The status and health burden of neurocysticercosis in Mbulu district, northern Tanzania

Knowledge, attitudes and practices regarding porcine cysticercosis control among smallholder pig farmers in Kongwa and Songwe districts, Tanzania: A cross-sectional study

Taenia solium taeniasis/cysticercosis (TSTC) is a parasitic zoonotic disease that is endemic in several developing countries, causing serious public health and economic impacts. A cross-sectional study was conducted to assess knowledge, attitudes and practices (KAP) related to porcine cysticercosis (PCC) transmission, prevention and control among smallholder pig farmers in Kongwa and Songwe Districts in Tanzania. A semi-structured questionnaire was administered to 692 smallholder pig farmers from randomly selected households. STATA software version 17 was used to analyse quantitative data, summarize farmers' KAP about PCC and calculate performance scores. Nearly half (42%) of the respondents had little knowledge regarding PCC, only 17% of the respondents had good practices towards prevention/control of PCC and 72% had a positive attitude towards PCC- prevention/control measures. The majority (73%) of smallholder pig farmers admitted deworming their pigs regularly, whereas 76% reported deworming themselves and their family members regularly. Albendazole and ivermectin are the most commonly used medications for deworming people and pigs, respectively. According to the findings, the majority of smallholder pig farmers in Kongwa and Songwe Districts showed a good attitude towards PCC prevention/control measures but had limited knowledge of the PCC life cycle and control. In addition, only one in five farmers was engaged in good practices. The findings revealed further that farmers are engaged in risky behaviours that aid the spread and perpetuation of the T. solium parasite in the study area. It is recommended that farmers should be given proper health education on the T. solium transmission cycle and preventive/control practices to limit PCC transmission.

An epidemiological survey of porcine cysticercosis in Rungwe District, Tanzania

Taeniasis/cysticercosis caused by tapeworms belonging to the genus Taenia, poses serious veterinary and public health problems, resulting in economic burden in endemic low-income countries worldwide. However, little epidemiological data exist on infection status among pigs in many areas in Tanzania. We conducted a cross-sectional survey in Rungwe District, Mbeya Region, Tanzania, to define the prevalence and risk factors associated with porcine cysticercosis transmission. One-hundred sixty-nine pigs from 152 households were examined for circulating taeniid antigens by cysticercosis antigen (Ag) enzyme-linked immunosorbent assay (ELISA). Agarose gel electrophoresis was used to differentially diagnose Taenia species-specific cysticerci DNA bands. Structured questionnaires were administered in the surveyed households to collect information on risk factors for porcine cysticercosis transmission. Sera from eleven household pigs tested positive for porcine cysticercosis in the Ag-ELISA with an apparent prevalence of 6.5 % (95 % C.I. 3.8-11.3 %) and estimated true prevalence of 6.1 % (95 % C.I. 3.3-10.9 %). DNA Gel electrophoresis confirmed that 100 % of cysticerci isolated amongst pigs slaughtered in the study area belonged to T. solium. Of the five surveyed wards, positive household pigs were from Bulyaga, Kiwira, and Mpuguso. Lack of knowledge on porcine cysticercosis among household members was found to be significantly associated with positivity of Taenia species antigen in pigs sera (OR = 7.742, p = 0.017). Our results show that porcine cysticercosis is prevalent in Rungwe. There is a definite need to establish control measures against this potential zoonosis to safeguard veterinary and public health in the Rungwe District.

Knowledge and misconceptions about epilepsy among people with epilepsy and their caregivers attending mental health clinics: A qualitative study in Taenia solium endemic pig-keeping communities in Tanzania

OBJECTIVE

Taenia solium (T. solium) neurocysticercosis (NCC) affects the central nervous system and is associated with 30% of acquired epilepsy in some endemic areas. Epilepsy is a stigmatizing disease in many societies and people with epilepsy (PWE) and their families experience discrimination. This study aimed to explore the knowledge, perceptions, and experiences of epilepsy among PWE and their caregivers attending mental health clinics.

METHODS

In T. solium endemic areas of Tanzania, PWE and their caregivers attending mental health clinics were identified and their informed consent was sought prior to study participation. In-depth interviews were conducted in Swahili language and analyzed thematically. The coding was undertaken by two independent researchers using NVivo (Version 12, QSR International).

