Knowledge, Attitude, and Beliefs of Communities and Health Staff about Echinococcus granulosus Infection in Selected Pastoral and Agropastoral Regions of Uganda.
According to World Health Organization (WHO)  cystic echinococcosis (CE) is a neglected zoonotic infection found throughout the world and is associated with high morbidity and mortality in poor resource countries especially in pastoral communities in Africa (Macpherson et al. ). In Uganda, the prevalence of CE has been found to vary between pastoral and agropastoral communities, with pastoral communities being at higher risk than agropastoral communities (Othieno et al. ). High prevalence of CE has equally been reported in livestock (Chamai et al.  and Magambo et al. ) and in dogs (Inangolet et al.  and Oba et al. ). Cystic echinococcosis is caused by a species of Echinococcus, namely, Echinococcus granulosus, whose definitive hosts are the carnivores such as dogs. Usually dogs become infected with Echinococcus granulosus by eating infected internal organs such as liver and lungs from dead animals that contain tape worm embryos. The dogs pass out tapeworm eggs in their stool, which can cause infection in other animals and/or in humans who accidentally swallow the eggs. In humans, Echinococcus granulosus forms slow-growing cysts (called hydatid cysts) in different organs of the body which can be very difficult to remove or treat in some cases (Nahmias et al. ).
Increased awareness of zoonotic infections has been found to influence the management and control of these diseases. However, lack of adequate knowledge by the communities on echinococcosis transmission has been linked to wide spread of the disease within and outside the communities in sub-Saharan African countries (John et al. ). Similarly, lack of knowledge by health staff on the diagnosis and treatment of CE has been found to be associated with poor management and control of the disease (Reyes et al. ). This has therefore contributed to underdiagnosis and reporting of zoonotic diseases thus culminating into poor disease monitoring coverage and lack of clear interventions to address the burden of zoonotic diseases (Reyes et al. ). An adequate information on knowledge, attitudes, and beliefs about echinococcosis by communities is therefore vital for them to play an important public health role (Otupiri et al. ). In addition, training of the health workers on the use of ultrasound for early diagnosis of CE is paramount. In Uganda, studies on the knowledge, beliefs, and attitudes of the communities and health workers about CE are scanty. It was against this background that this study was designed to determine the knowledge, attitudes, and beliefs of communities and health staff about echinococcosis infection in selected pastoral and agropastoral regions of Uganda.
2. Materials and Methods
2.1. Study Design. This was a descriptive cross-sectional survey conducted from July 2012 to January 2014.
2.2. Setting. The study comprised pastoral region of Northeastern and agropastoral regions of Eastern and Central Uganda. The districts of Nakapiripirit, Amudat, Moroto, and Napak were randomly selected in Northeastern region, while the districts of Kumi and Bukedea were selected in Eastern region. Nakasongola district was selected in Central region. The details of the regions is as shown in Figure 1 .
The selection of these regions was based on the predominance of the pastoral production system (Karamoja subregion) or mixed crop-livestock production systems (Eastern and Central subregions), where there is a high prevalence of CE in humans (Magambo et al. ), livestock (Chamai et al. ), and dogs as previously reported (Inangolet et al.  and Oba et al. ). These are remote, hard to reach communities with poor health infrastructure and with no specific control programs for CE.
2.3. Study Population. It comprised communities and health staff. Only the nurses and paramedical staff from Health Centers IVs were identified to avoid bias because they all had the same level of education background.
The prevalence of 66.3% of echinococcosis which was found in dogs (Inangolet et al. ) was used for the determination of the sample size for KAPs. It was assumed that the prevalence of echinococcosis in dogs would reflect the same prevalence of echinococcosis in humans, since the dogs are the primary hosts. The sample size calculation was then done using the equation of Kish and Leshlie (Kirkwood ) for proportions in cross-sectional studies.
n = ([Z.sup.2]/[d.sup.2])PQ, where Z is the value of 1.96 (Z in normal distribution curve), n is the required sample size, p is the estimated prevalence of CE, Q = 100-P, and d is the required precision (5%). Using this equation, a total sample size of 1,200 individuals in all the regions was therefore computed. However, we interviewed a total of 1,235 respondents.
