Assessment of health education products aimed at controlling and preventing helminthiases in China

Using social media for health education and promotion: a pilot of WeChat-based prize quizzes on China national malaria day

BACKGROUND

Imported malaria cases remains a key health concern, especially during the COVID-19 pandemic. Providing accurate health information is important to improving people's awareness of malaria. WeChat is an excellent social media tool for health information dissemination, especially during the pandemic. This study explored the effect of malaria knowledge dissemination via a WeChat public account.

METHODS

A questionnaire for data collection was constructed using the online survey tool Sojump. Questionnaires were sent to users who followed the Jiangsu institute of Parasitic Disease WeChat public account during the National Malaria Day 2021 period. A small incentive (WeChat Red Packet) was distributed to everyone who answered the questionnaire correctly on time.

RESULTS

A total of 13,169 valid questionnaires were collected during the China National Malaria Day period. Questions in which participants focused mainly on information pertaining to themselves, such as infection, symptoms, and epidemic areas, reached highest accuracy (above 90%). Questionnaires were submitted through smartphones and most of them were completed during the period of 4 days from April 23 to April 26, 2021 when a WeChat Red Packet was offered. The accuracy of responses was related to bolded words and location and number of knowledge points that were shown at the beginning of the questionnaire. The number of users of the WeChat public account in question increased from 5961 to 12,339 in just 4 days of the activity.

CONCLUSION

A WeChat public account is a convenient and accessible tool for spreading malaria-related health information to the public. Distribution of incentives (Red Packets) can effectively increase public attention to popular science and health information and activities.

Children education for sustainable control of liver fluke infections

Significant disease burden is caused by infections with human liver flukes, including Clonorchis sinensis, Opisthorchis viverrini and O. felineus. Epidemiology is characterized by high burden in the male than the female, and in the elder than the younger. Chemotherapy is the mainstream for morbidity control, but it could not prevent re-infection. Meanwhile, behavioral change on the dietary habit of ingesting raw freshwater fish is challenging. In this opinion, we argue why it is important to educate children for sustainable control of liver fluke infections. Then, the design, development and key messages of an educational cartoon for preventing liver fluke infections is introduced. Technical focuses are emphasized based on a pilot using the education cartoon for preventing clonorchiasis in China. Finally, how to further develop and verify this education strategy is discussed.

Cystic Echinococcosis: An Impact Assessment of Prevention Programs in Endemic Developing Countries in Africa, Central Asia, and South America

Background. Cystic echinococcosis (CE), caused by the tapeworm species, Echinococcus granulosus sensu stricto (G1), is one of many primary neglected zoonoses worldwide. Within endemic developing countries, CE has multiple effects on animal and human health and well-being. To address such effects, veterinary and human medical sector collaboration on prevention program delivery is essential. To begin preliminary evaluations of county specific prevention programs, a critically appraised topic (CAT) was conducted. It sought to answer: What impact do CE prevention programs have on human and animal disease prevalence, in populations living in endemic developing countries within Africa, Central Asia, and South America? Methodology. The aim was to assess the ability of prevention and control program outputs to produce measurable differences in health, social, and economic outcomes (e.g., improved access to medical services, positive behavioral change, or reduced treatment costs, respectively). Included articles were obtained using predefined inclusion/exclusion criteria from the four databases (CAB Abstracts and Global Health; the National Library of Medicine (PubMed); ScienceDirect; and WHO Institutional Repository of Information Sharing (IRIS)). The articles were appraised using three checklists: the Royal College of Veterinary Surgeons (RCVS), the Critical Appraisals Skills Programme (CASP), and the Joanna Briggs Institute checklists. Results. Ten articles were selected. Geographically, 20% of studies were conducted in South America, 30% in Africa, and 50% in Central Asia. For definitive hosts, dogs, CoproELISA antigen testing, before and after Praziquantel (PZQ) de-worming, was a primary focus. For humans, who are intermediate hosts (IH), disease surveillance methods, namely ultrasound (US), were commonly assessed. Whilst for sheep, also acting as IH, disease prevention methods, such as the EG95 livestock vaccine and de-worming farm dogs, were evaluated. Common to all studies were issues of program sustainability, in terms of regular human US screening, dog de-worming, and annual sheep vaccination. This was attributed to transient and remote human or animal populations; limited access to adequate roads or hospitals; few skilled health workers or veterinarians; an over-reliance on communities to administer preventatives; and limited resources. Conclusion. Despite variations in result validity and collection periods, useful comparisons of CE endemic countries produced key research and program recommendations. Future research recommendations included testing the significance of multiple program outcomes in relation to prevalence (e.g., the social outcome: behavioral change), further research on the impact of livestock vaccinations, and the CE transmission role of waterways and sanitation. Program recommendations included calculating and distinguishing between stray versus owned dog populations; formal representation of internal and external stakeholder interests through institutional organization; establishing sustainable guidelines around the frequency of PZQ and vaccination administration; improved veterinary-human medical training and resource sharing; and combined prevention methods and multiple canine disease management.