RESULTS

Thirty-eight participants were interviewed. Three themes were identified during the analysis, namely, knowledge about epilepsy; perception of epilepsy; and experience with epilepsy among PWE and their caregivers. Participants commonly defined epilepsy as a "falling disease," perceived to be caused by witchcraft, and were unaware of the association between T. solium and epilepsy. Stigmatization of epilepsy was reported as a problem. Reported treatment patterns after the initial onset of epilepsy varied widely; however, patients usually began treatment with traditional healing methods, and only later opted for biomedical treatment. Patients had generally poor adherence to antiseizure medication, which could be caused by inadequate knowledge or irregular supply.

SIGNIFICANCE

Level of knowledge about epilepsy was low, and NCC was not mentioned as a cause of epilepsy among participants. Epilepsy was generally perceived to be the result of witchcraft, evil spirits, or curses. Health education is needed, including an explanation of the model of T. solium transmission and the insistence on hygiene measures. This could reduce the number of new infections with T. solium, improve access to prompt biomedical treatment, and improve the lives of PWE.

Effects of a Digital Health Literacy Intervention on Porcine Cysticercosis Prevalence and Associated Household Practices in Iringa District, Tanzania

Digital health is considered an opportunity to engage a wider community in disease control for public health. It has been used in healthcare consultation, in medical treatments and in reporting emergencies. The current study developed digital health literacy content for public health education and assessed its effects on porcine cysticercosis prevalence, pig-keeping style and pig pen and latrine qualities. The intervention was designed and evaluated on the prevention and control of porcine cysticercosis in the Iringa District of southern Tanzania. A quasi-controlled field trial with pre-intervention and post-intervention assessments of porcine cysticercosis, pig-keeping style and pig pen and latrine qualities was conducted. A baseline cross-sectional study was followed immediately by digital health literacy intervention, which comprised educational messages on porcine cysticercosis shown on computer tablets or smartphones. Free internet access supported unsupervised community access. The 25-month post-intervention assessments revealed significantly increased pig confinement (20.1%) (p = 0.026) and pig pen quality (16.2%) (p = 0.025). However, the quality of household latrines (p = 0.453) was not improved, nor was there any significant effect on the prevalence of porcine cysticercosis (p = 0.231). The digital health literacy intervention suggests a strategy for wider and sustainable dissemination of educational messages for Taenia solium infection control.

A scoping review of burden of disease studies estimating disability-adjusted life years due to Taenia solium

Background

Taenia solium is the most significant global foodborne parasite and the leading cause of preventable human epilepsy in low and middle-income countries in the form of neurocysticercosis.

Objectives

This scoping review aimed to examine the methodology of peer-reviewed studies that estimate the burden of T. solium using disability-adjusted life years.

Eligibility criteria

Studies must have calculated disability-adjusted life years relating to T. solium.

Charting methods

The review process was managed by a single reviewer using Rayyan. Published data relating to disease models, data sources, disability-adjusted life years, sensitivity, uncertainty, missing data, and key limitations were collected.

Results

15 studies were included for review, with seven global and eight national or sub-national estimates. Studies primarily employed attributional disease models that relied on measuring the occurrence of epilepsy before applying an attributable fraction to estimate the occurrence of neurocysticercosis-associated epilepsy. This method relies heavily on the extrapolation of observational studies across populations and time periods; however, it is currently required due to the difficulties in diagnosing neurocysticercosis. Studies discussed that a lack of data was a key limitation and their results likely underestimate the true burden of T. solium. Methods to calculate disability-adjusted life years varied across studies with differences in approaches to time discounting, age weighting, years of life lost, and years of life lived with disability. Such differences limit the ability to compare estimates between studies.

Conclusions

This review illustrates the complexities associated with T. solium burden of disease studies and highlights the potential need for a burden of disease reporting framework. The burden of T. solium is likely underestimated due to the challenges in diagnosing neurocysticercosis and a lack of available data. Advancement in diagnostics, further observational studies, and new approaches to parameterising disease models are required if estimates are to improve.