2.4. Data Collection Procedure. Pretested structured questionnaires were used to generate information from eligible participants. Community participants were conveniently mobilized with the assistance of the elders and local leaders and brought to trading centers which had been identified for interviews. Random sampling procedure was then used to select community respondents. The names of the respondents were written in small chits of paper and then folded. Names of those to be interviewed were then randomly picked. The health staffs were consecutively recruited from their health facilities. Participation was limited to those voluntarily willing to take part in the study. All the participants were interviewed after seeking their consent.
2.5. Data Analysis. The data were entered and analyzed using software package for social sciences 10.0 (SPSS 10.0) . The statistical differences between respondents on the knowledge, attitude, and beliefs about echinococcosis were compared using open source epidemiologic statistic soft ware program for public health version 2.2.1 (OPENEPI) using 2 x 2 contingency tables . Odds ratios and 95% confidence intervals were computed. A p value of 0.05 was considered statistically significant.
3.1. Sociodemographic Characteristics (Distribution) of Respondents. A total of 421 respondents were identified and interviewed in Northeastern region, 405 from Eastern region, and 409 from Central region, giving a total of 1,235 respondents, which was 2.9% a little more than the calculated sample size of 1,200. A total of 75 health workers were interviewed in all the regions giving an overall total of 1310 participants. A total of 720 males and 590 females were interviewed. 291 respondents from Northeastern region had informal education, 167 from Eastern region, and 187 from Central region. Their ages ranged between 18 and 80 years giving mean age of 49 years. The details of the sociodemographic characteristics are as shown in Table 1.
3.2. Community Knowledge about CE. The results showed that 60.8% of the respondents in Northeastern region (NE) were aware of CE infection compared with 24.2% in Eastern (OR 4.9, CI: 2.58-9.57, and p < 0.001) and 21.3% in Central regions (OR 5.8, CI: 3.0-11.6, and p < 0.001). A significant difference was observed in the proportion of respondents who had heard of CE infection between Central and Eastern (E) region (OR 1.62, CI: 1.13-2.33, and p < 0.005). No differences were observed between Northeastern (NE) and E or between NE and Central region (p > 0.05). Notably, 91.4% of the respondents from Northeastern region claimed to have seen patients with CE signs compared with 23.4% and 19.5% from Eastern and Central region, respectively (OR 42.88; CI: 21.94-87.44; p < 0.001). None knew his/her CE status. The details are shown in Table 2.
The results in Table 2 show that respondents in Northeastern region were nearly five times more likely to have heard about CE than those in Eastern region (OR = 4.9).
3.3. Knowledge of Communities about CE Infection according to the Level of Education. Notably, there was no statistical difference in the awareness about CE between the respondents with informal and primary education in Northeastern and Central regions (p > 0.05). Similarly, there was no statistical difference in the awareness about CE between the respondents with secondary and tertiary education in all the regions of Uganda (p > 0.05%). However, the respondents with secondary and tertiary education were more aware about CE infection than those with informal and primary education in all the regions (p < 0.001). The details are as shown in Table 3.
The findings in Table 3 show that although there was high statistical difference between respondents with low and high level of education in the regions because of the differences in numbers, it is most unlikely that persons with high level of education would be more aware of CE than those with low level of education (OR less than 1).
3.4. Knowledge of Communities about CE Infection according to Sex. There was no statistical difference in the awareness about CE between male and female respondents in all the study regions (p > 0.05).
3.5. Health Workers Knowledge about Echinococcosis. Ninety percent of the health staff from Northeastern region and 96.2% and 93.1% from Eastern and Central regions, respectively, were aware of CE (p > 0.05). 57.7 percent of the health staff from Eastern region claimed to have seen patients with CE compared with 80.0% from Northeastern region (p < 0.05).
None of the health staffs knew how to screen for CE and knew his/her CE status. The details are shown in Table 4.
Although the results in Table 4 show that there was no statistical difference between health workers in all the study regions as far as their level of knowledge about CE was concerned, respondents from Northeastern region were nearly two times more likely to see tape worm than those from Central region (OR = 2.07).
