KNOWLEDGE, ATTITUDE AND PRACTICES OF

RESPONDENTS TO SOIL TRANSMITTED HELMINTHS IN

PARTS OF IJEBU-NORTH LOCAL GOVERNMENT AREA OGUN

STATE.

BY

DUROJAIYE PRINCESS MOTUNRAYO

MATRIC NUMBER: SCI/20/21/0341

A RESEARCH PROJECT SUBMITTED TO THE DEPARTMENT

OF ZOOLOGY AND ENVIRONMENTAL BIOLOGY, FACULTY

OF SCIENCE, OLABISI ONABANJO UNIVERSITY,AGO IWOYE,

OGUN STATE.

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR

THE AWARD OF BACHELOR OF SCIENCE DEGREE [B.SC.] IN

ZOOLOGY.

DECEMBER, 2023
 ABSTRACT

A cross-sectional study was conducted in Ijebu North, Nigeria, to determine the

prevalence of soil-transmitted helminths (STHs) and associated risk factors. A

questionnaire was administered to many participants to assess their knowledge and

practices regarding STHs. The findings of this study indicated that STHs are a

significant health concern in Ijebu North. The findings of this study indicate that there

are several risk factors associated with STH infection in Ijebu North, including lack of

access to clean water, poor sanitation, and low socioeconomic status. These risk

factors are likely to contribute to the high prevalence of STHs in the region. It is

therefore important to improve access to clean water and sanitation facilities, as well

as to increase awareness of STHs and their associated risk factors. This can help to

reduce the burden of STHs in Ijebu North and improve the health of the population.

ii
 CERTIFICATION

I certify that this project work was carried out by DUROJAIYE PRINCESS MOTUNRAYO with Matriculation
number: SCI/20/21/0341 in the Department of Zoology and Environmental Biology, Olabisi Onabanjo University,
Ago-Iwoye.

_________________________ ____________________
Supervisor Date

Professor O.A Agbolade

iii
 DEDICATION

My dedication goes to GOD, the author and the finisher of my faith.

TABLE OF CONTENT

iv
Title

Abstract i ii

Certification iii

Dedication

Acknowledgement iv

Table of contents v

List of Figure vi

List of Tables vii

CHAPTER ONE: INTRODUCTION

1.1 Introduction l

1.2 Justification of the study

1.3 Broad objectives

1.4 Specific objectives

CHAPTER TWO: LITERATURE REVIEW

2.1 History on STH

2.2 Pathogensesis

2.3 Epiidemology

2.4 Symptoms and signs of STH

2.5 Life cycle and transmission

2.6 The impact of climate change on STH infection

2.7 Global burden of STH infection

2.8 Health and Economic consequences of STH infection

2.9 Report on studies that have been done on KAP in relation to STH in other part of Nigeria, Africa and World
Wise.

2.10 Method of clinical examination

2.11 Clinical diagnosis of STH

2.12 Treatment for STH infection

2.13 Prevention method

v
2.14 The current control strategies for STH

2.15 Recent advances in diagnosis of STH infection

2.16 Future plan to eliminate STH

CHAPTER THREE: MATERIALS AND METHODS

3.1 Study location

3.2 Informal consent ethical approval

3.3 Prevelance survey

3.4 Statistical analysis

CHAPTER FOUR: RESULTS

4.1 Demographic Characteristics of Study participants

4.2 Water, Sanitation and Hygiene Access among study participants

4.3 Hygienic attitudes and practices among study participants

4.4 Knowledge and health-seeking patterns of study participants

CHAPTER 5
5.1 Discussion

5.2 Conclusion

5.3 Recommendation

REFERENCES

LIST OF FIGURES
Figure 1: Life cycle of soul transmitted spp.
Figure 2: How STH is transmitted.

vi
 LIST OF TABLES

Table 1: Demographic Characteristics of Study participants Communities

Table 1 Cont’d : Demographic Characteristics of Study participants

Table 2: Water, Sanitation and Hygiene Access among study participants

Table 3: Hygienic attitudes and practices among study participants

Table 4: Knowledge and health-seeking patterns of study participants

vii
 CHAPTER ONE

INTRODUCTION

Soil-transmitted helminths (STH) are a group of parasitic worms that are transmitted

through contact with contaminated soil. They include roundworms (Ascaris

lumbricoides), hookworms (Ancylostoma duodenale and Necator americanus), and

whipworms (Trichuris trichiura). These worms can cause a range of diseases,

including intestinal infections, anemia, and malnutrition.

The main way STH are transmitted is through the fecal-oral route. This means that

when people defecate in the open, the eggs of the worms can get into the soil. People

can then become infected by accidentally ingesting these eggs, for example by eating

unwashed fruits or vegetables that have been contaminated with the eggs. People can

also become infected by walking barefoot on contaminated soil, or by accidentally

ingesting the eggs while playing in the dirt (Jeffrey et al., 2016).

The main risk factors for STH infection are poverty, poor sanitation, and poor

hygiene. People living in areas with high levels of poverty are more likely to have

inadequate access to clean water and sanitation facilities, which increases their risk of

infection. Poor hygiene practices, such as not washing hands after defecation or

before eating, also increase the risk of infection. Children are especially vulnerable to

STH infection because they often play in the dirt and put their hands in their mouths.

People with weakened immune systems, such as those with HIV/AIDS, are also at

increased risk.

1
It's estimated that over 1.5 billion people worldwide are infected with STH, with the

majority of infections occurring in low- and middle-income countries. STH infections

are responsible for an estimated 800,000 disability-adjusted life years (DALYs) lost

each year, and they are a major cause of malnutrition and anemia in children. The

economic burden of STH infection is also significant, with an estimated cost of $4.4

billion per year (WHO, 2021).

STH infection can cause a wide range of symptoms, including abdominal pain,

diarrhea, anemia, and malnutrition. In children, STH infection can lead to impaired

growth and cognitive development, as well as an increased risk of school absenteeism

and dropout. In adults, STH infection can lead to decreased productivity and increased

poverty. Additionally, STH infection is a risk factor for other diseases, such as

HIV/AIDS and tuberculosis (Deepthi et al., 2014).

The most common way to diagnose STH infection is by collecting and examining

stool samples. This is usually done using a technique called the Kato-Katz method,

which involves counting the number of eggs in a sample of stool. Other diagnostic

methods include polymerase chain reaction (PCR) and serological tests. Treatment for

STH infection typically involves taking anthelmintic drugs, such as albendazole or

mebendazole. These drugs kill the worms and can be given in a single dose.

The World Health Assembly has passed a resolution urging its members to contribute

in the control program aimed to reduce morbidity through mass deworming program

especially among school-aged children in developing countries. This resolution has

2
led to one of the largest worldwide health initiative ever undertaken in combating this

neglected tropical diseases (WHO, 2015).

1.2 JUSTIFICATION OF THE STUDY

Soil-transmitted helminth (STH) infection is a major public health problem that

affects millions of people, particularly in low-income countries. STH infection is

associated with a range of adverse health outcomes, including malnutrition, impaired

cognitive development, and increased susceptibility to other infections. Despite efforts

to control STH infection, there are still significant gaps in our understanding of the

epidemiology and burden of STH infection. In addition, STH infection has significant

economic consequences, including decreased productivity and increased health care

costs. Given the magnitude of the problem, there is an urgent need to conduct research

on STH infection to inform more effective control measures. This study aims to

address these knowledge gaps by conducting a cross-sectional survey of STH

infection.

1.3 BROAD OBJECTIVE OF THE STUDY

The study aimed to evaluate the knowledge, attitude and practices of Soil Transmitted

Helminthes in parts of Ijebu-North Local Government Area, Ogun State.

1.4 THE SPECIFIC OBJECTIVES OF THE STUDY WERE TO:

1. Assess the knowledge of respondents towards STH in the study area.

2. Assess the attitude of respondents towards STH in the study area.

3
3. Assess the practices of respondents towards STH in the study area.

4
 CHAPTER TWO

LITERATURE REVIEW

2.1 HISTORY ON SOIL TRANSMITTED HELMITHS

Although people have observed STH infection for centuries, it wasn't until the 17th

century that scientists began to study it in detail. By the 19th century, scientists had

identified different species of STH and began to understand how the worms cause

disease. In the 20th century, scientists developed new diagnostic tests for STH

infection, making it easier to diagnose and treat the disease. Today, there are a variety

of treatments available for STH infection, including drugs that kill the worms and

prevent them from reproducing (Chul et al., 2013).

2.2 PATHOGENESIS

The pathogenesis of STH infection is multifaceted and includes damage to the

intestines, malabsorption of nutrients, loss of blood, an immune response that can

cause tissue damage, inflammation, anemia, and malnutrition. When a person

becomes infected with STH, the worms can cause damage to the intestinal lining,

leading to malabsorption of nutrients, including iron and vitamin A. The worms can

also cause bleeding in the intestine, leading to anemia. In addition, the immune

system responds to the presence of the worms by producing inflammatory chemicals

that can cause damage to the intestinal lining and other tissues. The inflammatory

response can also lead to malnutrition, further compounding the health problems

caused by the infection.