Challenges in the Diagnosis of Taenia solium Cysticercosis and Taeniosis in Medical and Veterinary Settings in Selected Regions of Tanzania: A Cross-Sectional Study

Background

Taenia solium (neuro) cysticercosis/taeniosis (TSCT) is a zoonotic disease complex. There is a perceived inefficient diagnosis of infections by either form, the adult pork tapeworm (taeniosis) and the larval stage of it (cysticercosis), in low-income settings, including Tanzania. This study aimed at identifying potential gaps around TSCT diagnosis and knowledge of primary healthcare providers (officers in charge (OICs) of primary healthcare facilities (PHFs)) and veterinarians (meat inspectors (MIs)) on various aspects of TSCT disease complex and addressing effective disease control in Tanzania. Methodology. A cross-sectional study was conducted between January and April 2020 in Manyara, Dodoma, Ruvuma, Iringa, and Arusha regions in Babati, Mbulu, Kongwa, Mbinga, and Nyasa districts. We interviewed 152 OICs of PHFs and 108 MIs using a structured questionnaire and 33 medical and veterinary officers from level I healthcare facilities and district livestock offices, respectively, from selected study districts to the respective ministerial level using key informant interviews.

Results

Quantitative data revealed inadequate microscopic diagnostic facilities (54.6%) and personnel (100%) for taeniosis diagnosis in PHFs (n = 152). Approximately 81.2% of MIs compared with only 42.1% of OICs of PHFs scored above average regarding T. solium cysticerci knowledge. Nevertheless, 61.2% of OICs of PHFs compared with only 42.6% of MIs scored above average regarding the adult T. solium tapeworm knowledge. Qualitative data revealed inadequate availability of advanced diagnostic facilities (neuroimaging) and trained personnel for specific diagnosis of TSCT with a focus on neurocysticercosis (NCC) in secondary and tertiary healthcare facilities. Inadequately number of qualified MIs, slaughter slabs, and resource facilitation challenged porcine cysticercosis diagnosis.

Conclusion

It is concluded that diagnostic capacity and knowledge of OICs of PHFs and MIs regarding TSCT are insufficient in both medical and veterinary sectors. A One Health approach should be adopted to improve TSCT diagnostic capacity and practitioners' knowledge in both medical and veterinary sectors.

Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force

OBJECTIVE

Despite the high prevalence of epilepsy in Africa, evaluation of epilepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted.

METHODS

A scoping review of the peer-reviewed literature on epilepsy from Africa (1989-2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics.

RESULTS

A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author leadership was evident in most reports. Nine countries had >50 publications identified; the remaining 45 countries had <50 or no publications. Research studies were typically of lower quality (case series and observational studies). Research themes were more focused on clinical epilepsy (descriptive observational studies) and social aspects (qualitative surveys). However, there were a number of unique and strong themes, specifically for neurocysticercosis and nodding syndrome, where strong research collaborations were evident, basic science understandings were explored, and interventional models were established.

SIGNIFICANCE

Despite Africa being the continent with the most countries, it is lacking in the quantity, quality, and for some areas, relevance of research on epilepsy. Targeted approaches are needed to upskill the strength of research undertaken with more basic science, interventional, and randomized controlled studies. Themes of research need to promote those with unique African content but also to align with current international research areas that have impact on care delivery, such as epilepsy surgery and epilepsy genetics. For this to be possible, it is important to strengthen research hubs with collaborations that empower Africa to own its epilepsy research journey.

Knowledge, attitudes and practices related to Taenia solium cysticercosis and taeniasis in Tanzania

Background

Taenia solium cysticercosis/taeniasis (TSCT) is reported to be endemic in pig producing areas around the world, causing significant disease burden and economic losses.

Methods

This cross-sectional study aimed at assessing Knowledge, Attitudes and Practices (KAP) regarding TSCT in four districts, namely Mbulu, Mpwapwa, Mbinga, and Rungwe in Tanzania. Data on KAP were collected through questionnaire-based interviews and household infrastructure observations.