3.6. Attitudes of the Communities towards the Screening and Treatment for Cystic Echinococcosis. 32.1% of the community participants from Northeastern region and 35.0% from Central region had a positive attitude towards going to hospital for treatment compared with 60.5% from Eastern region (p < 0.001). Twenty percent (19.8%) from Eastern region had positive attitude towards visiting witch doctors for treatment compared to 62.0% and 60.4% of the respondents from Northeastern and Central region, respectively (OR 6.61; CI: 4.81-9.81; p < 0.001 and OR 6.18; CI: 4.52-8.48; p < 0.001, resp.). The details are shown in Table 5.
The results in Table 5 show that respondents in Northeastern and Central regions were six times more likely to visit witch doctor for CE treatment than those from Eastern region (OR = 6.61and6.18, resp.). The results also show that although more respondents from Eastern region preferred hospital treatment for CE to witchcraft than those from Northeastern region, which was statistically significant, the likelihood that respondents from Eastern region would go to hospital was very low (OR less than 1).
4. Attitudes of the Health Staff towards the Screening and Treatment for Cystic Echinococcosis
There was no statistical difference between the health staff in all the study regions as far as their attitude towards echinococcosis screening and treatment was concerned (p > 0.05).
4.1. Beliefs of the Communities about Cystic Echinococcosis. The study showed that 36.7% of the community respondents from Northeastern region and 15.3% from Eastern region believed that drinking raw milk and eating raw meat causes CE (OR 3.3; CI: 1.81-6.16; p < 0.00). 43.9% of the respondents from Eastern and 28.7% from Central region believed CE is caused by sharing shelter with animal compared to 11.7% from Northeastern region (p < 0.001). Similarly, 31.3% of the respondents from Northeastern region believed CE is caused by witchcraft compared with 14.3% from Eastern region (OR 2.72; CI: 1.46-5.10; p < 0.001). Less than 3.4% of the respondents in all the regions believed CE is caused by eating food contaminated by dog fecal. The rest of the details are shown in Table 6.
The results in Table 6 show that respondents in Northeastern region were three times more likely to believe that CE is caused by drinking raw milk than those from Eastern region (OR = 3).
4.2. Beliefs of the Health Workers about Cystic Echinococcosis. There was no statistical difference in the beliefs about CE infection between the health workers in all the regions (p > 0.05).
4.3. Sources of Information of the Communities about Cystic Echinococcosis. Their main sources of information of the communities in all the regions about echinococcosis in descending order were traditional healers, elders in community and health workers, and hospitals/health centers.
4.4. Sources of Information of the Health Workers about Cystic Echinococcosis. Their main sources of information of the health staff in all the regions about echinococcosis in descending order were fellow health workers, hospitals/health centers, community, and traditional healers.
This study was conducted to determine the knowledge gaps, beliefs, and attitudes of the communities and health workers about echinococcosis infection in pastoral region of Northeastern and agropastoral regions of Eastern and Central Uganda . There was variability in the awareness, attitudes, and beliefs about CE among the respondents in the study regions. Our study found the pastoral communities in Northeastern communities to be more aware of CE than the agropastoral communities in Eastern and Central regions. However, this finding is not in agreement with the a study by Nyakarahuka et al.  which found awareness about CE in pastoral communities of Kasese in Western region to be low. The higher awareness about CE in pastoral communities noted in Northeastern region was probably influenced by the high prevalence of 3.9% of CE among the communities in this region as compared to 1.2% in Eastern and 2.7% in Central region (Othieno et al. ). This finding is in agreement with the study by Li et al. , which noted that awareness about CE was high in areas that were endemic for CE. This could also be one of the likely reasons why most of the communities in Northeastern region claimed to have seen more persons with CE signs than those from Eastern and Central regions, which is in conformity with the study by Craig et al.  which found that communities where the prevalence of CE is high were more likely to come across persons with CE.
Although there was no statistical difference in the knowledge ability about tape worm between respondents from Eastern region and Central region and between Central region and Northeastern region concerned, the likelihood that respondents from Eastern region would know about CE worm would be higher than those from Central region (OR 2.28, p < 0.354) (Table 2). Similarly, the likelihood that respondents from Northeastern region would know about CE worm would be higher than those from Central region, respectively (OR 1.19, p < 0.878) (Table 2). There was little variation in the way the CE tapeworm was locally called among the respondents who claimed to know CE tape worm. Those from Northeastern and Eastern regions were all calling it "ecidait" generally meaning a worm. This is probably because communities from these regions shared the same migration (Okwi et al. ). Those respondents from Central region called it "enfana" also generally meaning worm.
