Porcine Cysticercosis (PCC) and Human Cysticercosis (HCC)/Neurocysticercosis (NCC) are a burden to the community owing to the reduced value of animals, associated costs of treatment, decreased labour productivity and social discrimination. There is limited knowledge on the management and prevention of PCC and epilepsy in Iringa rural. Therefore, the present study aimed at assessing indigenous knowledge, practices, attitudes and social impacts of PCC and epilepsy in Iringa rural district. A total of 588 people participated in the survey whereby 306 were pig farmers, 223 non-pig farmers and 59 families with epileptic individuals. It was found that 49.8% ( χ 2 = 0.003, DF = 1, p = 0.954) of pig keepers were aware of PCC, whereas the remaining 50.2% were not aware ( χ 2 = 25.5, DF = 1, p < 0.001). The prevalence of late onset epilepsy was significantly higher (62.7%) than that of those who manifested seizures and convulsions in childhood 37.3% ( χ 2 = 3.814, DF = 1, p = 0.51). People in Iringa rural believe epilepsy is caused by evil spirits, witchcraft and/or inheritance. It was concluded that there was limited knowledge on T. solium cysticercosis and epilepsy. This ignorance is the cause of poor practices, negative beliefs and attitudes that negatively affect the social life of People with Epilepsy (PWE) in communities. This study recommends that health education to raise awareness on cysticercosis/taeniosis and epilepsy should be one of the intervention measures for elimination of cysticercosis and epilepsy in Iringa rural district.
Taenia solium cysticercosis and the associated public health and economic consequences are a growing problem in poor areas of Africa, Asia and Latin America where people eat pork and keep pigs in traditional ways [
Consequently, the lack of knowledge on the epidemiology of porcine and human cysticercosis leads to practices that encourage the transmission and persistence of Taenia solium [
Neurocysticercosis (NCC) refers to infection of the brain by the larval form of the pork tapeworm T. solium. It is a form of HCC and the main causes of late onset epilepsy. Epilepsy is a devastating clinical problem in communities where there is little education, high rates of poverty, and poor access to health care [
The study was carried out in the following villages: Kising’a, Igingilianyi, Ihominyi, Mikongw’i, Matembo, Ilambilole, Kihorogota, Igula, Ngano, Kiwere, Mfyome, Kipera, Nyamihuu, Nyang’oro, Chamdindi, Holo, Ikengeze, Mangawe, Malengamakali, Nyakavangala, Mkulula, Usolanga, Iguluba, Makadupa, Kibena, Muwimbi, Ifunda, Mibikimitali, Mfukulembe, Udumuka, Migoli and Mtera. These villages were selected from nine wards of Iringa rural district, Tanzania as per illustration in
The survey was carried out in the selected wards from July 2012 to August 2012. The households with pigs were randomly selected to participate in the study. The infection in pigs was inspected by lingual palpation and confirmed through postmortem examination. The questionnaire and interviews were used to collect data on risk factors for taeniosis, which was verified via direct observation.
The sample size estimation was calculated using the formula: n = Z2PQ/L2 [
1) Questionnaire administered to pig keepers.
The structured questionnaire had a range of questions including: time since started to raise pigs, ways of keeping pigs, awareness of PCC, transmission of T. solium cysticercosis to pigs, ways of prevention, the fate of affected pigs, clandestine (non-official) market, preference of eating pork, pork preparation methods, place of finding pork, hygienic and sanitary practices, how human acquire tapeworms.
2) Questionnaire administered to families with epileptic individuals and non-pig keepers.
The structured questionnaire comprised of a range of questions including; the age of epileptic individual; time since the epileptic signs manifested; symptoms; place of treatment, reasons for selecting type of treatment, awareness on the causes of epilepsy, means of transmission, means of prevention, knowing somebody with epilepsy, effects of epilepsy, segregation and discrimination to individuals and family members in marriage and reasons for segregation.
Data on indigenous knowledge, practices and beliefs were analyzed by the statistical package for social sciences version 19.0 for windows (SPSS Inc., Chicago , IL , USA ). The significance of parametric data was tested using t-test and non-parametric data were tested by using Chi-square analysis. P-value less or equal to 0.05 was considered to be significant. The 95% confidence interval was used in the present study (CI = 95%) for various factors at individual level.