Results

Knowledge about porcine cysticercosis was good, particularly among pig keepers across the districts. Many participants had heard about the pork tapeworm (T. solium taeniasis), and the knowledge about signs/symptoms and treatment was fair, but the means of transmission and prevention measures were often unknown. Whilst most participants were familiar with epilepsy, no one knew anything about human cysticercosis and the link between cysticercosis and epileptic seizures. A similar trend is reflected through the attitudes toward the low risk perception of cysticercosis infection. Not surprisingly, the risk perception of the infection with the pork tapeworm was low too. Many participants reported not washing their hands before eating or after using the toilet which highlights potential risks for the development of human cysticercosis. Albeit nearly every participant reported using the toilet always, household observations revealed that toilets were either lacking or had no complete walls. Generally, household observations revealed a discrepancy between questionnaire answers on the one hand and the availability of toilet and handwashing facilities and the confinement of pigs on the other hand.

Conclusion

This study demonstrates knowledge gaps and adverse practices which may hinder and/or slow down the control/elimination of T. solium in endemic countries. The study results are also useful for appropriate designing of TSCT health interventions that need to be planned carefully, taking into account the local context and designing TSCT in partnership with the local communities from the beginning to the end applying a One Health approach to allow the possible sustained and best impacts.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07408-0.

Validating efficacy of Sericocomopsis hildebrandtii, Carissa edulis, and Ximenia americana in treating Taenia solium cysticercosis in pigs: A randomized controlled trial

Ethnoveterinary use of plants dates back to ancient times. This study aimed to validate purported efficacy of Sericocomopsis hildebrandtii and a concoction of Carissa edulis and Ximenia americana in treating Taenia solium cysticercosis in pigs. Twenty-four infected pigs were randomly allocated to T1, T2, and T0 groups, each with eight pigs. Each T1 pig was provided with 8 g of S. hildebrandtii root powder, whereas each T2 pig was given 8 g of the concoction. T0 was a control. The pigs were slaughtered 16 weeks post treatment and carcase dissections were performed to establish cyst numbers. T1 cyst numbers were significantly lower than those of T0 (p = .004) and T2 (p = .013). No difference was observed between T2 and T0. This study validated efficacy of S. hildebrandtii but not of X. americana and C. edulis. Further studies are necessary for validation and documentation of plants of ethnoveterinary importance.

Socio-economic and health costs of porcine/human cysticercosis, neurocysticercosis and epilepsy to small-scale pig producers in Tanzania

BACKGROUND

Porcine cysticercosis, human cysticercosis, neurocysticercosis, and epilepsy pose a serious public health risk and lead to economic losses to the small-scale pig farmers in Tanzania's rural areas. It also resulted in lowering the pig's prices, high treatment expenses, lower labour productivity, and social discrimination. In Tanzania, small-scale pig producers are unaware of the methods that are used to manage and prevent the diseases associated with Taenia solium.

MAIN BODY

The main goal of the reviewed article was to investigate the socio-economic and health costs of porcine/human cysticercosis, neurocysticercosis, and epilepsy on small-scale pig producers in Tanzania. Several search engines yielded 80 peer-reviewed publications, 44 of which were considered to be relevant to the study. Taenia solium cysticercosis has been reported to cause huge financial losses in the management of pigs posing a burden in terms of vaccination and treatment.

CONCLUSION

The information on porcine/human cysticercosis, neurocysticercosis, and epilepsy is still insufficient in Tanzania. Poor habits, negative perceptions, and attitudes are the result of this misinformation. This review suggests that health education should be emphasized as one of the intervention methods for eliminating all forms of cysticercosis and epilepsy in Tanzania to promote and increase awareness about all forms of cysticercosis and epilepsy in rural areas.