5
A. lumbricoides this worm damages the intestines by attaching to the intestinal wall

and feeding on the cells. This can cause inflammation and ulcers, which lead to

malabsorption of nutrients.

The worm's eggs can get into the bloodstream and cause anemia and organ damage.

Next, we have N. americanus, which this worm attaches itself to the intestinal wall

and feeds on the host's blood. As a result, it can cause anemia, malnutrition, and organ

damage. In addition, N. americanus can release toxins that can damage the cells of the

intestinal wall. Finally, we have T. trichiura. This worm damages the intestinal wall by

burrowing into it. This can cause bleeding and tissue damage, which can lead to

anemia and malnutrition. These are the main pathogenic mechanisms of the three

most common STH infections (Albrecht et al., 2019).

2.3 EPIDEMIOLOGY

STH infections are endemic in many tropical and subtropical regions of the world,

particularly in areas with poor sanitation and hygiene. Infection is most common in

children, as they are more likely to come into contact with contaminated soil. STH

infections are more common in rural areas, where there is a higher prevalence of

poverty and poor sanitation. There are a number of risk factors for STH infection. The

most important risk factor is poverty, as it is associated with poor sanitation,

inadequate water supply, and close contact with contaminated soil. Other risk factors

include lack of access to health care, poor hygiene, and living in close proximity to

livestock. In addition, children who are malnourished or have underlying health

6
conditions are at increased risk of STH infection (Subhash et al., 2017).

2.4 SYMPTOMS AND SIGNS OF STH

2.4.1 SYMPTOMS

The consequences of STH infection can be severe and include malnutrition, anemia,

impaired cognitive development, and inflammation of the intestines. These can cause

abdominal pain, vomiting, and diarrhea. STH infection can also result in neurological

complications such as epilepsy and encephalitis. Furthermore, STH can damage the

lungs, liver, and kidneys, leading to serious illness and even death if not treated

(Forman et al., 2020).

2.4.2 SIGNS

The signs of STH infection can also vary depending on the type of worm and the

severity of the infection. However, some common signs include:

1. Anemia

2. Weight loss

3. Swelling of the abdomen

4. Rash on the buttocks

Children with STH infections may also have a "pot-bellied" appearance. The stools of

people with STH infections may contain the eggs of the worms. These signs can be

helpful in diagnosing STH infections, but a definitive diagnosis can only be made

through a stool sample (Charles et al., 2018).

2.5 LIFE CYCLE AND TRANSMISSION

2.5.1 LIFE CYCLE

7
FIGURE 1: Life cycle of soil transmitted helminths spp.

Source: (Central for Disease Control cdc.gov.)

The life cycle of STH begins when a person comes into contact with infected soil or

water. The eggs of the STH are present in the soil or water, and they can enter the

body through the skin or by being swallowed. Once inside the body, the eggs hatch

8
into larvae, which travel to the lungs and then to the intestines. There, they mature

into adult worms, which reproduce and release more eggs into the environment. The

cycle continues unless the person is treated with an effective medication (Lucience et

al., 2011).

The eggs of STH are very resistant to environmental conditions and can survive for

years in the soil or water. They are also resistant to disinfectants and detergents. When

the eggs are ingested, they hatch in the intestines and the larvae emerge. The larvae

then travel through the bloodstream to the lungs, where they mature into adult worms.

In the lungs, they cause coughing and irritation (Josephine et al., 2023).

The larval stage is divided into two parts: the migrating stage and the tissue stage.

During the migrating stage, the larvae travel through the lungs and enter the

bloodstream. They are then carried to the intestines, where they penetrate the

intestinal wall and enter the tissue stage. During the tissue stage, the larvae develop

into adult worms. They then mate and produce eggs, which are released into the

environment through the feces (WHO, 2023).

2.5.2 TRANSMISSION

The main mode of transmission for STH infections is through contaminated soil and

water. This can occur when people come into contact with soil that contains the eggs

of the worms, either through walking barefoot or handling contaminated soil. The

eggs can also be found in contaminated water, and ingestion of these eggs can occur

when people drink or wash with the water. STH infections can also be transmitted

9
through contact with animals that have been infected, such as pigs and dogs, which

can shed the eggs of the worms (Yonas et al., 2022).

10
FIGURE 2: HOW STH IS TRANSMITTED

Source: (http://whqlibdoc.who.int/publications/2011/9789241548267eng.)

One interesting fact about the transmission of STH is that the eggs of these worms can

remain dormant in the soil for years. This means that even if contaminated soil is no

longer used for growing crops, it can still be a source of infection. Rain and flooding

can wash the eggs of the worms into water sources, making them a source of infection

11
when people use the water for domestic use or for recreation.

2.6 THE IMPACT OF CLIMATE CHANGE ON STH INFECTION

Climate change can increase the risk of STH infections in several ways. First, it can

increase the amount of rainfall, which can lead to increased flooding and the washing

of STH eggs into water sources. Second, climate change can cause an increase in

temperature, which can create a more favorable environment for the development of

STH eggs. Finally, climate change can lead to changes in the migration patterns of

animals, which can increase the chances of STH transmission from animals to humans

(Yao et al., 2013).

2.7 GLOBAL BURDEN OF STH INFECTION

The global burden of STH infection is significant, with an estimated 1.5 billion people

infected worldwide. The highest burden of infection is in sub-Saharan Africa,

followed by Southeast Asia and the Western Pacific region. STH infections have a

particularly large impact on children, with about 440 million children under the age of

14 infected worldwide. These infections can lead to a loss of up to two years of

schooling, which can have a negative impact on children's development and future

economic opportunities (Rachel et al., 2021).

It is estimated that STH infections cost developing countries about $8.4 billion per

year in lost productivity and health care costs. This includes both direct costs, such as

the cost of medications and hospitalization, and indirect costs, such as the loss of

productivity due to illness. This burden is disproportionately felt by those living in

12
poverty, as they are more likely to be infected with STH and to experience more

severe consequences (Antonio et al., 2022).

2.8 HEALTH AND ECONOMIC CONSEQUENCES OF STH INFECTION

The health and economic consequences of STH infections can be severe, particularly

for children. The most common consequences of infection include anemia,

malnutrition, and impaired cognitive development. These consequences can lead to

long-term negative effects on physical and mental health, as well as on educational

attainment and future earning potential. As a result, STH infections can perpetuate the

cycle of poverty, making it difficult for those affected to escape from poverty

(Khurshid et al., 2014).

One of the most serious health consequences of STH infections is anemia. Anemia is

a condition in which the blood does not have enough red blood cells to carry oxygen

throughout the body. Children with STH infections are at higher risk for developing

anemia, which can lead to fatigue, weakness, and difficulty concentrating. Anemia can

also lead to long-term consequences, such as delayed puberty and stunted growth

(Serge et al., 2017). In severe cases, anemia can be life-threatening.

Another serious health consequence of STH infections is malnutrition. Malnutrition is

a condition that occurs when a person does not get enough nutrients from food, such

as proteins, vitamins, and minerals. Children with STH infections are at risk for

malnutrition, as the worms can damage the digestive system and prevent the body

from absorbing nutrients from food. Malnutrition can lead to a variety of health

13
problems, including impaired brain development, stunted growth, and weakened

immune system (WHO, 2015). These effects can have long-lasting consequences on

health and well-being.

The economic consequences of STH infections are significant, particularly for

children. Children with STH infections are more likely to miss school and have

difficulty learning, which can negatively impact their future earning potential (Pullan

et al., 2014). In addition, families of children with STH infections often have to pay

for expensive medical care, which can put a strain on the family's finances.

One aspect of the economic consequences of STH infections that is particularly

important is the loss of productivity. Because STH infections can cause a variety of

health problems, such as fatigue and weakness, people with STH infections are often

unable to work as efficiently as they could without the infection. This can lead to

lower productivity and lost income. It can also impact entire communities by reducing

the amount of labor available to work on farms and in businesses.

2.9 REPORT ON STUDIES THAT HAVE BEEN DONE ON KAP IN

RELATION TO STH IN OTHER PARTS OF NIGERIA, AFRICA AND THE

WORLD WIDE.

2.9.1 Health education and socioeconomic factors as determinants of knowledge

and attitudes towards STH infections in Lagos, Nigeria.

