Table 1. The force of transmission, as measured by incidence and reinfection, demonstrated a slight improvement in Ebiana, whilst reinfection increased from 58 to However, the intensity of infection remained very similar in both villages in the follow-up years after falling compared to the baseline, particularly in El-Rouse.
Although no infection was detected among children younger than five years in Ebiana, ominously, more than quarter of the children of the same age were infected in El-Rouse.
Incidence and reinfection data reveal that children below five were negative at the first annual follow-up in Ebiana, while more than one third of those of the same age category were re-infected, and one fifth were newly infected, in El-Rouse.
Following PZQ chemotherapy, the first annual follow-up revealed an initial improvement followed by either stationary results, as shown in Ebiana, or deterioration, as shown in El-Rouse. This trend was similar among all age groups Fig. The malacological and sentinel mice data are shown in Table 2. The number of transmission foci in El-Rouse exceeded that of Ebiana, i.
Five of the eight infected test sites were drains in El-Rouse versus only one out of the four in Ebiana. The distribution of infected mice coincided with the foci harbouring infected snails.
Furthermore, a longer canal area was infected in El-Rouse compared to Ebiana, where the transmission sites were closer to each other. Results demonstrate different levels of general knowledge on schistosomiasis between the two villages. While both villages showed modest levels of knowledge Ebiana: Focusing on knowledge related to the individual, ways of self-protection and treatment were the most frequently correctly answered questions.
Nevertheless, the role of human excreta and mode of transmission were the least correctly understood by all villagers Table 3. The total knowledge score did not only significantly differ between the two villages, but varied also significantly according to age, gender, educational background and occupation.
Poor knowledge was more prevalent among older age, females, lower educational levels, farmers and non-working groups Table 4. The mean attitude scores regarding prevention and control of schistosomiasis as perceived by Ebiana and E-Rouse inhabitants is displayed in Table 5.
Despite the favourable attitude reported by both villagers across all domains, the participants maintained that they could not avoid using canals even if public water taps and indoor water are available. Many reasons were reported, such as no water in the tap water for days on end, poor quality of tap water when available, crowding around public taps in addition to exposure to canal water as a natural occupational part of various activities.
However, people seemed to use the canals for many different domestic and occupational purposes, i. Findings related to source of health care indicated clearly that the role of the health centre differed substantially between the two villages. In Ebiana, the village health centre was found to be the primary or secondary source of care more frequently As many as Private clinics were found to be the primary source of health care by the greater proportion at both villages, but more frequently at El-Rouse Concerning analysis and treatment for schistosomiasis, it appears that the current project was the site of the last analysis and treatment for the greater proportion at Ebiana Findings related to the opinion of respondents towards several aspects of the services available at the village health centres indicate a more favourable score at the lower-prevalence village Ebiana, which has a greater utilization of the health centre than El-Rouse.
The difference was particularly marked in relation to opinion with respect to the physicians. Thus, The health centres at both villages were felt to be reasonably accessible to their users, but the centre at Ebiana more so than in the neighbouring village. Waiting time in the centre to see a physician during the latest visit was rated as reasonable by Primary care healthcare centres maintain the NTD control strategies in the field on a day-to-day basis dispensing health education, diagnosis and treatment under the supervision of the MoHP.
Despite the generally favourable attitude towards the health centres and their work reported by villagers across all domains, the participants felt that they could not completely avoid canal water contact. Although most villagers participating in the study had an understanding of the type of infections lurking in the canal water, they downplayed the risk.
Local knowledge how schistosomiasis is transmitted and prevented and view of the healthcare services available are crucial to achieve the target of effective control. In accordance with our results, previous studies highlight the insufficient knowledge about schistosomiasis in the endemic areas [ 21 , 22 , 25 ]. This leads to a false feeling of safety indicating that education needs to be strengthened.
In addition, tap water provision must be improved encouraging people to abstain from other forms of water contact. This was underlined by the more favourable scores obtained at the low-prevalence village and its greater utilization of the health centre and more positive attitude towards the physicians there.
Access and waiting time, which were more favourable at the low-prevalence village, might also play a role. Lack of knowledge is the ultimate outcome of poverty and the attenuated role of the healthcare services.
They both perpetuate the risk of reinfection and negatively affect treatment seeking. This clearly applies to sub-Saharan Africa, having the highest prevalence of schistosomiasis coupled with the lowest income per-capita [ 49 ], and to the situation in Yemen [ 38 ]. This is in contrast to developed countries which succeeded in eliminating this infection; for example, Japan [ 50 ] and modern-day China [ 51 ], which has made a remarkable progress towards elimination.
Evaluation in showed that prevalence dropped from pre-control Also mean intensity attained low levels consistent of low grade infections. A review of achievements of the national schistosomiasis control program in middle and upper Egypt areas.
Abrir menu Brasil. Abrir menu. Volume 5 Volume 4 Volume 3 Volume 2 Volume 1 Issue 2. Issue 1. Zaher, T. Abstract Background and study aim: Schistosomiasis was endemic in Egypt since the ancient times. It was traditionally the most important public health problem.
This study aimed to evaluate the current status of schistosomiasis in Sharkia governorate ,Egypt.
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