Helminthiases in the People's Republic of China: Status and prospects

Helminth infections, many of them listed as neglected tropical diseases by the World Health Organization, remain a public health issue in many parts of the world. The People's Republic of China (P.R. China) stands out due to impressive progress in the control and local elimination of helminth infections. An important contextual factor is P.R. China's sustained social and economic development that allowed implementation of health-related poverty alleviation, improving water, sanitation and hygiene, enhancing information, education and communication, coupled with major engineering and infrastructure development and intersectoral collaboration. Nonetheless, food-borne trematodiases, soil-transmitted helminthiases, echinococcosis, cysticercosis/taeniasis and schistosomiasis still exert a considerable burden in P.R. China, even though the numbers of infected people have decreased substantially since the new millennium. This special issue of Acta Tropica provides a comprehensive update of the current knowledge of the main helminth infections in P.R. China, summarises progress in research and discusses future prospects for gaining and sustaining control towards the final goal of breaking transmission and hence, eliminating helminthiases. It consists of 34 articles with a wide coverage that can be grouped into six domains: (i) epidemiological assessment and disease burden estimates; (ii) diagnostics and antigen characterisation; (iii) drug and vaccine development; (iv) host-parasite interactions and snail genetics; (v) surveillance and public health response; and (vi) capacity building and international cooperation. The control and elimination of helminthiases not only furthers the health and wellbeing of the Chinese people, but also provides innovative approaches, tools and strategies, which can be adopted and applied in other countries and regions of the world where helminthiases still prevail.

Effectiveness of health education in improving knowledge, practice and belief related to clonorchiasis in children

Clonorchiasis is caused by the ingestion of raw freshwater fish containing Clonorchis sinensis larvae. Health education is crucial in sustainable control of clonorchiasis but extremely challenging when dealing with adults. To investigate if education in children would be a beneficial long-term approach, a cluster-controlled trial was implemented in two primary schools between 2017 and 2019 in Binyang county, Guangxi, China. A baseline survey was conducted in both schools, and then comprehensive education activities were implemented in the interventional one. Six and 12 months later, all pupils were subjected to a survey to assess the potential change of knowledge, practice and belief related to clonorchiasis. Finally, 247 pupils in interventional school and 151 ones in control were eligible for analysis. In the interventional school, the percentage of pupils with knowledge on transmission route, early symptoms, complications and carcinogenicity increased from 15.0% to 78.5% (p < 0.001), from 6.5% to 36.8% (p < 0.001), from 4.0% to 93.9% (p < 0.001) and from 4.5% to 49.4% (p < 0.001) after 12 months. In this school, 16 pupils (6.5%) had eaten raw freshwater fish during the year immediately before the baseline survey, a number that decreased to 3 (1.2%) (p = 0.002) 12 months later. The percentage of students had the belief on the ability not to eat raw freshwater fish in the future was 70.9% at the baseline and 97.2% 12 months later (p < 0.001). Although knowledge related to clonorchiasis also increased in the control school, the absolute percentage of changes was lower; in particular, practice and belief had not changed.

Familial assimilation in transmission of raw-freshwater fish-eating practice leading to clonorchiasis