While the findings of this study (Table 3) are in conformity with the study by Omadang et al.  which noted that the level of awareness increased with level of education, this study found that respondents from NE region, with high CE prevalence (Othieno et al. ), were more likely to be more aware of CE than those from Eastern and Central regions of low prevalence regardless of their level of education.
Notably, it was found that the difference in the awareness between male and female respondents in all the regions was marginal. This agrees with the study by Omrani et al.  which noted there was no statistical significance in the awareness about CE between males and females in the same study population.
Whereas the health respondents in all the study regions were aware that CE can be screened and treated in hospital; surprisingly, none knew how to screen for CE and none had participated in the screening exercise for CE. This probably explains why none of the health workers and community members had been screened for CE and knew his/her CE status in spite of the fact that CE cases are present in these regions (Othieno et al. ). Our findings are in agreement with a study by Reyes et al. , which found that lack of knowledge of the health workers on the use of ultrasound for detection of CE was a likely major contributor of endemicity of CE since they are not treated. This was also noted by Nasrieh et al.  study, which observed that lack of knowledge of the health workers on the use of ultrasound for detection of echinococcosis was probably association with the spread of the disease in the community. A similar study by Dawit et al.  found lack of understanding about CE detection by health professionals was associated with poor management, control of CE, and high transmission of CE in the communalities, since those with the disease were not being detected and treated. These observations are equally in agreement with a study by John et al.  which showed that lack of adequate knowledge by health workers on echinococcosis detection was associated with poor management and high prevalence of echinococcosis in sub-Saharan African countries.
The majority of the community respondents preferred going to witch doctors for treatment for CE. This is probably because none the health staff in these regions knew how to screen for CE (Tables 4 and 5). Our findings tally with the study by Karim  which noted that members of the communities were often seeking treatment for CE from traditional healers due to poor provision of health care.
Respondents in the study regions had divergent beliefs about the causes of CE. The majority of the community participants in all the study regions believed CE is caused by drinking raw milk and eating raw meat. Few of the participants believed that CE is punishment from God and is due to witchcraft which was in conformity with the study by Nyakarahuka et al. . While a study by Acosta-Jamett et al. [25, 26] found dog fecal as a risk factor for CE in Chile, most of the community respondents in this study did not believe that eating dog fecal-contaminated food was the key mode of CE transmission. This is in agreement with the findings by El Berbri et al. , which showed that most of the respondents had poor beliefs about the role of a dog in CE transmission. The same observation was made by Oba et al.  study, which found that most respondents had poor knowledge of CE transmission.
The main sources of information about CE infection among the communities in all the study regions were found to be traditional healers. This probably explains why most of the respondents in Northeastern and Central regions believed that CE is caused by witchcraft and were inclined towards traditional healers (witch doctors) for health services (Table 5).
6. Limitations of the Study
The participants were not interviewed from the households because some of these communities especially pastoral communities do not have permanent houses since they continuously move from one place to the other in such pasture. Participants' responses of CE disease were limited to only physical observations of CE signs and thus subjective interpretations of CE could have introduced errors in the study.
7. Conclusions and Recommendations
Communities in Northeastern region were more aware of CE than those from Eastern and Central regions, respectively. The majority of the communities in all regions were not aware that CE can be treated in hospital and can be caused by eating food contaminated by dog fecal. None of the health staff was screening for CE and none of the community respondents including health workers had been screened for CE. Sensitizing the communities about CE and its detection and treatment is cardinal to the prevention and control of CE. There is also need to train the health staff preferably radiographers on the use of ultrasound for detection of CE and have these services established at referral health facilities.
Abbreviations MoH: Ministry of Health ERC: Ethics and Research Committee MUCVM: Makerere University College of Veterinary Medicine EC: Ethical Council DHO: District Health Officer CAO: Chief Administrative Officer DVO: District Veterinary Officer LCs: Local Councils.
