Perceptions and Experiences of School Teachers During the Implementation of a School-Based Deworming Activity in Kenya

Background:

Primary school teachers are key stakeholders in the success of school-based deworming activity as they are responsible for drug administration and provision of health education to the School-Age Children (SAC). In Kenya, the National School-Based Deworming Programme (NSBDP) for control of soil-transmitted helminths and schistosomiasis was initiated in the year 2012 in prioritised areas. By the year 2013, over 6 million SAC had been treated. The present study sought to assess the teachers' perceptions and experiences of the school-based deworming activity in an effort to improve programme effectiveness.

Methods:

Qualitative data were collected, using in-depth interviews, in 4 subcounties of the coastal region of Kenya. Using purposive selection, 1 primary school teacher from each of the 38 schools also purposively selected participated in the study. The data were audio-recorded, transcribed, coded and analysed manually by study themes which included: reason for being selected for training to administer drugs; perceptions of training content and duration; experiences during drug acquisition, administration and record-keeping and motivation to continue participating in the deworming of school-age children.

Results:

Half of the teachers indicated that they were selected to administer drugs to children as they were responsible for school health matters. The duration and content of the training were considered sufficient, and no challenges were faced during drug acquisition. Challenges faced during drug administration included non-compliance and experience of side effects of the drugs. No major problems were experienced in record-keeping, although the teachers felt that the forms needed to be simplified. Improvement of the children's health and class performance was reported as a source of motivation to the teachers to continue administering the drugs. Fellow teachers were reported to have given moral support while over half of the respondents indicated that parents did not provide much support.

Conclusion:

Generally, teachers have positive experiences and perceptions of the deworming activity. There is, however, a need to involve all stakeholders especially the parents through the school board of management to help counter non-compliance and possibly support in providing meals to the children to help minimise side effects after drug consumption. Inadequate moral support and incentives are negative factors on the teachers' motivation.

The role of pre-school teachers in the control of soil-transmitted helminthes in coastal region, Kenya

Background

Soil transmitted helminthes (STH) are significant health problems among school-age children. In Kenya’s coastal region, the prevalence among pre-school age children (PSAC) ranges from 27.8 to 66.7 %. Whereas some pre-schools are as far as 7 km from the nearest primary schools, the National School-Based Deworming Programme (NSBDP) requires the pre-school teachers to walk with the children to primary schools for deworming by trained primary school teachers. The long distances may contribute in making drug delivery ineffective and unsustainable.

Methods

To assess the pre-school teachers’ knowledge, experiences and perceptions of STH and the NSBDP, a cross-sectional study using qualitative methods was conducted in four sub-counties of the Coast Region. Through purposive sampling, 41 pre-schools which are 2 or more kilometers away from a primary school were selected and in-depth interviews administered to the teachers. Separate in-depth interviews were administered to 34 community health extension workers, 40 opinion leaders and 38 primary school teachers all purposively selected to assess their perceptions of the role of pre-school teachers in the NSBDP. Data was audio recorded, transcribed, coded and analyzed manually by study themes.

Results

A third of the pre-school teachers were aware of signs of STHs and a half indicated that poor hygiene and sanitation practices are major causes. A majority of the pre-school teachers reported that health education and environmental sanitation are key control methods. Majority (39) had received information on NSBDP from various sources and all took part in community sensitization and in treating the pre-school children. A large majority of all study participants indicated that treating the children at pre-schools is ideal for increased coverage. Majority of the pre-school teachers perceived the NSBDP as important in improving the health status of the children. All study participants felt that the parents needed to be given adequate information on STHs and training the pre-school teachers to assist in community sensitization and drug administration would be useful.

Conclusion

Pre-school teachers are a potential resource to the NSBDP that should be utilized to instill proper water and sanitation practices to the young children and assist in community sensitization. They should be empowered and allowed to administer treatment for STH control. County Governments, their current employers should find ways of engaging them in worm control efforts.

Trial registration

KEMRI SSC 2547, Registered 22 July 2013.

Spatial distribution and risk factors of Schistosoma haematobium and hookworm infections among schoolchildren in Kwale, Kenya

Background

Large-scale schistosomiasis control programs are implemented in regions with diverse social and economic environments. A key epidemiological feature of schistosomiasis is its small-scale heterogeneity. Locally profiling disease dynamics including risk factors associated with its transmission is essential for designing appropriate control programs. To determine spatial distribution of schistosomiasis and its drivers, we examined schoolchildren in Kwale, Kenya.

Methodology/Principal findings

We conducted a cross-sectional study of 368 schoolchildren from six primary schools. Soil-transmitted helminths and Schistosoma mansoni eggs in stool were evaluated by the Kato-Katz method. We measured the intensity of Schistosoma haematobium infection by urine filtration. The geometrical mean intensity of S. haematobium was 3.1 eggs/10 ml urine (school range, 1.4–9.2). The hookworm geometric mean intensity was 3.2 eggs/g feces (school range, 0–17.4). Heterogeneity in the intensity of S. haematobium and hookworm infections was evident in the study area. To identify factors associated with the intensity of helminth infections, we utilized negative binomial generalized linear mixed models. The intensity of S. haematobium infection was associated with religion and socioeconomic status (SES), while that of hookworm infection was related to SES, sex, distance to river and history of anthelmintic treatment.