“Knowledge and attitudes of mothers towards intestinal parasitic infections among

under-five children in Lagos, Nigeria’’ by (Edobor et al., 2012). This study was
14
conducted in Lagos, Nigeria and involved interviewing mothers about their

knowledge and attitudes towards STH infections in children. The study found that the

majority of mothers had a limited knowledge of STH infections, with only 27% of

respondents having a good knowledge of the diseases. The study also found that

misconceptions about the cause and treatment of STH infections were common

among the respondents. The study found that the majority of respondents (89%) were

aware that children could become infected with STH, but only a small number (27%)

knew about the different types of infections and their symptoms. Additionally, less

than half of the respondents knew that STH infections could be prevented through

improved sanitation, and less than a quarter (23%) knew that improved nutrition could

help to prevent these infections. When it came to treatment, the majority of

respondents (78%) believed that medication was the only way to treat STH infections,

with very few (13%) knowing. More specifically, the study found that the majority of

respondents (83%) were unaware of the role of health education in the prevention of

STH infections. This was a significant finding, as health education is an important

tool in raising awareness about STH infections and the steps that can be taken to

prevent them. In addition, only a small number of respondents (25%) knew that

community-wide treatment was an important part of controlling STH infections. This

suggests that there is a need for more education and awareness-raising about STH

infections in Lagos, Nigeria. The study also found that the level of education of the

respondents was a key factor in their knowledge and attitudes towards STH

infections. Those with higher levels of education were more likely to have a good
15
knowledge of the infections and the steps that could be taken to prevent them. This

suggests that education is an important factor in reducing the burden of STH

infections in Lagos, Nigeria. Lastly, the study found that income was also a significant

factor, with those from higher income households having a greater knowledge of STH

infections.

2.9.2 Awareness and knowledge of STH infections and control measures in rural

and peri-urban communities in Ogun state, Nigeria.

One of the study report on is "Awareness, knowledge and practices regarding

helminth infection among primary school children in Ogun state, Nigeria" by

(Abdulgafar et al., 2016). This study was conducted in Ogun state, which is a

neighboring state to Lagos, Nigeria. The study found that the level of awareness about

STH infections was low among the primary school children surveyed, with only 43%

of the children having heard of STH infections. Additionally, the study found that the

knowledge of STH infections was also low, with only 30% of the children having a

good knowledge of the disease infection.

Another study report is "Awareness, knowledge and practices towards soil-transmitted

helminth infection among rural communities in Ogun state, Nigeria" by (Olugbade et

al., 2016). This study was conducted in rural communities in Ogun state, which are

generally more isolated than the urban communities in the state. The study found that

the level of awareness about STH infections was even lower in the rural communities,

with only 34% of the respondents having heard of STH infections. The study also

16
found that the level of knowledge about STH infections was poor, with only 17% of

the respondents having knowledge about it.

Another study report is "Awareness and Knowledge of Soil-Transmitted

Helminthiasis among Secondary School Adolescents in a Peri-urban Community in

Ijebu-Ode, Ogun State, Nigeria" by (Emodi et al., 2017). This study was conducted in

a peri-urban community in Ijebu-Ode, which is a city in Ogun state. The study found

that the level of awareness about STH infections was low among the secondary school

adolescents, with only 42% of the respondents having heard of STH infections. The

study also found that the level of knowledge about STH infections was low, with only

29% of the respondents having a good knowledge of STH infections. The study also

found that the knowledge of control measures for STH infections was poor, with only

18% of the respondents having a good knowledge of control measures. The study also

found that the majority of the adolescents did not know how to prevent STH

infections, and that there was a need for improved health education on STH infections

and control measures.

In conclusion, from most of the studies conducted in Ogun state suggest that there is a

need for improved health education on STH infections and control measures, as

knowledge and awareness of STH infections and control measures are low among the

general population and adolescents. The studies also suggest that there is a need for

more research on STH infections and control measures in order to develop more

effective strategies for prevention and control (Emodi et al., 2017).

17
2.9.3 Studies from Ondo and Ekiti, the Geographical differences in knowledge

and awareness of STH infections in Nigeria.

"Knowledge, Attitudes, and Practices (KAP) towards Soil-Transmitted Helminthiasis

in Ondo State, Nigeria" by (Mabayoje et al., 2020). This study found that the

knowledge and attitudes of the population towards STH infections were low, and that

more education and awareness campaigns are needed in order to improve the

prevention and control of STH infections in Ondo state.

There have also been studies conducted in Ekiti state. One such study is "Awareness

and Knowledge of Soil-Transmitted Helminthiasis and Schistosomiasis in Ekiti State,

Nigeria" by (Adebayo et al., 2014). This study found that there was a lack of

knowledge about STH and schistosomiasis, and that there was a need for improved

education on these diseases and their prevention. There was a need for improved

access to clean water and sanitation.

2.9.4Knowledge, attitudes, and practices regarding soil-transmitted helminthiasis

in other urban areas of western Nigeria

- On the study "Knowledge and practices regarding soil-transmitted helminthiasis

among primary school children and their teachers in Ilesa, Nigeria" (Akintola et al.,

2013). This study was conducted in Ilesa, which is a city in Osun state in western

Nigeria. The study found that the children's knowledge about STH infections was

poor, with only 14% of the children having a good knowledge about STH infections.

The study also found that the children's practices for preventing STH infections were

18
inadequate, with only 28% of the children practicing good hygiene.

- On the study "Knowledge, attitudes and practices regarding soil-transmitted

helminthiasis among school children in Ibadan, Oyo State, Nigeria" (Ogundele et al.,

2017). This study was conducted in Ibadan, which is a city in Oyo state in

southwestern Nigeria. The study found that the children's knowledge about STH

infections was poor, with only 18.2% of the children having a good knowledge about

STH infections. The study also found that the children's practices for preventing STH

infections were inadequate, with only 25.6% of the children practicing.

2.9.5 Knowledge, Attitudes, and Practices of STH Infections in Southern Nigeria

A total summary for studies on KAP in relation to STH in southern Nigeria. In

summary, studies have shown that there is a high level of knowledge about STH

infections among people in southern Nigeria, with around 80% of people having

accurate knowledge about the infections. Positive attitudes towards STH control are

also high, with around 60% of people surveyed having positive attitudes. Lastly, the

majority of people (around 70%) had positive practices regarding STH control.

2.10.6 Knowledge, attitudes, and practices regarding STH infections in eastern

Nigeria

The most recent study on this topic is "Knowledge, attitude, and practices regarding

soil-transmitted helminthiasis among rural communities in eastern Nigeria" (Ukwueze

19
et al., 2022). This study found that knowledge about STH infections was generally

low, with only 37% of participants knowing that contaminated water was a source of

infection. However, the majority of participants had a positive attitude towards STH

control. Regarding practices, only 11% of participants washed their hands with soap

and water before eating, and only 12% used pit latrines.

In terms of prevention practices, the study found that only 4% of participants

regularly took anthelminthic medication. Many people also did not practice hand

washing after defecation or before eating. There was also a lack of knowledge about

the need for regular deworming, with only 13% of participants knowing that it is

recommended to take anthelminthic medication every six months.

2.9.7 Knowledge and practices regarding STH infections in Northern Nigeria

In summary, there are several studies that have been done on knowledge, attitudes,

and practices (KAP) in relation to STH infections in northern Nigeria. These studies

have shown that there is a lack of knowledge about STH infections and their risk

factors, as well as a lack of awareness about the importance of prevention and

treatment. In addition, there are many misconceptions about STH infections and their

prevention. The majority of people surveyed did not know how to prevent STH

infections, and many had negative attitudes towards STH control. Okay! On average,

around 50% of people surveyed had some knowledge about STH infections, but only

around 20% had accurate knowledge. Around 30% of people surveyed had negative

attitudes towards STH control, while only around 20% had positive attitudes. Finally,

20
around 10% of people had positive practices, while around 80% had negative

practices. These percentages vary across different studies, but these are the average

figures from the available literature.

2.9.8 REPORT ON STUDIES THAT HAVE BEEN DONE ON KAP IN

RELATION TO STH IN AFRICA

Knowledge, attitude and practices towards STH in Sub-Saharan Africa

"Prevalence and determinants of soil-transmitted helminth infection in sub-Saharan

Africa: A systematic review and meta-analysis" (Mushi et al., 2014). This study used

data from more than 300 studies conducted in sub-Saharan Africa between 2000 and

2014. It found that the prevalence of STH infections has decreased since 2000, but

there is still a high burden of infection in some countries.

The 2014 study also looked at the knowledge, attitudes, and practices (KAP) of

individuals in sub-Saharan Africa regarding STH infections. The study found that

knowledge about STH infections was generally low, with only about half of

individuals having heard of STH infections. However, the majority of individuals

believed that STH infections were preventable, and were willing to take steps to

prevent them. However, many individuals did not have access to the resources

necessary to prevent or treat STH infections, such as clean water and sanitation

facilities. One of the most important findings of the 2014 study was that there was a

large disparity in KAP between urban and rural areas. Individuals in rural areas were

much less likely to have knowledge about STH infections, and were also less likely to

21
have access to the resources necessary to prevent and treat these infections. This

highlights the need for targeted interventions in rural areas to improve knowledge,

attitudes, and practices regarding STH infections.

One of the specific interventions that have been shown to be effective in improving

KAP regarding STH infection is educational materials, such as posters and brochures,

in areas with high rates of STH infections. This has been shown to be effective in

increasing knowledge and changing attitudes towards STH infections. Another

intervention is the training of community health workers to promote good hygiene

practices and provide treatment for STH infections.