Data is available in hard copies and can be accessed on request.
The permission to carry out this study and disseminate its findings was obtained from the Ministry of Health (MoH) Ethics and Research Committee (ERC) and Makerere University College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) Institutional Review Board (IRB).
Informed consent was obtained from all the participants before they were involved in the study.
Field activities clearance was sought from the District Health Officer (DHO), the Chief Administrative Officer (CAO), District Veterinary Officer (DVO), and Village Local Councils (LCs). All the data that was generated was treated with highest level of confidentiality.
Conflicts of Interest
The authors affirm that they have no conflicts of interest.
Emmanuel Othieno designed the study, collected data from the field, managed and analyzed it, and participated in manuscript development and revision. Andrew Livex Okwi was responsible for study design, field data collection and data analysis, manuscript development, and reading of manuscript. Ezekiel Mupere was responsible for study design and manuscript reading. Peter Oba was responsible for study design, data analysis, and manuscript revision. Leonard Omadang was responsible for study design and manuscript revision. Michael Ocaido developed overall CE study concept, participated in study design, collected field data, and analyzed and revised data. All authors have read and approved the final manuscript.
The authors would like to acknowledge the contributions of the following: Ludwing Siefert, Eberhard Zeyhle, and District Health Officers, in charges of health centres, and District Veterinary Officers in the districts visited.
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Emmanuel Othieno, (1) Michael Ocaido, (2) Ezekiel Mupere, (3) Leonard Omadang, (2) Peter Oba, (2,4) and Andrew Livex Okwi (iD) (1)
(1) Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
(2) Department of Wild Life, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University P.O. Box 7062, Kampala, Uganda
(3) Department of Pediatrics, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
(4) National Agricultural Research Organization, Abi Zonal Agricultural Research and Development Institute, P. O. Box 219, Arua, Uganda
Correspondence should be addressed to Andrew Livex Okwi; firstname.lastname@example.org
Received 20 September 2017; Revised 21 February 2018; Accepted 29 March 2018; Published 13 May 2018
Academic Editor: Jose F. Silveira
Caption: FIGURE 1: Map of Uganda showing the selected study regions.
TABLE 1: Sociodemographic characteristics (distribution) of respondents. Variable Category Northeastern Eastern Number (%) Number (%) Community Respondents 421 34.1 405 32.8 Health staff 20 26.7 26 34.7 Age (years) Below 18 54 32.1 65 38.7 21 to 40 233 33.5 224 32.2 41 to 60 31 33.6 123 31,5 60 to 80 23 40.4 19 33.3 Sex Male 180 25.0 291 40.4 Female 261 42.2 140 23.7 Education Informal 291 45.3 167 25.9 level Primary 125 24,6 200 39.3 Secondary 20 18.9 36 34.0 Tertiary 5 9.6 28 53.9 Variable Category Central Totals Number (%) Community Respondents 409 33.1 1235 Health staff 29 38.6 75 Age (years) Below 18 49 29.2 168 21 to 40 238 34.2 695 41 to 60 136 34.9 390 60 to 80 15 26.3 57 Sex Male 249 34.6 720 Female 189 32.0 590 Education Informal 185 