Clonorchiasis is caused by raw-freshwater fish-eating practice and causes high burden in Asia. Transmission mechanism of this behavior hasn't been illuminated, which hinders the adoption of sustainable control activities. A cross-sectional survey was implemented in students from four endemic provinces in China. Data with 23,222 students aged 9-18 and their parents were eligible. Familial clustering of raw-eating practice, impact of parents' practice on children, interaction of spouses' practice was analyzed. Raw-eating practice met β-binomial distribution (χ2 = 0.8, p>0.05). Clustering coefficient increased by students' age (R2 = 0.82, p<0.001) and was higher in those families with boys compared to girls (t = 4.1, p<0.01). The proportion of students with raw-eating practice increased yearly by 8.9% in girls and 10.5% in boys. Compared to those without parents' raw-eating practice, adjusted odds ratio of students' raw-eating practice was 10.5 (95% confidential intervals (95% CI): 9.4-11.7) in those with fathers' practice, 33.6 (95% CI: 26.3-42.9) in those with mothers' practice and 47.1 (95% CI: 42.0-52.8) in those with both parents' practice. There existed interaction between spouses' practice (χ2 = 6713.1, p<0.001) and the impact from husband on his wife was higher than that from wife on her husband. Familial assimilation characterizes the transmission of raw-freshwater fish-eating practice, consisted of vertical intergenerational assimilation from parents to their children and horizontal martial assimilation between spouses. A sustainable strategy against clonorchiasis should interrupt the transmission of raw-freshwater fish-eating practice. Additionally, further studies are expected to explore more information, e.g. the frequency in raw-eating practice and type of raw freshwater fish, infection status of C. sinensis in participants, as well as direct collection of parents' eating information from themselves.

From awareness to action: NIPD's engagement in the control of food-borne clonorchiasis

Clonorchiasis is caused by ingestion of raw freshwater fish containing infective larvae of Clonorchis sinensis. China harbours the largest number of people with C. sinensis infection. During the past three decades, the National Institute of Parasitic Diseases, affiliated to the Chinese Center for Disease Control and Prevention (NIPD) conducted many studies to facilitate the control on clonorchiasis. Three national surveys have shown the updated epidemiology of clonorchiasis in China. Recently, a national surveillance system has also been established, which will enable the production of high-resolution map. The evaluation of the disease burden has enhanced the awareness on clonorchiasis. Diverse diagnosis techniques including rapid screening by questionnaire, serological tests, faecal examination and a molecular method have been developed or evaluated. The NIPD also participated in the early evaluation of praziquantel against clonorchiasis, which enhanced its application in China. Also, the NIPD has verified the efficacy of tribendimidine against clonorchiasis. A new sustainable strategy is also being explored. However, more research is expected to further facilitate control of clonorchiasis in China, as well as international cooperation in fighting human liver fluke infections in Asia.

Multi-disciplinary integration of networking through the RNAS+: Research on other target diseases

In 2005, the network decided to increase its number of target diseases to include other helminthic zoonoses such as fascioliasis, clonorchiasis, opisthorchiasis, paragonimiasis and cysticercosis and in the process expanding membership to include South Korea, Vietnam, Thailand and Japan. NTDs were eventually included as awareness is heightened on these diseases affecting poor and developing countries. Researches on clonorchiasis and opisthorchiasis unravel the mechanism by which these diseases eventually predispose to cholangiocarcinoma. The liver cancer associated with these liver fluke infections necessitate the need to clarify the global burden of disease of these infections. The magnitude of these liver fluke diseases in endemic countries like China, Vietnam, Laos, Cambodia and Thailand is described. Success in elimination of lymphatic filariasis in PR China and Cambodia is highlighted to show how intensified multisectoral collaboration and strong political become strong ingredients in elimination of parasitic diseases like LF. New advances are presented that clarify species and strain differences in Fasciola spp., Paragonimus spp., Taenia spp. and Echinococcocus spp. Conventional diagnostic techniques are compared with new serologic techniques that are being developed. New control strategies such as the Lawa model are presented.

Needs and coordination mechanism for capacity building by the RNAS

For the Regional Network on Asian Schistosomiasis and Other Helminth Zoonosis (RNAS⁺), capacity building with emphasis on modern technology with correspondence to traditional techniques was found to be a priority. This article summarized the actual needs of capacity building among RNAS⁺ member countries and the working mechanism of capacity building during the last 20 years. The needs with respect to the RNAS⁺ target diseases are highly correlated with the research priorities, since most problems with regard to the performance of the national disease control programme in the member countries are connected with inadequate capacity in relation to implementation of innovative research, epidemiological investigations, laboratory performance; and sociological investigations. The capacity building arranged through RNAS⁺ platform includes short training courses, individual training in member institutions, e.g., supervision of Ph.D./Masters students; postdoctoral training; and internship training in institutions of southeast Asia as well as in famous institutions of Europe and the United States. In the future, capacity building will focus on platform design and technical standardization aiming at fostering research capacity in the future. Moreover, new training projects, such as massive online courses (MOOC) will be explored under RNAS⁺ platform.