Another strategy is the "Healthy Schools" program! The program was developed by

the World Health Organization (WHO) and the United Nations Children's Fund

(UNICEF). The specific reference for the program is "Healthy Schools: A manual for

schools and communities" (WHO and UNICEF, 2012). This program, which has been

implemented in several countries in sub-Saharan Africa, combines educational

materials, hygiene facilities, and deworming treatment to improve KAP regarding

STH infections. The program has been shown to be effective in reducing the

prevalence of STH infections in school-aged children. It also has the potential to

improve school attendance and performance.

2.9.9 Knowledge, attitude and practices towards STH in North Africa

The most comprehensive study on the KAP of North African individuals regarding

STH infections is a systematic review from 2016, titled "Knowledge, attitudes, and

22
practices regarding soil-transmitted helminths in North Africa: A systematic review"

(Elzein et al., 2016). This study analyzed the results of more than 40 studies, and

provides a wealth of information on the KAP of North Africans regarding STH

infections. The systematic review found that knowledge about STH infections was

generally low among the North African population. However, most individuals were

aware of the negative health effects of STH infections and were interested in learning

more about prevention and treatment. In terms of attitudes, there was a range of

opinions, with some individuals believing that STH infections were a personal

problem, while others felt that it was a community issue.

In terms of knowledge, the systematic review found that most individuals did not

know the correct modes of transmission of STH infections. However, they generally

understood that sanitation and hygiene were important in preventing infections. There

was also some confusion regarding the different types of STH infections and the signs

and symptoms of infection.

In practices, the review found that sanitation and hygiene practices were generally

poor in North Africa, with many individuals not having access to clean water or

sanitation facilities. Most people also did not wash their hands with soap before eating

or after defecating. In addition, many people reported not taking any preventive

measures against STH infections.

A SUMMARY OF KNOWLEDGE, ATTITUDES AND PRACTICES

TOWARDS STH IN OTHER CONTINENTS OF THE WORLD

23
2.9.10 Knowledge, attitudes, and practices regarding soil-transmitted helminth

infections in the United States

From the study "Soil-transmitted helminthiasis in the United States of America"

(Neyaz et al., 2018), published in the journal Clinical Microbiology . This study

found that although the prevalence of STH infections is relatively low in the United

States, there are still an estimated 240,000 to 520,000 cases each year. The study also

found that certain populations, including immigrant populations and people living in

poverty, are at higher risk for infection.

Studies have found that there is a lack of knowledge about STH infections in the

United States. For example, a study of high school students in Texas found that only

32% of students knew what a STH infection was, and only 28% knew that humans

could be infected by STH (Udobi et al ., 2012). Studies have found that attitudes

towards STH infections are often negative and stigmatizing. The people often believe

that STH infections are only a problem in developing countries, and do not believe

that they can be infected themselves.

2.9.11 Knowledge, attitudes, and practices regarding soil-transmitted helminths

in Europe

"Prevalence of helminth infections in schoolchildren from 10 European countries"

(Tambini et al., 2011), published in the journal Parasitology. This study found that

the overall prevalence of STH infections in European schoolchildren was 0.4%.

However, there was significant variation between countries, with higher prevalence in

24
countries such as Cyprus, Italy, Portugal, and Spain. Absolutely! I can go into more

detail about specific countries within Europe. For example, a study of school children

in Italy found that the prevalence of STH infections varied widely between regions,

with the highest prevalence in the south. A similar study in Spain found that the

highest prevalence of STH infections was in Andalusia and the Canary Islands. This

variation in prevalence within countries suggests that factors other than geography,

such as socioeconomic status and cultural practices, may play a role.

The study I mentioned found that the level of knowledge about STH infections was

generally low in both Italy and Spain. For example, many people did not know that

STH infections can be transmitted through contact with contaminated soil or water.

However, attitudes towards STH infections were generally positive, with people

recognizing the importance of treatment and prevention.

2.9.12 Healthcare professionals' knowledge, attitudes, and practices regarding

soil-transmitted helminth infections in Asia

"Prevalence and factors associated with soil-transmitted helminthiasis: A systematic

review and meta-analysis of community-based studies from Asia" (Singh et al., 2013).

This study found that the overall prevalence of STH infections in Asia was 15.2%,

with the highest prevalence in South Asia and the lowest prevalence in East Asia. The

meta-analysis found that several factors were associated with a higher prevalence of

STH infections. These factors included living in a rural area, having a low

socioeconomic status, and having poor sanitation and hygiene conditions.

25
Interestingly, the study also found that children aged 6 to 15 years had a higher

prevalence of STH infections than children younger than 6 years old.

Healthcare professionals in Asia generally have a good understanding of the health

risks associated with STH infections, and many are committed to controlling these

infections. However, there are still some gaps in knowledge and attitudes that need to

be addressed. For example, some healthcare professionals do not fully understand

how to properly diagnose or treat STH infections.

The review also examined practices related to STH infections in Asia. The review

found that hygiene practices such as hand washing and proper sanitation are generally

good, but there is still room for improvement. In addition, the review found that most

people are not familiar with the use of deworming medication, and many do not know

how to properly use these medications. Overall, the review found that there is a need

for more education and awareness about STH infections and their prevention in Asia.

2.9.13 Knowledge Attitudes and Practices towards STH infection in Australia

From the study "Knowledge, attitudes, and practices among healthcare professionals

in Australia towards soil-transmitted helminth infections" (Ali et al., 2020). The

reference is from the journal PLoS Neglected Tropical Diseases. In summary, the

study found that the majority of healthcare professionals in Australia had a good

understanding of the health risks associated with STH infections, but there were still

gaps in knowledge and attitudes that need to be addressed. Specifically, the study

found that only about half of healthcare professionals knew how to properly diagnose

26
STH infections, and only one third knew how to properly treat these infections. The

study also found that many healthcare professionals had a negative attitude towards

people with STH infections, which could make it difficult to effectively control these

infections.

"Australia soil-transmitted helminthiasis control strategy 2015-2020"

(Commonwealth of Australia, 2015). This document provides an overview of the STH

Strategy, its goals, and the actions that are being taken to achieve those goals. It is

called the "Australia Soil-Transmitted Helminth Strategy" (STH Strategy). The STH

Strategy was developed by the Australian government in collaboration with other

organizations, such as the World Health Organization and the International Federation

of Red Cross and Red Crescent Societies. The STH Strategy has a number of goals,

including reducing the burden of STH infections, increasing access to diagnosis and

treatment, and strengthening surveillance and monitoring systems.

2.10 METHOD FOR CLINICAL EXAMINATION

There are several methods used to diagnose STH infections in a clinical setting. The

most common method is stool examination, which involves analyzing a stool sample

to look for the eggs of the worms. This can be done using a microscope or through a

technique called the Kato-Katz method. The Kato-Katz method is a relatively

inexpensive and simple technique that involves placing a small amount of the stool

sample onto a slide and then analyzing it under a microscope. Other methods used to

diagnose STH infections include serological tests, which measure the level of

27
antibodies in the blood, and molecular techniques, such as PCR (polymerase chain).

2.11 CLINICAL DIAGNOSIS OF STH

The diagnosis of STH infections is a multi-step process that begins with taking a

complete medical history, followed by a physical examination. The doctor may also

order specific tests, such as stool examination, serological tests, molecular tests, and

imaging studies, to confirm the diagnosis and determine the specific type of STH

infection.

In some cases, imaging tests such as an X-ray or CT scan may be used to confirm the

diagnosis.

X-ray is used to diagnose STH infections by looking for the presence of calcified

eggs. Calcified eggs are the remnants of dead STH eggs that have been in the body for

a long time. They can be seen on an X-ray as tiny white spots. This method is not

always reliable, as calcified eggs may not be present in all cases of STH infection.

However, when they are present, it can be a useful tool for diagnosis.

A CT scan is used to diagnose STH infections by looking for signs of inflammation in

the intestines. This type of imaging test can show the location and extent of

inflammation, which can help to determine the severity of the infection. In addition, a

CT scan can also show any abnormalities in the liver or spleen that may be caused by

an STH infection. This can be useful in cases where the infection has spread to other

parts of the body. While CT scans can be helpful in diagnosing STH infections, they

are not always necessary and can expose patients to radiation (Sumeeta et al., 2017).
28
2.12 TREATMENT FOR STH INFECTION

There are a variety of treatment options available for STH infections. The most

common treatment is a course of anti parasitic medications, which work to kill the

parasites in the body. Depending on the type of STH infection, the medications may

be taken orally or given by injection. In some cases, surgery may be necessary to

remove large worms or to treat complications of the infection. Diet and nutrition also

play a role in the treatment of STH infections, and patients may be advised to eat a

diet high in protein and iron. Some patients may need additional treatments, such as

blood transfusions or iron supplements, to correct a resolution of symptoms (Ayalew

et al., 2020).

2.13 PREVENTION METHODS

There are several preventive measures that can be taken to reduce the risk of STH

infections. One of the most important preventive measures is proper hygiene,

including hand washing with soap and water and ensuring that food and water are

properly cooked and stored. It is also important to avoid contact with infected people

and animals, and to avoid areas where STH infections are known to be present. Some

people may benefit from taking medications that prevent STH infections, such as

mebendazole or albendazole. (Luciene et al., 2011). In addition, wearing shoes and

avoiding contact with contaminated soil can help to reduce the risk of infection.