Epilepsy due to Neurocysticercosis: Analysis of a Hospital Cohort

Introduction: Neurocysticercosis (NCC) is a common helminthic infection of the nervous system that occurs when humans become intermediate hosts in the life cycle of the pig tapeworm (Taenia solium) after ingesting its eggs. The objective of this study was to analyze socio-demographic, clinical and paraclinical features of patients with NCC in Lubumbashi, DRC. Methods: This is a cross-sectional study conducted over a period of 2 years within the Neuropsychiatric Center of Lubumbashi. Socio-demographic, clinical, paraclinical and therapeutic features were studied. Results: A total of 18 patients with NCC were listed. Epilepsy was found in 72.2% (13/18) of the cases. The mean age of the patients was 30.2 ± 13.5 years; males accounted for 61.2% of the cases. 84.6% were consumers of pork. Generalized epilepsy was found in 84.6% of the cases and hypereosinophilia in 38% of the cases. On the neuroimaging, the parietal location of lesions represented 92.3%; calcifications were the type of lesion in 53.8% of the cases and 69.2% of the cases presented lesions in the 4th evolutionary stage. Electroencephalogram was normal in 84.4% of the cases. Phenobarbital was the antiepileptic drug used in 69.3%; albendazole and prednisone were used in 53.9% of the cases. Conclusion: This study shows that NCC is one of the causes of epilepsy in Lubumbashi. Generalized tonic-clonic seizures are the most common form of presentation and calcified parenchymal lesions are the most common radiological feature of NCC. So, any patient with acute onset of afebrile seizure should be screened for NCC provided other common causes been ruled out.

Soil contamination by Taenia solium egg DNA in rural villages in Kongwa district, Tanzania

The presence ofTaenia solium DNA from eggs in soils around the households in four Tanzanian villages in Kongwa district were analysed in relation to seasonal fluctuations and infection risk implications. A total of 192 pooled soil samples from five sampling points per household were examined by droplet digital Polymerase Chain Reaction (ddPCR) from 96 pig-keeping households both during the dry and rainy seasons. The pooled samples were first processed by a flotation-double sieving technique, followed by screening for worm DNA employing universal primers targeting the mitochondrial cytochrome c oxidase subunit I (cox1) gene of human taeniid species and some other helminths. All DNA positive samples were later confirmed by a specific ddPCR probe assay targeting the mitochondrial cox1 gene of T. solium. A total of 17.2% (n = 33) samples were positive with the universal ddPCR, whereas T. solium DNA was confirmed by the specific ddPCR only in 3.1% (n = 3) of the surveyed households. The detection of T. solium DNA in this study spells out a low risk of exposure to T. solium eggs from contaminated household soil. Based on our results, ddPCR seems to be a promising technology for screening T. solium eggs in soil.

Seroprevalence of circulating taeniid antigens in pigs and associated risk factors in Kongwa district, Tanzania

The aim of this study was to investigate exposure to porcine cysticercosis (PC) and associated risk factors in the Kongwa District, eastern-central Tanzania. For the first time a cross-sectional investigation of the seroprevalence in pigs using a commercial genus specific cysticercosis enzyme linked immunosorbent assay (apDia Ag-ELISA) was undertaken in eastern-central Tanzania. Moreover, the identity of suspected T. solium cysts from pigs in the study area were confirmed by sequencing parasites' mitochondrial cox1 gene. Structured questionnaires and direct observations were used to investigate risk factors associated with parasite transmission. A total of 102 pig-keeping households were surveyed during the dry season between July and August 2017 and 126 households in the rainy season between March and April 2018. Of the 447 examined pigs, 77 (17%, 95% C.I. 14%-20%) tested positive in the ELISA. Seroprevalence was higher in pigs examined during the rainy (21%, 95% C.I. 16%-26%) than dry (12%, 95% C.I. 7%-17%) season (p = 0.019). Eight cyst-positive-pigs were confirmed to be infected with T. solium by sequencing. Risk factors associated with PC seropositivity included origin of piglets or pigs (OR = 0.27, 95% C.I. 0.13-0.42, p = 0.001), socioeconomic factors and pig production system (OR = 0.22, 95% C.I. 0.07-0.37, p = 0.005) and sanitation and hygiene practices (OR = 0.19, 95% C.I. 0.04-0.34, p = 0.014). This study has recorded a high Taenia spp. seroprevalence in pigs in Kongwa suggesting the presence of people in the community carrying the adult parasite, Taenia solium. Our findings also suggest risk of infection by T. solium to people in urban centres and cities consuming pigs from rural areas in Kongwa. The high seroprevalence in Kongwa calls for further studies on taeniasis and cysticercosis in the human population in order to determine suitable control strategies.