28.8 643 level Primary 184 36.1 509 Secondary 50 47.2 106 Tertiary 19 36.5 52 TABLE 2: Knowledge level of communities about CE infection in humans. Knowledge Region Response attribute Yes (n) (%) No (n) % Heard of CE Northeastern 256 60.8 165 39.2 Eastern 98 24.2 307 75.8 Northeastern 256 60.8 165 39.2 Central 87 21.3 322 78.7 Eastern 98 24.2 307 75.8 Central 87 21.3 322 78.7 Only for those aware of CE Known a CE Northeastern 7 1.7 249 98.3 tapeworm Eastern 5 5.1 93 94.9 Northeastern 7 2.7 249 98.3 Central 2 2.3 85 97.7 Eastern 5 5.1 93 94.9 Central 2 2.3 85 97.7 Had seen Northeastern 234 91.4 22 8.6 patients with Eastern 23 23.5 75 76.5 CE signs Northeastern 234 91.4 22 8.6 Central 17 19.5 70 80.5 Eastern 23 23.4 75 76.5 Central 17 19.5 70 80.5 Knowledge Region Total OR 95% CI p value attribute Heard of CE Northeastern 421 4.85 3.60-6.60 0.001 ** Eastern 405 Northeastern 421 5.73 4.22-7.82 0.001 ** Central 409 Eastern 405 1.18 0.85-1.64 0.321 Central 409 Only for those aware of CE Known a CE Northeastern 256 0.52 0.16-1.84 0.295 tapeworm Eastern 98 Northeastern 256 1.19 0.26-8.53 0.878 Central 87 Eastern 98 2.28 0.44-17.32 0.354 Central 87 Had seen Northeastern 256 34.06 18.22-65.94 0.001 ** patients with Eastern 98 CE signs Northeastern 256 42.88 21.94-7.44 0.001 ** Central 87 Eastern 98 1.44 0.71-2.95 0.312 Central 87 Only for those aware Northeastern None Know their Eastern None CE status Central None NS = p > 0.05 not significant, p < 0.05 significant, ** p < 0.01 highly significant, and p < 0.001 very highly significant. OR = odds ratio and CI = confidence interval. TABLE 3: Knowledge of communities about CE infection according to the level of education. Region Number Heard about CE OR Yes (%) No (%) Northeastern (421) Informal 278 123 44.2 155 55.8 0.78 Primary 119 60 50.4 59 49.6 Informal 278 123 44.2 155 55.8 0.27 Secondary 19 15 78.9 4 21.1 Informal 278 123 44.2 255 55.8 0.20 Tertiary 5 4 80.0 1 20.0 Primary 119 60 50.4 59 49.6 0.21 Secondary 19 15 78.9 4 21.1 Primary 119 60 50.4 59 49.6 0.26 Tertiary 5 4 80.0 1 20.0 Secondary 19 15 78.9 4 21.1 0.94 Tertiary 5 4 (80.0) 1 20.0 Central (409) Informal 173 18 10.4 155 89.6 0.66 Primary 172 24 14.0 148 86.0 Informal 173 18 10.4 155 89.6 0.04 Secondary 46 34 73.9 12 26.1 Informal 173 18 10.4 155 89.6 0.03 Tertiary 18 14 77.8 2 22.2 Primary 172 24 14.0 148 86.0 0.06 Secondary 46 34 73.9 12 26.1 Primary 172 24 14.0 148 86.0 0.03 Tertiary 18 14 77.8 2 22.2 Secondary 46 34 73.9 12 26.1 0.79 Tertiary 18 14 77.8 4 22.2 Eastern (n = 405) 405 Informal 157 16 10.2 141 89.8 0.43 Primary 188 35 18.6 153 81.4 Informal 157 16 10.2 141 89.8 0.03 Secondary 34 26 76.5 8 23.5 Informal 157 16 10.2 141 89.8 0.01 Tertiary 26 23 88.5 2 11.5 Primary 188 35 18.6 153 81.4 0.07 Secondary 34 26 76.5 8 23.5 Primary 188 35 18.6 153 81.4 0.03 Tertiary 26 23 88.5 3 11.5 Secondary 34 26 76.5 8 23.5 0.69 Tertiary 26 23 88.5 3 11.5 Region 95% CI p value Northeastern (421) Informal 0.44-1.34 0.355 Primary Informal 0.14-0.50 0.001 Secondary Informal 0.10-0.37 0.001 Tertiary Primary 0.11-0.39 0.001 Secondary Primary 0.13-0.48 0.001 Tertiary Secondary 0.47-1.87 0.850 Tertiary Central (409) Informal 0.27-1.57 0.353 Primary Informal 0.03-0.12 0.001 Secondary Informal 0.01-0.11 0.001 Tertiary Primary 0.05-0.19 0.001 Secondary Primary 0.01-0.15 0.001 Tertiary Secondary 0.41-1.52 