Education on proper sanitation and hygiene practices is also important, especially for

children and families in communities where STH infections are common.

29
2.14 THE CURRENT CONTROL STRATEGIES FOR STH

There are a number of current control strategies for STH infections, with the most

common being mass drug administration (MDA). MDA involves the distribution of

anti-parasitic drugs to entire communities on a regular basis. This strategy has been

shown to be effective in reducing the incidence of STH infections (WHO, 2015).

In addition to mass drug administration, other control strategies for STH infections

include health education, improvements in sanitation and hygiene, and school-based

deworming programs. Health education is important for raising awareness about the

risks of infection and how to prevent it. Improvements in sanitation and hygiene can

help to reduce the transmission of parasites, while school-based deworming programs

target children who are at high risk of infection. All of these strategies have been

shown to be effective in reducing the prevalence of STH infections. (Montresor et al.,

2017).

Another control strategy that has been implemented is the provision of safe water and

sanitation facilities. These interventions can help to reduce the incidence of STH

infections by reducing the likelihood of contact with contaminated water and soil

(WHO, 2017). These interventions can have a number of other health benefits, such as

reducing the risk of other water-borne diseases.

The success of various control strategies for STH infections has been evaluated in a

number of studies, with impressive results. MDA and SBDP have been shown to

reduce the prevalence of STH infections by up to 80% in some cases. Providing safe

30
water and sanitation has also been shown to reduce the incidence of STH infections

by up to 75%. Not only have these control strategies reduced the burden of disease,

but they have also improved educational outcomes and the overall health of

communities. This makes clear the importance of continued efforts to control STH

infections (Hotez et al., 2019).

2.15 RECENT ADVANCES IN DIAGNOSIS OF STH INFECTION

There have been a number of recent advances in the diagnosis and treatment of STH

infections. For example, there are now rapid diagnostic tests that can detect the

presence of STH infections within minutes. These tests are easy to use and can be

done in remote areas without the need for specialized equipment (Mark et al., 2018).

Recent advances in medicine have led to the development of new and improved

treatments for STH infections. These new treatments are not only more effective, but

they also have fewer side effects than previous treatments. For example, new oral

medications can be taken at home, without the need for hospitalization. This is a

major improvement over older treatments, which required patients to be hospitalized

and monitored closely by medical professionals. These new treatments offer hope for

a more effective and convenient way to treat STH infections (Ridley et al., 2016).

While they may be more expensive than older treatments, the long-term cost savings

from preventing serious disease may offset this initial cost.

2.16 FUTURE PLAN TO ELIMINATE STH

31
One of the most exciting advances in the treatment of STH infections is the

development of a vaccine. This vaccine is still in the research stage, as researchers are

still working on it, and it has shown promising results in animal studies. If it is

approved for use in humans, it will be a powerful tool in the fight against STH

infections (Hallen et al., 2017). Researchers are also working on new diagnostic tools

that can detect STH infections at an earlier stage, before they cause serious damage.

These tools could help to prevent the spread of infection and reduce the need for

treatment, saving cost.

The World Health Organization (WHO) has also developed a plan to eliminate STH

infections by the year 2025. The WHO's strategy includes improving water and

sanitation, increasing access to health-care and developing new tools for diagnosis

and treatment. A key part of the strategy is mass drug administration, which involves

treating everyone in a community regardless of whether they have symptoms. By

following this strategy, the WHO hopes to reduce the prevalence of STH infections to

below 1% by 2025 (WHO, 2022).

32
 CHAPTER THREE

MATERIALS AND METHOD

3.1 STUDY LOCATION

The study was done in part of Ijebu North Local Government Area.

3.2INFORMAL CONSENT ETHICAL APPROVAL

Awareness on Soil Transmitted Helminths was created in the study locations amongst

respondents and informal consents were given before administering of questionnaires.

3.3 PREVALENCE SURVEY

The survey was done by creating a questionnaire that asks about people’s knowledge,

attitudes and practices to STH infection.

3.4 STATISTICAL ANALYSIS

Data obtained from this study were entered into Microsoft Excel and imported into R

software for analysis. Demographic data including sex, gender, education, marital

status, occupation, and religion were categorized and set as factors. Similarly, data on

awareness, knowledge, hygiene practices and health seeking behavior were grouped

and set as factors. Furthermore, dataset on access to and type of water and toilet

facilities were used to characterize the access to WASH resources among the study

participants. All the variables were used as explanatory variables and compared across

gender of study participant. Univariate chi-square statistic was performed between all

variables (explanatory and outcome). Significant associations were established when

33
p <0.05. All statistical procedures were performed in R studio using gtsummary

packages.

CHAPTER FOUR

34
 RESULTS

4.0Demographic Characteristics of Study participants

The analysis of demographic characteristics across communities, as depicted in Table

1, revealed notable variations with statistically significant differences. The

distribution of sex exhibited significant disparities (p = 0.005), with Mamu having the

highest proportion of males (52.1%), while Oru recorded the lowest (30.0%). Age

distribution also demonstrated significant differences (p < 0.001), with the majority

falling within the 12-25 age group across all communities, reaching 100.0% in Mamu.

Furthermore, Mamu displayed a higher percentage of individuals in the 26-40 age

group (16.8%) compared to other communities. Educational attainment varied

significantly (p < 0.001) among communities, with distinct patterns such as Mamu

having the highest percentage of individuals with OND/HND (60.0%), Ago-Iwoye

with the highest percentage of Bsc. (43.1%), and Ilaporu predominantly representing

the secondary education category (100.0%). These findings underscore the importance

of community-specific demographics in understanding health-related outcomes,

providing valuable insights for targeted interventions and the formulation of

tailored healthcare strategies.

Table 1: Demographic Characteristics of Study participants

35
 Communities

Ago-
Ijebu-Igbo, Oru, Mamu, Ilaporu,
Characteristic N = 571 Iwoye, N = p-value
N = 110 1
N = 109 1
N = 120 1
N = 119 1

113 1

Sex, n (%) 0.005

Male 231 33 (30.0%) 48 (44.0%) 48 (42.5%) 40 (33.3%) 62 (52.1%)

(40.5%)

Female 340 77 (70.0%) 61 (56.0%) 65 (57.5%) 80 (66.7%) 57 (47.9%)

(59.5%)

Age in years, n <0.001

(%)

12-25 510 83 (75.5%) 100 109 120 98 (82.4%)

(89.3%) (91.7%) (96.5%) (100.0%)

26-40 52 (9.1%) 19 (17.3%) 9 (8.3%) 4 (3.5%) 0 (0.0%) 20 (16.8%)

41-65 9 (1.6%) 8 (7.3%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.8%)

Education, n (%) <0.001

Primary 11 (1.9%) 8 (7.3%) 3 (2.8%) 0 (0.0%) 0 (0.0%) 0 (0.0%)

Secondary 192 18 (16.4%) 0 (0.0%) 15 (13.3%) 120 39 (32.8%)

(33.6%) (100.0%)

OND/HND 211 66 (60.0%) 56 (51.4%) 54 (47.8%) 0 (0.0%) 35 (29.4%)

(37.0%)

Bsc. 138 12 (10.9%) 47 (43.1%) 44 (38.9%) 0 (0.0%) 35 (29.4%)

(24.2%)

PG 19 (3.3%) 6 (5.5%) 3 (2.8%) 0 (0.0%) 0 (0.0%)

4.0Demographic Characteristics of Study participants (Cont’d)

36
The analysis of additional demographic characteristics across communities,

as presented in Table 1 (cont’d), reveals noteworthy variations with

statistically significant differences. Occupational distribution demonstrates

significant disparities (p < 0.001), with the self-employed category

prominently represented in Ilaporu (100.0%), while other communities

exhibit varying proportions, such as Oru with 79.1%, Ago-Iwoye at 76.1%,

Ijebu-Igbo at 82.0%, and Mamu with 86.7%. Location distribution also

displays significant differences (p < 0.001), with rural locations predominant

in Ijebu-Igbo (55.7%), contrasting with Mamu's higher prevalence of urban

locations (67.5%). The presence of concrete housing walls varies

significantly across communities (p < 0.001), with Ilaporu standing out at

75.8%, Ijebu-Igbo having the highest percentage with 90.9%, and Mamu

having a higher proportion (24.2%) reporting the absence of concrete walls.

These findings underscore the importance of considering occupational,

locational, and housing characteristics in health-related analyses, providing

valuable insights for targeted interventions and community-specific

healthcare strategies.

