E-ISSN: 2814 – 1822; P-ISSN: 2616 – 0668
ORIGINAL RESEARCH ARTICLE
1Kadaura, U. M., *2Askira U. M. 3Ali. K. B., 3Baba A. S., 4 Yakubu Y. M., 5Zaman A. A., 1Abdullahi, A.
1Department of Medical Microbiology, Federal University of Health Sciences, Azare, Bauchi, Nigeria
2Department of Medical Laboratory Science, University of Maiduguri, Maiduguri, Nigeria
3Department of Medical Microbiology, University of Maiduguri, Maiduguri, Nigeria
4Department of Medical Microbiology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
5Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
*Correspondence: mohammedaskirau@gmail.com:+234(0)7062842988
https://orcid.org/0000-0002-0792-1342
Soil-transmitted helminthiasis (STH) is a parasitic disease caused by nematodes acquired through feces-contaminated soil, affecting nearly 2 billion people globally. Understanding maternal knowledge, attitudes, and practices is crucial for effectively preventing and controlling intestinal helminths. This study was carried out to assess mothers' knowledge, attitudes, and practices in Maiduguri Metropolis, Borno State, regarding the prevention and control of intestinal helminths. A cross-sectional survey was conducted among 153 mothers in Maiduguri using a structured questionnaire. Participants were categorized based on age, education, and occupation. Knowledge was assessed using a Guttmann Scale, with scores classified as knowledgeable (below the median score) or non-knowledgeable (above the median). Descriptive statistics were used to summarize the findings. In terms of practices, a significant proportion of mothers demonstrated awareness of basic hygiene and preventive measures, such as handwashing and ensuring proper sanitation. However, 21.6% of participants lacked sufficient knowledge, reflecting gaps in understanding critical aspects of intestinal helminth prevention. While 93.4% of respondents correctly identified symptoms such as vomiting, diarrhea, and abdominal discomfort, 5.3% admitted unawareness of any symptoms, highlighting the need for further education. Community health programs should target the identified gaps through tailored health education initiatives. Efforts should prioritize improving awareness of symptoms, infection sources, and the importance of consistent hygiene practices. This would ensure better preventive behavior and reduce intestinal helminths' prevalence in the region.
Keywords: knowledge, helminthiasis, Maiduguri, malnutrition, Neglected Tropical Diseases.
The term "solubilized tremors of helminthiasis" (STH) refers to a class of parasitic diseases caused by nematode worms that are spread to humans through feces-contaminated soil. Approximately 2 billion people worldwide are infected with STH (Nazir et al., 2021). The majority of STH patients are school-aged children (5–14 years old), with preschoolers being affected to a lesser extent (Nazir et al., 2021). According to estimates, roundworm infections (Ascaris lumbricoides; approximately 820 million) are the most common, followed by hookworm infections (Necator americanus and Ancylostomaduodenale; approximately 460 million) and whipworm infections (Trichuris trichuria; approximately 440 million) (Rajoo et al.2017).
Neglected tropical diseases (NTDs) impact at least 1.7 billion people worldwide in 185 countries; to reduce the burden, NTDs must be treated and cared for either widely or personally. Five NTDs affect at least 1.1 billion (65%) of them, who live in low- and middle-income countries (Nazir et al., 2021). According to Cox (2016), 3.3 million disability-adjusted life years are attributed to STH worldwide. The illness could affect about 600 million school-age children (SAC) and 270 million preschool-aged children (PSAC).
According to Odinaka et al. (2015), Nigeria
has the largest load and highest endemicity of soil-transmitted
helminths. Children aged 5 to 14 who reside in rural regions and some
who come from urban slums make up a bigger portion of those affected (Oluwole et al., 2015). Cultural, social, and
environmental factors are among the elements that contribute to the
persistence of infection (Eke et al., 2018).
There are still regions in Nigeria, including Maiduguri, where
epidemiological data on STH infections are either nonexistent or very
scarce. Most of the people in Borno State are farmers, so children in
these areas are constantly at risk of contracting helminths. Children
and adults in agricultural communities engage in activities such as open
defecation, barefoot strolling, and eating raw, unwashed fruits and
vegetables, which might put one at risk of contracting STH infection (Naish, 2014). Many people in rural areas of low- and
middle-income nations, such as those in sub-Saharan Africa, still face
significant obstacles in getting access to health interventions because
these regions have weak health systems and insufficient means of
providing essential medical care to those who need it most (Makaula et al., 2022). The World Health
Organization (WHO) has identified the primary interventions for the
prevention and control of non-transformed disease (NTD) as mass drug
administration (MDA) preventive chemotherapy, case management, vector
management, environmental improvement initiatives, and health promotion
(Makaula et al. 2022). According to
Sanchez et al. (2013), children who
contract parasitic infectious agents run the risk of experiencing growth
retardation due to compromised nutritional utilization, hepatomegaly,
splenomegaly, weakened immune systems, and decreased IQ. (Sanchez et al., 2013).