Conclusions/Significance

Both S. haematobium and hookworm infections showed micro-geographical heterogeneities in this Kwale community. To confirm and explain our observation of high S. haematobium risk among Muslims, further extensive investigations are necessary. The observed small scale clustering of the S. haematobium and hookworm infections might imply less uniform strategies even at finer scale for efficient utilization of limited resources.

The World Health Organization is spearheading the war on neglected tropical diseases, including helminth infections, by encouraging its member states to intensify control efforts. This call has recently been answered in most endemic regions of helminthiasis and governments are scaling up chemotherapy-based control programs in collaboration with private and public partners. However, it is necessary to clearly understand factors driving local transmission dynamics of helminth infections to design effective control programs. Here, we conducted a cross-sectional survey of 368 primary schoolchildren in Kwale, Kenya, and identified factors associated with the intensity of Schistosoma haematobium and hookworm infections. The negative binomial generalized linear mixed model showed the intensity of S. haematobium infection was much higher among Muslims and schoolchildren from low socioeconomic status households. High intensity of hookworm infection was associated with sex, SES, distance to river and history of anthelmintic treatment. Our findings demonstrate considering social and cultural drivers of NTDs could be beneficial in designing of efficient control programs and expediting NTDs control.

Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast

Background

The 2012 London declaration which committed to “sustaining, expanding and extending drug access programmes to ensure the necessary supply of drugs and other interventions to help control soil-transmitted helminths (STH) by 2020” has seen many countries in Africa roll out mass drug administration (MDA) especially among school age children. In Kenya, however, during the National school-based deworming exercise, pre-school aged children (PSAC) have to access treatment at primary schools as the pre-school teachers are not trained to carry out deworming. With studies being conducted on the effectiveness of MDAs, the experiences of key education stakeholders which could improve the programme by giving best practices, and challenges experienced have not been documented.

Methods

This was a cross-sectional qualitative study using Focus group discussions (FGDs) and Key informant interviews (KIIs). It was conducted in 4 sub-counties with high STH prevalence at the Kenyan coast (Matuga, Malindi, Lunga Lunga and Msambweni) to understand best practices for implementing MDA among PSAC.FGDs categorized by gender were conducted among local community members, whereas KIIs involved pre-school teachers, primary school teachers, community health extension workers (CHEWs) and opinion leaders. Participants were purposefully selected with the saturation model determining the number of interviews and focus groups. Voice data collected was transcribed verbatim then coded and analyzed using ATLAS.Ti version 6.

Results

Majority of the primary school teachers and CHEWs reported that they were satisfied with the method of mobilization used and the training tools. This was however not echoed by the pre-school teachers, parents and chiefs who complained of being left out of the process. Best practices mentioned included timely drug delivery, support from pre-school teachers, and management of side effects. Overcrowding during the drug administration day, complexity of the forms (for instance the ‘S form’) and long distance between schools were mentioned as challenges.

Conclusion

There is need to utilize better sensitization methods to include the local administration as well as the parents for better uptake of the drugs. Extending deworming training to pre-school teachers will enhance the national deworming programme.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4481-7) contains supplementary material, which is available to authorized users.

Knowledge, practices and perceptions of geo-helminthes infection among parents of pre-school age children of coastal region, Kenya

BACKGROUND

Soil-transmitted helminthes (STHs) are common human parasitic diseases in most of the developing world particularly in Kenya. The ongoing National School-Based Deworming Programme (NSBDP) was launched in 2012 and is currently targeting 28 of the 47 endemic Counties. In an effort to improve treatment intervention strategies among Pre-School Age Children (PSAC) attending Early Childhood Development Centres (ECDC), we sought to assess parents' knowledge, perceptions and practices on worm infection.

METHODOLOGY

We conducted a qualitative cross-sectional study in four endemic sub-counties of two counties of coastal region of Kenya. A total of 20 focus group discussions (FGDs) categorized by gender were conducted among parents of pre-school age children. Participants were purposively selected based on homogenous characteristics with the saturation model determining the number of focus group discussions conducted. The data collected was analyzed manually by study themes.

FINDINGS

The majority of the parents had knowledge on worms and modes of transmission of the parasitic infections among the pre-school children. Also, most of the participants knew the causes of worm infection and the pre- disposing factors mentioned included poor hygiene and sanitation practices. Due to poor knowledge of signs and symptoms, misconceptions about the drugs administered during the NSBDP were common with a large majority of the parents indicating that the drugs were ineffective in worm control. The findings also indicated that most of the participants sought medical care on the onset of the signs and symptoms of worm infestation and preferred services provided at public health facilities as opposed to private health facilities or buying drugs from the local market citing mistrust of such services. Cultural beliefs, high cost of building and availability of vast pieces of land for human waste disposal were factors that contributed to low or lack of latrine ownership and usage by a large majority of the respondents.

CONCLUSIONS

Our results show that to a large extent the parents of the pre-school age children have information on worm infections. However, some cultural beliefs and practices on the pathology and mode of transmission mentioned could be a hindrance to prevention and control efforts. There is need to implement health promotion campaigns to strengthen the impact of control strategies and reduce infection.