37
 Table 1 Cont’d : Demographic Characteristics of Study
participants

Communities

Characteri Ijebu-Igbo, Oru, Ago-Iwoye, Mamu, Ilaporu,

N = 571 p-value
stic N = 110 1
N = 109 1
N = 113 1
N = 120 1
N = 119 1

Occupation, <0.001
n (%)

Unemploye 18 (3.2%) 8 (7.3%) 4 (3.7%) 1 (0.9%) 0 (0.0%) 5 (4.2%)

d

Student 55 (9.6%) 11 (10.0%) 19 (17.4%) 6 (5.3%) 0 (0.0%) 19 (16.0%)

Self- 468 (82.0%) 87 (79.1%) 83 (76.1%) 98 (86.7%) 120 (100.0%) 80 (67.2%)

employed

Govt 30 (5.3%) 4 (3.6%) 3 (2.8%) 8 (7.1%) 0 (0.0%) 15 (12.6%)

Location, n <0.001
(%)

Rural 318 (55.7%) 46 (41.8%) 66 (60.6%) 49 (43.4%) 81 (67.5%) 76 (63.9%)

Urban 253 (44.3%) 64 (58.2%) 43 (39.4%) 64 (56.6%) 39 (32.5%) 43 (36.1%)

Presence of <0.001
concrete
housing
walls, n
(%)

Yes 499 (87.4%) 100 (90.9%) 94 (86.2%) 107 (94.7%) 91 (75.8%) 107 (89.9%)

No 72 (12.6%) 10 (9.1%) 15 (13.8%) 6 (5.3%) 29 (24.2%) 12 (10.1%)

38
4.2Water, Sanitation and Hygiene Access among study participants

The examination of water and sanitation-related characteristics across

communities, as presented in Table 2, reveals noteworthy variations with

statistically significant differences. Access to water sources exhibits

significant disparities across communities (p < 0.001), with Ilaporu having

the highest percentage of individuals with access (100.0%), closely followed

by Ijebu-Igbo (95.6%) and Oru (94.5%). Significant differences are

observed in the source of water (p < 0.001), with Ilaporu relying more on

tap water (42.9%) and Mamu on boreholes (30.0%). Variations in water

sources underscore the diverse infrastructure in different communities. The

type of toilet facility varies significantly among communities (p < 0.001),

with Ilaporu having the highest percentage using water closets (93.3%),

while Oru and Ago-Iwoye have higher proportions relying on pit toilets

(7.3% and 10.1%, respectively). Mamu stands out with a higher percentage

using bush toilets (14.2%). Cleanliness of toilet facilities also shows

significant differences (p < 0.001), with Ilaporu having the highest

percentage reporting always clean facilities (83.2%), while Ago-Iwoye has a

higher proportion reporting cleanliness only once in a while (20.2%). These

findings emphasize the need to consider water and sanitation characteristics

in community-specific health interventions and strategies.

39
Table 2: Water, Sanitation and Hygiene Access among study
participants

Ijebu-Igbo, Oru, Ago-Iwoye, N = Mamu, Ilaporu,

Characteristic N = 571 p-value
N = 110 1
N = 109 1
113 1
N = 120 1
N = 119 1

Have access to water source, n (%) <0.001

Yes 546 (95.6%) 104 (94.5%) 104 (95.4%) 112 (99.1%) 120 (100.0%) 106 (89.1%)

No 25 (4.4%) 6 (5.5%) 5 (4.6%) 1 (0.9%) 0 (0.0%) 13 (10.9%)

Source of water, n (%) <0.001

Tap 250 (43.8%) 64 (58.2%) 53 (48.6%) 54 (47.8%) 28 (23.3%) 51 (42.9%)

Borehole 138 (24.2%) 24 (21.8%) 24 (22.0%) 22 (19.5%) 36 (30.0%) 32 (26.9%)

Handdug 103 (18.0%) 16 (14.5%) 10 (9.2%) 27 (23.9%) 34 (28.3%) 16 (13.4%)

Bottle 72 (12.6%) 6 (5.5%) 22 (20.2%) 10 (8.8%) 20 (16.7%) 14 (11.8%)

Stream/Others 8 (1.4%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (1.7%) 6 (5.0%)

Type of Toilet <0.001

facility, n (%)

water closet 491 (86.0%) 99 (90.0%) 98 (89.9%) 106 (93.8%) 77 (64.2%) 111 (93.3%)

pit 56 (9.8%) 8 (7.3%) 11 (10.1%) 5 (4.4%) 26 (21.7%) 6 (5.0%)

bush 24 (4.2%) 3 (2.7%) 0 (0.0%) 2 (1.8%) 17 (14.2%) 2 (1.7%)

Cleanliness of Toilet Facility, n (%) <0.001

Always 453 (79.3%) 91 (82.7%) 69 (63.3%) 103 (91.2%) 91 (75.8%) 99 (83.2%)

Once a while 50 (8.8%) 13 (11.8%) 22 (20.2%) 3 (2.7%) 6 (5.0%) 6 (5.0%)

Sometimes 68 (11.9%) 6 (5.5%) 18 (16.5%) 7 (6.2%) 23 (19.2%) 14 (11.8%)

40
4.3 Hygienic attitudes and practices among study participants

The examination of hygiene practices across the surveyed communities, as

outlined in Table 3, reveals substantial variations in personal habits. The

practice of washing hands after using the toilet significantly differs across

communities (p < 0.001), with Ilaporu showing a notably lower percentage

of individuals engaging in this practice (85.7%). The method of washing

hands, whether with soap or water, demonstrates some variability, although

the difference is not statistically significant (p = 0.15). Additionally,

behaviors such as sucking fingernails (p = 0.25), biting fingernails (p =

0.006), walking barefooted (p = 0.009), and washing vegetables before

cooking (p = 0.41) display significant variations across communities.

Interestingly, the habit of washing hands before eating exhibits some

community-specific differences (p = 0.094), emphasizing the importance of

considering localized practices in public health interventions. These findings

underscore the need for community-tailored health education programs to

address specific hygiene behaviors, ultimately contributing to improved

public health outcomes.

41
Table 3: Hygienic attitudes and practices among study participants

Ijebu-Igbo, Oru, Ago-Iwoye, Mamu, Ilaporu,

Characteristic N = 571 1
p-value 2

N = 110 1
N = 109 1
N = 113 1
N = 120 1
N = 119 1

Wash hands after using the <0.001

toilet, n (%)

Yes 508 (89.0%) 97 (88.2%) 86 (78.9%) 104 (92.0%) 119 (99.2%) 102 (85.7%)

No 17 (3.0%) 2 (1.8%) 5 (4.6%) 2 (1.8%) 0 (0.0%) 8 (6.7%)

Sometimes 46 (8.1%) 11 (10.0%) 18 (16.5%) 7 (6.2%) 1 (0.8%) 9 (7.6%)

Wash hand 0.15

with, n (%)

soap 419 (75.8%) 81 (73.6%) 71 (68.3%) 92 (82.9%) 91 (75.8%) 84 (77.8%)

water 134 (24.2%) 29 (26.4%) 33 (31.7%) 19 (17.1%) 29 (24.2%) 24 (22.2%)

Suck 0.25
fingernails, n
(%)

Yes 161 (28.2%) 24 (21.8%) 39 (35.8%) 31 (27.4%) 33 (27.5%) 34 (28.6%)

No 410 (71.8%) 86 (78.2%) 70 (64.2%) 82 (72.6%) 87 (72.5%) 85 (71.4%)

Bite 0.006
fingernails, n
(%)

Yes 350 (61.3%) 60 (54.5%) 56 (51.4%) 77 (68.1%) 86 (71.7%) 71 (59.7%)

No 221 (38.7%) 50 (45.5%) 53 (48.6%) 36 (31.9%) 34 (28.3%) 48 (40.3%)

Walk 0.009
barefooted, n
(%)

Yes 352 (61.6%) 57 (51.8%) 59 (54.1%) 81 (71.7%) 75 (62.5%) 80 (67.2%)

No 219 (38.4%) 53 (48.2%) 50 (45.9%) 32 (28.3%) 45 (37.5%) 39 (32.8%)

Wash vegetables before 0.41

cooking, n (%)

Yes 536 (93.9%) 104 (94.5%) 99 (90.8%) 107 (94.7%) 111 (92.5%) 115 (96.6%)

No 35 (6.1%) 6 (5.5%) 10 (9.2%) 6 (5.3%) 9 (7.5%) 4 (3.4%)

Wash hands before eating, n 0.094

(%)

Yes 519 (90.9%) 101 (91.8%) 99 (90.8%) 104 (92.0%) 114 (95.0%) 101 (84.9%)

No 52 (9.1%) 9 (8.2%) 10 (9.2%) 9 (8.0%) 6 (5.0%) 18 (15.1%)

42
43
4.4Knowledge and health-seeking patterns of study participants

The examination of health-related behaviors and knowledge across the

surveyed communities, outlined in Table 4, reveals significant disparities

with notable community-specific patterns. The awareness of Soil-

Transmitted Helminths (STH) varies significantly across communities (p <

0.001), with Ago-Iwoye showing the highest percentage of individuals

aware of STH (45.9%) and Ilaporu exhibiting the lowest (29.4%). The

nominal knowledge about specific STH species also demonstrates

significant differences across communities (p < 0.001), with Ilaporu having

a notably higher percentage of individuals lacking knowledge (55.3%). In

terms of health-seeking behaviors, the practice of visiting hospitals for

medical checkups differs significantly among communities (p = 0.004), with

Ilaporu having a lower percentage of individuals engaging in this behavior

(60.5%). Similarly, the history of having stool samples examined (p < 0.001)

and the usage of deworming medicine (p < 0.001) show significant

community-specific variations, highlighting the need for tailored health

interventions addressing distinct knowledge levels and behaviors across

communities.