The WHO has strongly recommended the regular mass administration of
anthelmintic medicines outside of healthcare settings as one of the
preventative initiatives (Imam et al.
2019). Anti-helminth treatment has been administered to millions of
school-age children (Tchuem Tchuenté, 2011).
However, due to inadequate sanitation, a lack of clean water, and low
levels of education, the control measures are limited in their ability
to be entirely successful in developing nations (Truscott et al., 2014). The primary
causes of the high prevalence of intestinal parasites in tropical and
sub-tropical regions are inadequate sanitation, contaminated drinking
water, and a lack of restroom facilities (Ziegelbauer et al. 2012). From the
foregoing, a deeper understanding of the key factors influencing
intestinal parasite infections, including social, cultural, and
behavioral aspects, is essential for eliminating STHs, and community
awareness of the impact of these parasites plays a crucial role in
shaping effective control strategies. By identifying how these elements
affect the epidemiology and management of intestinal helminths, targeted
interventions can be developed to reduce their prevalence and associated
health burdens. This is what the current study aims to achieve (Sharma et al., 2020).
The study was conducted in Nigeria's Borno State, in the Maiduguri Metropolis. Borno, referred to as yerwa by the indigenous population, is a state located in the northeast region. Its headquarters and main city is Maiduguri. The Kanem-Bornu Empire is headquartered at Maiduguri, which the British established in 1907 as a military garrison. Most of the population comprises Fulani, Hausa, Shuwa, Bura, Marghi, Chibok, and Kanuri ethnic groups. The Boko Haram insurgency has affected Borno State, and over 40% of the local government districts have moved into the metropolitan regions, one of which being Maiduguri. The internally displaced people are staying in camps with insufficient communal facilities.
The study is a descriptive, cross-sectional study. The study was designed to obtain information using a survey questionnaire. The questions are categorized into three sections to obtain information on demography, knowledge, attitude, and practice, the questionnaire was designed in such a way that the different section was analyzed separately. Five items were included in the questionnaire used to gather the knowledge data. Unfavorable questions received a point if they were erroneous and a zero if they were correct while entering and assessing the knowledge data using the Guttmann Scale grading system. There were several answers to those five questions. Out of the several alternatives, option "I don't know" received a score of 1, while all other options received a score of 0. To receive 0, the participants had to select at least one right response from the available options. As a result, 5 and 0 would be the highest and lowest possible scores. It was determined that the mean and median were 2.97 and 2.0, respectively. Following the central tendency calculation, the median was used to classify the data into knowledgeable and non-knowledgeable categories.
The study focused on mothers/caregivers in the Maiduguri metropolis, including Jere, Konduga, Mafa local government areas, and Maiduguri metropolitan council with a population of more than 822,000 (National Population Commission, 2022). Seven questions were included in the questionnaire used to collect the attitude data. According to the Likert Scale, four points were given for "extremely disagree," three for "disagree," two for "extremely agree," and one point for "agree." As a result, 28 was the highest score possible, and 7 was the lowest. The median value was used to classify a set of favorable and negative attitudes. The results were regarded as a positive attitude if the score was less than the median. Conversely, when the score exceeded the median, a negative attitude was taken into account. The attitude scale had a mean of 6.05 and a median of 6.00.
All Mothers who fulfilled the inclusion criteria were recruited consecutively until the minimum sample size was attained.
Mothers with their children, whose age were between 2 and 6 years and who had lived in Maiduguri town for at least 6 months, were included
1. Mothers/caregivers with children aged 2-6 years and do not live or are visitors to Maiduguri
2. Mothers who refuse to consent
A computer program was created using the data from the patient questionnaire as well as additional pertinent information from this investigation. The Statistical Package for Social Sciences (SPSS) version 23 computer program from the United States was used to analyze the data, and the results are shown in tables and percentages. Data descriptive statistics were summarized using frequency and cross-tabulation. Tables were used to display the percentage of mothers' knowledge, attitudes, and practices.
Ethical approval was sought for and obtained at Borno State Ministry of Health with a reference number SHREC no. 077/2024.
Each participant provided their signed or thumb-printed informed consent, with the option to withdraw or opt out anytime.
Out of the 153 respondents who participated in this survey, the majority of the respondents in this study were within the age range 28-37 years with 56.2% (86) followed by the age greater than 37 years with 30.7% (47), lastly 18-27 years with 13.1% (20). For the level of education, 83% (127) of the respondents have tertiary education, while 3.9% (6) and 13.1% (20) have primary and secondary education, respectively. About 24.8% (38) of the respondents are businesswomen, 51.6% (79) are civil servants, 12.4% (19) are farmers, and 11.2% (17) are housewives. (Table 4.1) The majority of the mothers, 43.1% of moms, had values above the median based on the data and were considered as having a negative attitude, while 56.9% of mothers had values below the level of the median and were considered as having a positive attitude.