0.484 Tertiary Eastern (n = 405) Informal 0.20-0.92 0.001 Primary Informal 0.01-0.08 0.001 Secondary Informal 0.006-0.04 0.001 Tertiary Primary 0.04-.15 0.001 Secondary Primary 0.01-0.06 0.001 Tertiary Secondary 0.29-1.59 0.389 Tertiary NS = p > 0.05 not significant, p < 0.05 significant, p < 0.01 highly significant, and p < 0.001 very highly significant. OR = odds ratio; CI = csonfidence interval. TABLE 4: Knowledge of the level of the health workers about CE infection. Knowledge attribute Region Response Yes, n (%) No, n (%) Heard of CE Northeastern 18 (90.0) 2 (10.0) Eastern 25 (96.0) 1 (4.0) Northeastern 18 (90.0) 2 (10.0) Central 27 (93.1) 2 (6.9) Eastern 25 (96.2) 1 (3.8) Central 27 (93.1) 2 (6.9) Know a CE Tapeworm Northeastern 15 (75.0) 5 (25.0) Eastern 22 (84.6) 4 (15.4) Northeastern 15 (75.0) 5 (25.0) Central 21 (72.4) 8 (27.6) Eastern 22 (84.6) 4 (15.4) Central 21 (72.4) 8 (27.6) Had seen patients with Northeastern 16 (80.0) 4 (20.0) CE signs Eastern 15 (57.7) 11 (42.3) Northeastern 16 (80.0) 4 (20.0) Central 22 (75.9) 7 (24.1) Eastern 15 (57.7) 11 (42.3) Central 22 (75.9) 7 (24.1) Knowledge attribute Region Totals Heard of CE Northeastern 20 Eastern 26 Northeastern 20 Central 29 Eastern 26 Central 29 Know a CE Tapeworm Northeastern 20 Eastern 26 Northeastern 20 Central 29 Eastern 26 Central 29 Had seen patients with Northeastern 20 CE signs Eastern 26 Northeastern 20 Central 29 Eastern 26 Central 29 Knowledge attribute Region OR (95% CI) Heard of CE Northeastern 0.37 (0.12-5.15) Eastern Northeastern 0.67 (0.07-6.95) Central Eastern 1.83 (0.13-56.67) Central Know a CE Tapeworm Northeastern 0.69 (1.11-4.49) Eastern Northeastern 1.42 (0.30-7.92) Central Eastern 2.07 (0.45-11.27) Central Had seen patients with Northeastern 0.19 (0.02-0.96) CE signs Eastern Northeastern 1.80 (0.31-14.82) Central Eastern 0.35 (0.09-1.22) Central Knowledge attribute Region p value Heard of CE Northeastern 0.238 Eastern Northeastern 0.361 Central Eastern 0.341 Central Know a CE Tapeworm Northeastern 0.295 Eastern Northeastern 0.340 Central Eastern 0.354 Central Had seen patients with Northeastern 0.044 * CE signs Eastern Northeastern 0.273 Central Eastern 0.051 Central Only for those aware of CE Know how to screen for CE Northeastern None Eastern None Central None Know their CE status Northeastern None Eastern None Central None NS = p > 0.05 not significant, * P < 0.05 significant, OR = odds ratio, and CI = confidence interval. TABLE 5: Attitudes of the communities towards screening and treatment for CE infection. Attitude attribute Region Response Yes (n) % No (n) % Willingness to be Northeastern 182 71.1 74 28.9 screened (only those Eastern 70 71.1 28 28.6 aware of CE) Northeastern 182 71.1 74 28.9 Central 67 77.0 20 23.0 Eastern 70 71.1 28 28.6 Central 67 77.0 20 23.0 Prefer hospital Northeastern 135 32.1 286 67.9 treatment Eastern 245 60.5 160 40.0 Northeastern 135 32.1 286 67.9 Central 143 35.0 266 65.0 Eastern 245 60.5 160 40.0 Central 143 35.0 266 65.0 Go to witch doctors Northeastern 261 62.2 160 38.0 Eastern 80 19.8 325 80.2 Northeastern 261 62.0 160 38.0 Central 247 60.4 162 39.6 Eastern 80 19.8 325 80.2 Central 247 60.4 162 39.6 Attitude attribute Region Totals OR 95% CI Willingness to be Northeastern 256 0.98 0.58-1.68 screened (only those Eastern 98 aware of CE) Northeastern 256 0.73 0.14-1.29 