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Knowledge, Attitude, and Beliefs of Communities and Health Staff about Echinococcus granulosus Infection in Selected Pastoral and Agropastoral Regions of Uganda.

1. Introduction

According to World Health Organization (WHO) [1] 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. [2]). 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. [3]). High prevalence of CE has equally been reported in livestock (Chamai et al. [4] and Magambo et al. [5]) and in dogs (Inangolet et al. [6] and Oba et al. [7]). 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. [8]).

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. [9]). 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. [10]). 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. [10]). 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. [11]). 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 [12].

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. [5]), livestock (Chamai et al. [4]), and dogs as previously reported (Inangolet et al. [6] and Oba et al. [7]). 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. [6]) 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 [13]) 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) [14]. 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 [15]. Odds ratios and 95% confidence intervals were computed. A p value of 0.05 was considered statistically significant.

3. Results

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.

5. Discussion

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 [12]. 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. [16] 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. [3]). This finding is in agreement with the study by Li et al. [17], 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. [18] 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. [19]). 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. [20] 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. [3]), 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. [21] 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. [3]). Our findings are in agreement with a study by Reyes et al. [10], 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. [22] 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. [23] 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. [9] 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 [24] 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. [16]. 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. [27], 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. [7] 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.


https://doi.org/ 10.1155/2018/5819545

Data Availability

Data is available in hard copies and can be accessed on request.

Ethical Approval

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).

Consent

Informed consent was obtained from all the participants before they were involved in the study.

Disclosure

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.

Authors' Contributions

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.

Acknowledgments

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.

References

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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; liajd17@gmail.com

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
Article Type:Survey
Date:Jan 1, 2018
Words:7018
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