The outcomes were considered knowledgeable if the actual score was lower than the median and categorized as non-knowledgeable if the calculated score was higher than the median. According to the median value, 21.6% of the women scored above the median value and were considered non-knowledgeable, and 78.4% of mothers scored below the median value and were considered knowledgeable about soil-transmitted helminths and its prevention and control methods in Maiduguri town.
Table 4.2 shows respondents’ knowledge of intestinal helminths. About 86.3% (132) of the respondents know that intestinal worms are harmful, while 10.5% (16) of the respondents believe worms are not harmful, and 3.3% (5) did not know. Most respondents, 90.2% (138), agreed to have heard about intestinal worms, while 9.8% (15) stated that they had not heard of intestinal worms. A good number of the respondents, 50.9% (78), stated that the source of infection is soil and feces, while 39.9% believe the source is from soil only, and a minority, 9.2% (14), do not know the source of intestinal worm. A total number of 93.4% (143) of the respondents believed that abdominal pain, diarrhea, and vomiting as signs of intestinal worm, and 3.3 %( 5) of the respondents stated weight loss as a sign, while 3.3% (5) said that they don’t know the sign of intestinal worms. The majority of the participant, 73 %( 112), believed that malnutrition and growth retardation as some of the complications of intestinal worms, while a few numbers, 20.3 %( 31), had Anemia, and about 6.5% (10) did not know any complications.
Out of the 153 respondents in the survey, 75.1% (115) agreed that lack of hygiene is associated with intestinal helminths, while 6.6% (10) of the participants strongly disagreed. However, a good number of the respondents, 18.3% (28), were neutral. From the study, 92.2% (141) of the respondents settled that intestinal worms can be treated, while none of the respondents disagreed, and a minority, 7.8 % (12) of the respondents were neutral. The majority of the respondents, 87.6% (134), agreed that health education could reduce intestinal helminths, 0.7% (1) of the respondents disagreed, while the minority of the respondents, 11.7 % (18), were neutral. The majority of the respondents, 83.7% (128), agreed to hand washing as a preventive measure of intestinal helminths, while 8.5% (13) disagreed, and 7.8% (12) were neutral. (Table 4.3)
The data regarding practice were acquired using 8 “yes” and “no” questions, where the highest and lowest scores were 8 and 0 points (Ordinal Scale), respectively. One mark was awarded for 1 correct answer and 0 for a wrong answer. A group of good and poor practices was categorized based on the median. The result was considered good practice if the score was higher than the median value and poor practice if the score was lower than the median.
Table 4.1: Socio-demographic Characteristics of Respondents
| Variables | Frequency | Percentage ( % ) |
|---|---|---|
Age (years) 18 – 27 28 – 37 >37 |
20 86 47 |
13.1 56.2 30.7 |
Marital status Divorced Married Single Widowed |
4 113 27 9 |
2.6 73.4 17.5 5.8 |
Educational status Non or primary Secondary Tertiary |
6 20 127 |
0.6 16.9 82.5 |
Occupation Business Civil servant House wife Farmer |
38 79 17 19 |
24.8 51.6 11.2 12.4 |
Table 4.2: Knowledge of intestinal helminths among respondents in Maiduguri
| Question | Frequency (N=153) | Percentage (%) |
|---|---|---|
| Are intestinal worms harmful? | ||
| Yes | 132 | 86.3 |
No I don’t know |
16 5 |
10.5 3.3 |
| Have you heard about intestinal worms | ||
| Yes | 138 | 90.2 |
| No | 15 | 9.8 |
| What is the source of intestinal worm infection | ||
| Feces and soil | 78 | 50.9 |
| Soil | 61 | 39.9 |
| I don’t know | 14 | 9.2 |
| What are the symptoms of infection with intestinal worms | ||
| Abdominal pain, vomiting and diarrhea | 143 | 93.4 |
| Weight loss | 5 | 3.3 |
| I don’t know | 5 | 3.3 |
| What are the complication of intestinal worm infection | ||
| Aneamia | 31 | 20.3 |
Malnutrition and growth retardation I don’t know |
112 10 |
73.2 6.5 |
Table 4.3: Participants attitude towards prevention of intestinal helminths
| Questions | Frequency (N=153) |
Percentage (%) |
|---|---|---|
| Lack of hygiene is associated with intestinal helminths | ||
| Strongly disagree | 3 | 2.0 |
| Disagree | 7 | 4.6 |
| Neutral | 28 | 18.3 |
| Agree | 83 | 54.2 |
| Strongly agree | 32 | 20.9 |
| Intestinal worms can be treated | ||
| Strongly disagree | 0 | 0 |
| Disagree | 0 | 0 |
| Neutral | 12 | 7.8 |
| Agree | 85 | 55.6 |
| Strongly agree | 56 | 36.6 |
