Research Article: Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia

Date Published: March 4, 2015

Publisher: Public Library of Science

Author(s): Séverine Thys, Kabemba E. Mwape, Pierre Lefèvre, Pierre Dorny, Tanguy Marcotty, Andrew M. Phiri, Isaak K. Phiri, Sarah Gabriël, Margaret Gyapong.

Abstract: Taenia solium cysticercosis is a neglected parasitic zoonosis occurring in many developing countries. Socio-cultural determinants related to its control remain unclear. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. The study objective was to assess the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia inhabited by the Nsenga ethno-linguistic group, and to identify possible barriers to their construction and use. A total of 21 focus group discussions on latrine use were organized separately with men, women and children, in seven villages of the Petauke district. The themes covered were related to perceived latrine availability (absence-presence, building obstacles) and perceived latrine use (defecation practices, latrine management, socio-cultural constraints).The findings reveal that latrines were not constructed in every household because of the convenient use of existing latrines in the neighborhood. Latrines were perceived to contribute to good hygiene mainly because they prevent pigs from eating human feces. Men expressed reluctance to abandon the open-air defecation practice mainly because of toilet-associated taboos with in-laws and grown-up children of the opposite gender. When reviewing conceptual frameworks of people’s approach to sanitation, we found that seeking privacy and taboos hindering latrine use and construction were mainly explained in our study area by the fact that the Nsenga observe a traditionally matrilineal descent. These findings indicate that in this local context latrine promotion messages should not only focus on health benefits in general. Since only men were responsible for building latrines and mostly men preferred open defecation, sanitation programs should also be directed to men and address related sanitary taboos in order to be effective.

Partial Text: Taenia solium taeniosis/cysticercosis is an important neglected parasitic zoonosis prevailing in many developing countries. The adult tapeworm lives in the intestines of humans, causing taeniosis, while the metacestode larval stage (cysticercus) usually develops in pigs following the ingestion of eggs excreted with the stool of tapeworm carriers, causing cysticercosis. Cysticercosis may also occur in humans upon accidental ingestion of eggs via faeco-oral contamination and may cause severe neurological disorders when cysticerci lodge in the central nervous system (neurocysticercosis, NCC) [1]. NCC is the most important parasitic neurological infection, to which almost 30% of acquired epilepsy cases are attributed in endemic areas [2].

The results highlight the different themes that emerged in the analysis. To reflect as much as possible what was expressed in the discussions, the order used to present the themes in each sub-sections reflects the level of importance given by the participants to these topics (going from a strong to a weaker consensus). No significant differences were observed between villages (very homogeneous), we indicate when the main ideas were mentioned across all the FGDs and where consensus or differences arose the most among the three different categories of FGDs conducted (men, women and children).

Considering the results presented in this manuscript, it is clear that the transmission of T. solium can easily continue in this very suitable fecal contaminated environment where few infrastructure for safe excreta disposal are available and correctly built or used and therefore allowing free roaming pigs to maintain the lifecycle in such endemic area.



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