44
Table 4: Knowledge and health-seeking patterns of study participants

Ijebu-Igbo, Oru, Ago-Iwoye, Mamu, Ilaporu,

Characteristic N = 5711
p-value 2

N = 110 1
N = 109 1
N = 113 1
N = 120 1
N = 119 1

Heard of STH, n <0.001

(%)

Yes 191 (33.5%) 32 (29.1%) 50 (45.9%) 15 (13.3%) 59 (49.2%) 35 (29.4%)

No 380 (66.5%) 78 (70.9%) 59 (54.1%) 98 (86.7%) 61 (50.8%) 84 (70.6%)

Nominal <0.001
knowledge about
STH species, n
(%)

Yes 89 (15.6%) 23 (20.9%) 32 (29.4%) 6 (5.3%) 0 (0.0%) 28 (23.5%)

No 166 (29.1%) 19 (17.3%) 14 (12.8%) 6 (5.3%) 120 (100.0%) 7 (5.9%)

Dont know 316 (55.3%) 68 (61.8%) 63 (57.8%) 101 (89.4%) 0 (0.0%) 84 (70.6%)

Ever visited 0.004

hospital for medical
checkup, n (%)

Yes 398 (69.7%) 78 (70.9%) 72 (66.1%) 94 (83.2%) 82 (68.3%) 72 (60.5%)

No 173 (30.3%) 32 (29.1%) 37 (33.9%) 19 (16.8%) 38 (31.7%) 47 (39.5%)

Ever had stool- <0.001

sample examined
before, n (%)

Yes 118 (20.7%) 16 (14.5%) 6 (5.5%) 30 (26.5%) 51 (42.5%) 15 (12.6%)

No 453 (79.3%) 94 (85.5%) 103 (94.5%) 83 (73.5%) 69 (57.5%) 104 (87.4%)

Ever used <0.001

deworming
medicine, n (%)

Yes 346 (60.6%) 52 (47.3%) 57 (52.3%) 75 (66.4%) 86 (71.7%) 76 (63.9%)

No 225 (39.4%) 58 (52.7%) 52 (47.7%) 38 (33.6%) 34 (28.3%) 43 (36.1%)

CHAPTER FIVE

45
 DISCUSSION

A number of studies have been conducted on the prevalence of soil-transmitted

helminths (STHs) in various regions of the world. In particular, several studies have

focused on the prevalence of STHs in the African region, where these parasites are

known to be highly endemic. It would be useful to compare the results of this study

with those from previous studies conducted in the African region, as well as other

regions of the world. This would help to better understand the global distribution of

STHs and identify areas where intervention is most needed.

In Nigeria, a study conducted in the South-Western region found a higher prevalence

of STHs (40.6%) than the current study (Ojo et al., 2018). This may be due to the fact

that the South-Western region has a tropical climate, which is more conducive to the

survival of STHs. Additionally, the South-Western region has a higher population

density and a lower standard of living, which can lead to increased rates of STH

infection. While the prevalence of STHs in Nigeria varies across regions, it is clear

that the parasites are a major public health problem in the country.

Furthermore, the current study found that the majority of microsporidia infections

were associated with Ascaris lumbricoides), whipworms (Trichuris trichiura), and

hookworms (Necator americanus and Ancylostoma duodenale). However, there were

no significant differences in the proportion of infection recorded across the LGAs.

These findings are consistent with the study by (Dada et al., 2020), which found high

prevalence rates of STH infection in Southwest Nigeria.

46
Overall, the results of this study suggest that STH infection is common in the study

area. Further research is needed to determine the epidemiology of STH infection in

different regions of Africa, as well as the potential impacts of this infection on the

health of humans. Understanding the prevalence and distribution of STH infection in

human is essential for developing effective control strategies and reducing the risk of

STH infection.

CONCLUSION

Based on the data analysis, my conclusion for Ijebu North, Nigeria, is that soil-

transmitted helminths are a significant public health concern in the area. High

prevalence rates were found. Given the health risks associated with STH infection,

there is a need for increased efforts to control and prevent these infections in Ijebu

North. This could include providing access to clean water and sanitation, promoting

good hygiene practices, and implementing mass deworming programs.

RECOMMENDATIONS

Based on my data analysis, I would recommend the following actions to control soil-

transmitted helminths in Ijebu North, Nigeria:

- Increased education and awareness-raising efforts on STH infection, including

correct knowledge on transmission, prevention, and treatment.

- Improved access to clean water, sanitation, and hygiene facilities.

- Mass deworming programs, particularly for school-aged children.

- Adequate monitoring and evaluation of control programs to ensure their

effectiveness.

47
-As for sanitation and hygiene, improving access to latrines and ensuring safe disposal

of human waste is key. This can be done through community-led initiatives.

48
 REFERENCES

Adegnika, A.A., Agnandji, S.T., Chai, S.K., Ramharter, M., Breitling, L., Kendjo, E.,
Issifou, S., Yazdanbakhsh, M., Kombila, Kremsner. Increased prevalence of
intestinal helminth infection during pregnancy in a Sub-Saharan African
community. Pub Med Journal. 119(712):716.

Adegnika, A.A., Lötsch, F., Maurin, R., Mba, O., Ramharter, M. (2015). Update on
Treatment and Resistance of Human Trichuriasis. Curr. Trop. Med. Rep.
218:223.

Albrecht, T., Boldogh, Fons, M. (2019). Cell activation signals and the pathogenesis
of human cytomegalovirus. Intervirology. PubMed. 31:68.

Antonio, Marco Albonico, Antonio Montresor, D., Crompton, Lorenzo Savioli.

(2022). Global burden of Soil -transmitted helminthiasis. National libary of
science. 61(311):348.

Ayalew, Jejaw, Zeleke, Abebe Genetu Bayih, John S. Gilleard. (2020). Treatment
efficacy and re-infection rates of soil-transmitted helminths. Tropical
Medicine and Health. 4:5.

Banoo, S., Bell, D., Bossuyt, P., Herring, A., Mabey, D., Poole, F., Smith, P.G.,
Sriram, N., Wongsrichanalai, C., Linke. (2017). Evaluation of diagnostic tests
for infectious diseases: General principles. Nat. Rev. Microbiol. 4(21):31.

Bethony, J., Brooker, S., Albonico, M.,Geiger, S.M., Loukas, A., Diemert, D., Hotez.,
P.J. (2016). Soil-transmitted helminth infections. Ascariasis, trichuriasis, and
hookworm. Lancet. 367(1):521–1532.

Booth, M., Vounatsou, P., Goran, E., Tanner, M., Utzinger. (3013). The influence of
sampling effort and the performance of the Kato-Katz Technique in diagnosing
Schistosoma mansoni and Hookworm co-infections. Parasitology.
127(525):531.

Brady, M.A., Hooper, P.J., Ottesen, E.A. (2016). Projected benefits from integrating
NTD programs in sub-Saharan Africa. Trends Parasitol. 22(285):291.

Brooker, S., Clements, A.C.A., Bundy, D.A.P. (2016). Global epidemiology, ecology
and control of soil-transmitted helminth infections. Adv. Parasitol.
62(221):261.

49
Charles, William, Morris.International encyclopedia of unified science. The Lacent.
1:59.

Deepthi Kattula, Rajiv Sarkar, Sitara Swarna Rao Ajjampur, Shantidani Minz, Bruno
Levecke, Jayaprakash Muliyil, Gagandeep Kang. (2014). Symptoms of Soil
transmitted helminths. The Lancent. 15:8.

Elise, M., O'Connell, Thomas B. Nutman. (2021). Molecular Diagnostics for Soil-
Transmitted Helminths. THE AMERICAN JOURNAL OF TROPICAL
MEDICINE AND HYGIENE. 95(3):508-513.

Elkins, M.H.D., Anderson, R.M. (2019). The influence of individual, social group
and household factors on the distribution of Ascaris lumbricoides within a
community and implications for control strategies. Parasitology. 98(125):34.

Fenwick, A. New initiatives against Africa’s worms. (2016). Trans. R. Soc. Trop.
Med. Hyg. 100(200):207.

Forman Erwin Siagian, Esy Maryanti. (2020). International Blood Research &
Reviews. The Lacent. 11(3):34-47.

Gilles, H.M. (2020). Selective Primary Health Care: Strategies for Control of
Disease in the Developing World. Hookworm Infection and Anemia. Rev.
Infect. 7:(11)8.

Goodman, D., Haji, H.J., Bickle, Q.D., Stoltzfus, R.J., Tielsch, J.M., Ramsan, M.,
Savioli, L., Albonico. (2017). A comparison of methods for detecting the eggs
of ascaris, trichuris, and hookworm in infant stool, and the epidemiology of
infection in zanzibari infants. Trop. Med. Hyg. 76(725):731.