Central 87 Eastern 98 0.73 0.51-1.29 Central 87 Prefer hospital Northeastern 421 0.31 0.23-0.41 treatment Eastern 405 Northeastern 421 0.89 0.66-1.17 Central 409 Eastern 405 2.85 2.14-3.79 Central 409 Go to witch doctors Northeastern 421 6.61 4.81-9.08 Eastern 405 Northeastern 421 1.07 0.81-1.47 Central 409 Eastern 405 6.18 4.52-8.48 Central 409 Attitude attribute Region p value Willingness to be Northeastern 0.477 screened (only those Eastern aware of CE) Northeastern 0.146 Central Eastern 0.146 Central Prefer hospital Northeastern 0.001 treatment Eastern Northeastern 0.189 Central Eastern 0.001 Central Go to witch doctors Northeastern 0.001 Eastern Northeastern 0.318 Central Eastern 0.001 Central NS = p > 0.05 not significant and p < 0.001 very highly significant. OR = odds ratio and CI = confidence interval. TABLE 6: Beliefs of the communities about cystic echinococcosis. Belief attributes Regional Response comparison Yes (n) % No (n) % Only those aware of Northeastern 96 37.5 160 62.5 CE CE is caused by Eastern 24 24.5 74 75,5 punishment from God Northeastern 96 37.5 160 62.5 Central 30 34.5 57 65.5 Eastern 24 24.5 74 75.5 Central 30 34.5 57 65.5 CE is caused by Northeastern 94 36.7 162 63.3 drinking raw milk Eastern 15 15.3 83 84.7 and eating raw meat. Northeastern 94 36.7 162 63.3 Central 31 35.6 56 64.4 Eastern 15 15.3 83 84.7 Central 31 35.6 56 64.4 CE is caused by Northeastern 80 31.3 176 68.7 witch craft Eastern 14 14.3 84 85.7 Northeastern 80 31.3 176 68.7 Central 45 51.7 42 48.3 Eastern 14 14.3 84 85.7 Central 45 51.7 42 48.3 CE is caused by Northeastern 30 11.7 226 88.3 sharing shelter with Eastern 43 43.9 55 56.1 animal Northeastern 30 11.7 226 88.3 Central 25 28.7 62 71.3 Eastern 43 43.9 55 56.1 Central 25 28.7 62 71.3 CE is caused by Northeastern 6 2.3 250 97.7 eating food Eastern 2 2.0 96 98.0 contamination by dog Northeastern 6 2.3 250 97.7 fecal Central 3 3.4 84 96.6 Eastern 2 2.0 96 98.0 Central 3 3.4 84 96.6 Belief attributes Regional OR 95% CI p value comparison Only those aware of Northeastern 1.85 1.10-3.17 0.019 CE CE is caused by Eastern punishment from God Northeastern 1.14 0.69-1.91 0.620 Central Eastern 0.51 0.26-0.98 0.043 Central CE is caused by Northeastern 3.3 1.81-6.16 0.001 drinking raw milk Eastern and eating raw meat. Northeastern 1.05 0.63-1.75 0.861 Central Eastern 0.32 0.15-0.66 0.001 Central CE is caused by Northeastern 2.72 1.46-5.10 0.001 witch craft Eastern Northeastern 0.43 0.26-0.70 0.001 Central Eastern 0.16 0.08-0.31 0.001 Central CE is caused by Northeastern 0.17 0.10-0.30 0.001 sharing shelter with Eastern animal Northeastern 0.33 0.18-0.61 0.001 Central Eastern 1.93 1.05-3.60 0.034 Central CE is caused by Northeastern 1.15 0.24-8.41 0.912 eating food Eastern contamination by dog Northeastern 0.67 0.16-3.36 0.597 fecal Central Eastern 0.59 0.10-3.58 0.593 Central NS = p > 0.05 not significant, p < 0.05 significant, p < 0.01 highly significant, and p < 0.001 very highly significant. OR = odds ratio; CI = confidence interval.
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|Title Annotation:||Research Article|
|Author:||Othieno, Emmanuel; Ocaido, Michael; Mupere, Ezekiel; Omadang, Leonard; Oba, Peter; Okwi, Andrew Live|
|Publication:||Journal of Parasitology Research|
|Date:||Jan 1, 2018|
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