| Health education can reduce | ||
| Strongly disagree | 0 | 0 |
| Disagree | 1 | 0.7 |
| Neutral | 18 | 11.7 |
| Agree | 91 | 59.5 |
| Strongly agree | 43 | 28.1 |
Hand washing Strongly disagree Disagree Neutral Agree Strongly agree Eating unwashed raw fruits |
1 12 12 76 52 |
0.7 7.8 7.8 49.8 33.9 |
Strongly disagree Disagree Neutral Agree Strongly agree |
0 11 12 87 43 |
0 7.2 7.8 56.9 28.1 |
Table 4.4: Practice of mothers towards prevention of intestinal helminths among respondents in Maiduguri
| Question | Frequency (N=153) | Percentage (%) |
|---|---|---|
| Have your child ever been diagnosed with intestinal worms? | ||
| Yes | 39 | 25.5 |
No May be |
112 2 |
73.2 1.3 |
| Do you often cut your child’s nail? | ||
| Yes | 134 | 87.6 |
No May be |
18 1 |
11.7 0.7 |
| Do you wash your child’s hands before and after meals? | ||
| Yes | 136 | 88.9 |
| No | 16 | 10.4 |
| May be | 1 | 0.7 |
| Does your child have any stool examination before? | ||
Yes No |
55 98 |
35.9 64.1 |
Do you wash your child’s hand after playing with sand? Yes No May be Do you use chemically treated or tap water? Yes No May be Do you give drugs to your child to prevent intestinal worms? Yes No May be Have your child ever been diagnosed with intestinal worms? Yes No |
129 20 4 114 31 8 109 39 5 39 114 |
84.3 13.1 2.6 74.5 20.3 5.2 71.2 25.5 3.3 25.5 74.5 |
In Maiduguri town, the median result showed that 73.9% of the women were thought to be informed of soil-transmitted helminths and their prevention and control measures, whereas 26.1% of the women did not know anything about them. One reason for this could be that many operational definitions have been used. Although the comparative operationalized as good knowledge, fair knowledge, and low knowledge, the operational definition of this study was classified as knowledgeable and non-knowledgeable. The total of one's fair and decent knowledge counts as knowledge. This could have raised the degree of knowledge and strayed from the lower border. A prior Ibadan research also demonstrated a knowledge of 43.2%, which is less than what this study discovered. Nonetheless, the fact that both males and females participated in the study could account for the poor awareness (Oyebamiji et al., 2018). This study's findings were greater than another conducted in South Africa by Gwebu et al., who reported that 79.2% of respondents were aware of soil-transmitted helminths. This discrepancy could be the result of a concentrated group discussion and simultaneous assessments of STH and schistosomiasis knowledge. However in this investigation, just STH was evaluated, and a self-administered questionnaire was employed. Contaminated food, contaminated water, raw veggies, dirty fruits, and uncooked vegetables were all listed as key factors in this study, comparable to a study done in Ethiopia (Kassaw et al., 2020).
Similar to a study where mothers reported that intestinal parasites manifested as diarrhea, vomiting, loss of appetite, abdominal discomfort, and an enlarged abdomen, mothers also mentioned anorexia, diarrhea, abdominal cramps, and vomiting as the main signs and symptoms of intestinal parasites (Nyentekyi et al., 2019). Mothers cited growth retardation, anemia, and malnourishment as the main intestinal parasite complications; these findings are consistent with a study that found intestinal parasites could lead to serious health issues, such as malnourishment and growth retardation, if left untreated (Nyentekyi et al., 2019).
Childhood infections caused by intestinal helminths are common. In this study, mothers' positive knowledge, attitude, and practice regarding STH prevention were found to be 78.4%, 56.9%, and 62.1%, respectively, while those with negative or poor knowledge, attitude, and practice were 21.6%, 43.1%, and 37.9%, respectively. Compared to 45.2% of positive knowledge discovered in Ethiopia, this study found a higher level of positive knowledge. This disparity could be the result of using a different population. While moms and caregivers are included in this study, mothers of children under five are used in the Ethiopian study (Mesfin et al., 2020).
In conclusion, Community health programs should target the identified gaps through tailored health education initiatives. Efforts should prioritize improving awareness of symptoms, infection sources, and the importance of consistent hygiene practices. It is recommended that this would ensure better preventive behavior and contribute to reducing the prevalence of intestinal helminths in the region.
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