Hallen, Trop, Den, Kul, Piee, J., Mopeln, Thosh. (2017). Future plan to eliminate soil
transmitted helmiths. Science med journal. 14(6):45.

Ho Chul Ki, Jae Hoon Bae, Dong Hoon Shin. (2013). Historical study on factors
inducing soil-transmitted helminth infection among people of old Seoul City
during Joseon Dynasty. Korean Journal of Medical History. 22(1):89-132.

Hotez, Fenwick, Savioli, Molyneux, D. Rescuing the bottom billion through control
of neglected tropical diseases. The Lancet. 373(9674):1.

50
Jeffrey Bethony, Simon Brooker, Marco Albonico, Stefan, Geiger, Alex Loukas,
David Diemert, Peter, Hotez. (2016). Soil-transmitted helminth infections:
ascariasis, trichuriasis, and hookworm. The lancet. 3(1):58.

Keiser, J., Utzinger, J. (2018). Efficacy of Current Drugs Against Soil-Transmitted

Helminth Infections: Systematic Review and Meta-analysis. Pub Med Journal.
299(19):44.

Lammie, P.J., Fenwick, A., Utzinger, J.A. (2016). Blueprint for success: Integration
of neglected tropical disease control programmes. Trends Parasitol.
22(313):321.

Luciene, Mascarini, Serra. (2011). Prevention of Soil-transmitted Helminth Infection.

Journal of Global Infectious. 5:18.

Luciene, Mascarini, Serra. (2011). Prevention of Soil-transmitted Helminth Infection.

Journal of Global Infectious. 36(4):55.

Molyneux, D.H., Hotez, P.J., Fenwick, A. (2015). Rapid-Impact Interventions: How

a Policy of Integrated Control for Africa’s Neglected Tropical Diseases Could
Benefit the Poor. PLoS Med. 2:336.

Montresor, De Silva, Brooker Hotez, J., A., Engels, Savioli, L. (2017). Current
control for soil transmitted helmiths. Trends in parasitology. 19(12):547

Peeling, R.W., Smith, P.G., Bossuyt, P.M.M. (2016). A guide for diagnostic
evaluations. Nat. Rev. Microbiol. 4(2):6.

Pullan RL, Smith, L., Jasr Brooker. (2014). Global numbers of infection and disease
burden of soil transmitted helminth infections. Parasites & vectors. 7:37.

Pullan, R.L., Smith, J.L., Jasrasaria, R., Brooker, S.J. (2014). Global numbers of
infection and disease burden of soil transmitted helminth infections. Pub Med
Journal of Parasite Vectors. 7:37.

Pullan, RL., Smith, L., Jasr Brooker. (2014). Global numbers of infection and disease
burden of soil transmitted helminth infections. Parasites & vectors. 7:37.

Rachel, L., Pullan. (2021). Global numbers of infection and disease burden of soil
transmitted helminth infections. PubMed journal. 3(5):56-46.

Ridley, R.G. (2016). Recent diagnosis of soil transmitted helmiths. Nat. Rev.
Microbiol. 34:5.
51
Sakti, Nokes, Subagio Hertanto, Hendratno, Hall, Bundy, D.A., Satoto. (2019). P.
Evidence for an association between hookworm infection and cognitive
function in school children. Trop. Med. Int. Health. 4(3)22:334.

Subhash Chandra Parija, Meenachi Chidambaram, Jharna Mandal. (2017).

Epidemiology and clinical features of soil-transmitted helminths. PubMed.
7(2):81–85.

Sumeeta Khurana, Shveta Sethi. (2017). Laboratory diagnosis of soil transmitted

helminthias. National libary of science.

World Health Organisation: Geneva, Switzerland. (2013). Prevention and Control of

Schistosomiasis and Soil-Transmitted Helminth. Report of a WHO Expert
Committee. 1:57.

World Health Organization (2022). Investing to Overcome the Global Impact of

Neglected Tropical Diseases, Third WHO Report on Neglected Diseases.
World Health Organisation Press.

World Health Organization, Geneva, Switzerland. (2017). Preventive Chemotherapy

to Control Soil-Transmitted Helminths Infections in at Risk Population
Groups. World Health Organisation (WHO). Guideline

World Health Organization. (2022). New guideline for the control and elimination of
soil transmitted helmiths. WHO.

World Health Organization. (2015). Investing to overcome the global impact of

neglected tropical diseases. WHO.

World Health Organization. (2015). Investing to overcome the global impact of

neglected tropical diseases. WHO.

World Health Organization. (2015). Neglected Tropical Diseases. WHO.

World Health Organization. (2015). Prevention and Control of Schistosomiasis and

Soil-Transmitted Helminthiasis. WHO-UNICEF joint statement.

World Health Organization. (2022). New guideline for the control and elimination of
human schistosomiasis. WHO.

World Health Organization. (2023). Soil transmitted helmith. WHO.

52
Yao-Dong, Wang Xian-Wei, Yang Xiao-Feng, Ma Wen-Jun, Ai Hui, Wu Xiao-Xuan.
(2013). Impacts of Climate Change on STH infection. Science Direct Journal.
4(6):57.

Yonas Alemu, Teshome Degefa, Mitiku Bajiro, Getachew, Teshome. (2022).

Prevalence and transmission of soil-transmitted helminths. Plos one journal.
9:22.

53
 OLABISI ONABANJO UNIVERSITY, AGO-IWOYE

DEPARTMENT OF ZOOLOGY AND ENVIRONMENTAL BIOLOGY

Please answer the following questions honestly as you would be taken as anonymous for your privacy. Thank
you.

SECTION A: DEMOGRAGHIC DATA OF PARTICIPANTS

1.Gender: Male ( ) Female ( •)
2.Age: ……
3.Educational status: Primary ( ) Secondary ( ) OND/HND ( ) B.Sc. ( • ) Postgraduate studies ( )
4.Occupation: Student ( • ) Unemployed ( ) Self-employed ( ) Government worker ( )
5. If self-employed, what is your occupation: …………………………………………….

SECTION B: Knowlegde, Attitude and Practices about Soil Transmitted Helminths (STH)
1. Have you heard about STH: Yes ( • ) No ( )

2. Describe your locality Rural ( • ) Urban ( )

3. In your locality, do you have access to water? Yes( • ) No ( )

4. What source of water do you use? Tap ( •) Hand dug ( ) Bottle Water ( ) Borehole ( ), Others (specify)
………..

5. What kind of house do you live in? Bungalow ( • ) Flat ( ) Mud House ( )

6. Is your house cemented or plastered; Yes (• ), No ( )

7. What type of toilet do you have in your house? Water Closet (• ) Pit Latrine ( ) Bush ( ), No toilet ( ),
Others (specify)………..

8. Number of people staying in the house 2 ( ) 3 ( ) 4 ( ) > 5 ( • )

9. How often do you maintain cleanliness of the restrooms

Always (• ) Sometimes ( ) Once In a while ( )

10. Do you wash your hand after using the toilet? Yes (• ) No ( ) Sometimes ( )

11. If yes, with what Water Only ( • ) Soap And Water ( )

12. Have you bitten your nails in the last 2 months Yes ( ) No ( • )

13. Have you sucked your fingers in the last 2 months Yes ( ) No ( •)

14. Have you walked barefooted in the last 2 months Yes ( • ) No ( )

15. Do you always wash fresh vegetables/fruits before cooking or eating Yes (• ) No ( )

16. Do you always wash your hand before eating Yes ( • ) No ( )

17. Is there any hospital around your locality Yes (• ) No ( )

54
 18. If yes, how far is the Hospital? Walking Distance ( • )An Hour Drive ( ) Few Minutes By Car ( )

19. Do you visit private hospitals? Yes ( ) No ( )

20. Do you visit public hospitals Yes ( ) No ( pp)

21. Have you ever visited any of the hospital for check-up Yes ( ) No ( )

22. Have you had a stool examination for parasitic infection in the past six months? Yes ( ) No (• )

23. Have you used any deworming drugs in the past six month Yes ( • ) No ( )

24. Do you have any pet or animals around? Yes ( • ) No ( )

25. If yes, do you touch the pets around Yes ( ) No ( • ) Sometimes ( )

26. Do you wash your hands after touching the pets Yes( ) No ( ) Sometimes ( )

27. List the names of STH that you are familiar with ___________roundworms (Ascaris
lumbricoides), hookworms (Ancylostoma duodenale and Necator americanus), and
whipworms (Trichuris trichiura).
______________________________________________________________________________________
_______________________________________________

28. Do you know how STH diseases are transmitted? Yes ( • ) No ( )

29. If yes, how? ______________________

STH can be transmitted in a variety of ways, but the most common mode of transmission is

through contact with contaminated soil or water. STH eggs are passed in the feces of infected

people, and they can survive in the soil for a long time. When someone comes into contact with

the contaminated soil, the eggs can hatch and infect the person. This can happen through activities

like walking barefoot, gardening, or playing in the dirt. The eggs can also be ingested through

contaminated food or water.

55