Research Article: Gut Instincts: Knowledge, Attitudes, and Practices regarding Soil-Transmitted Helminths in Rural China

Date Published: March 25, 2015

Publisher: Public Library of Science

Author(s): Louise Lu, Chengfang Liu, Linxiu Zhang, Alexis Medina, Scott Smith, Scott Rozelle, Darren J. Gray.

Abstract: BackgroundSoil-transmitted helminth (STH) infections affect more than two out of every five schoolchildren in the poorest regions of rural China, an alarmingly high prevalence rate given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STH infection in rural China has until now, been sparse, although such information is critical for prevention and control initiatives.Methodology/Principal FindingsThis study aims to elucidate the structural and sociocultural factors that underlie high STH infection rates as well as explain why deworming treatment is rarely sought for children. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children’s parents and grandparents, and village doctors. Data analysis exposed three predominant reasons for high STH prevalence: (1) lack of awareness and skepticism about the high prevalence of STH infection, (2) local myths about STH infection and deworming treatment, and (3) poor quality of village health care.Conclusions/SignificanceThe findings from this study reveal reasons for why deworming treatment is not sought, and inform specific recommendations for a deworming intervention that can more effectively address underlying barriers to deworming in areas of persistently high STH infection rates. The main barrier to seeking STH treatment is not availability or cost of the drugs, but rather the lack of impetus to seek the drugs. A comprehensive nationwide deworming program in China should involve annual provision of free deworming treatment in village clinics or schools, distribution of culturally appropriate educational materials to inform children and families about STH infection, and improvement of the quality of health care delivered by village clinicians.

Partial Text: Soil-transmitted helminths (STH) are a group of parasitic intestinal worms that can infect humans through ingestion of parasite eggs or skin contact with motile larvae. Four STH species are of particular significance in public health: roundworm (Ascaris lumbricoides), whipworm (Trichuris trichiura), and two species of hookworm (Necator americanus and Ancylostoma duodenale) [1]. As of June 2013, it was estimated that more than one billion people around the world are infected with at least one of these four species [2].

Three predominant reasons for high STH infection prevalence emerged from analysis of the data: lack of awareness about STHs; local myths about worms and deworming, and poor quality of village health care.

Field interviews with parents, grandparents, children, and village doctors revealed insight into the knowledge, attitudes, and practices surrounding STH in rural China. The three major reasons identified in the Results section provide a comprehensive understanding of the sociocultural and structural factors that appear to contribute to high STH prevalence among schoolchildren in rural Guizhou.



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