A total of 306 pig keepers were surveyed during the study for the assessment of knowledge and practices on T. solium cysticercosis. About 49.8% (χ2 = 0.003, DF = 1, p = 0.954) of the pig farmers were aware of PCC, but among these only 33.7% knew that human faeces were the source of T. solium cysticercosis infection to pigs. About 50.2% (n = 306) believed that cysticercosis in pigs was caused by jiggers and mice. Thirty five percent (35%) of non-pig keepers were aware of pork tapeworms and 21.7% believed pork and vegetables or unwashed fruits as the source of taeniasis in humans. About 44.8% of the respondents mentioned “under the tongue” as the predilection site for cysts in pigs, 8.5% mentioned “under the skin and legs” and 46.8% did not know. Only 31.8% of pig keepers were able to detect (identify) cysts in live pigs. The general community’s awareness on the pork tapeworm was high (59.1%) but knowledge on transmission was low (35.0%) (χ2 = 25.5, DF = 1, p < 0.001). About 22.7% slaughtered pigs at home and sold uninspected pork. The majority of the surveyed population 89.8% (χ2 = 185.287, DF = 1, p < 0.001) eat pork; while 10.2% do not eat pork due to various reasons including allergy and religious beliefs (
A total of 282 participants responded to the questionnaire on the assessment of knowledge, practices and beliefs on epilepsy. About 54.7% (n = 276) of respondents knew somebody with epilepsy, but the majority were ignorant on the prevention measures for the epileptic condition 65.6 %, (χ2 = 41.362, DF = 1, p < 0.05). In Iringa rural 62.7% of the epileptic individuals had late onset (adulthood) epilepsy, whereas 37.3% developed seizure since childhood. When an individual showed epileptic symptoms, the hospital was the preferred place for treatment (56.9%), (30.4%) used traditional healer and 12.7% used both hospitals and traditional healing. The choice of treatment was mostly determined by family decision (80.8%) (χ2 = 88.615, DF = 1, p = 0.001) and the beliefs of the sufferer were slightly considered (19.2%).
Based on the responses of the surveyed population in Iringa rural, epilepsy is caused by different agents. About (38.2%) sited evil spirits and/or witchcraft as causes of epilepsy, 24% sited pork and other raw/under- cooked foods, 18% sited personal hygiene and 20.1% said it was inherited from parents. Over half (56.6%) of respondents believed epilepsy was transmitted from one person to another by sleeping with an epileptic individual, and 8.5% mentioned sex and contact with the saliva of epileptic patients during convulsions.
Epilepsy was reported by respondents to have various consequences on the health of the sufferers; physical discomfort was the most (67.5%) pronounced effect; other effects included falling (16.8%) and failure to work (15.7%). About 69.5% of epileptic people experienced headaches. In school children poor performance was the most sited (44.7%) effect, and being forced to drop from school was the least sited (15.4%) effect. About 73.7% of respondents considered epileptic individuals as disabled who needed close attention, while 65.3% reported that epileptic individuals were not allowed in community gatherings because of unpredictable attacks manifested by seizures, convulsions and personal discomfort. About 67.4% (n = 261) responded that family members did not segregate epileptic individuals but the segregation and discrimination arises during social functions. Both people with epilepsy (51.5%) and 48.5% of the other members of the family experience difficulties in getting married. In marriage, epilepsy was the source of quarrels (58.7%), and at sometimes caused divorce (12.2%) (
Indigenous knowledge (IK) is a set of perceptions, information and behaviours that guide members of particular community towards a certain way of living or behaving. It can be used in various sectors for instance in veterinary medicine with the intimate understanding of their environments [
Some pig farmers know that indiscriminate disposal of human faeces is central to the transmission of T. solium infection. Most of such farmers live along the main roads and were frequently visited by paravets. On the
Factors | Responses (%) |
---|---|
Knowledge on T. solium cysticercus (n = 299) | 49.8 |
Yes | 50.2 |
No | |
Possibility to see cysticercus in live pigs (n = 277) | |
Yes | 31.8 |
No | 68.2 |
Predilection sites for cysts in live pigs (n = 201) | |
Under skin | 8.5 |
Under the tongue | 44.8 |
Don’t know | 46.8 |
How human can get tapeworm (n = 198) | |
Through pork | 59.1 |
Without washing hands | 5.6 |
Contaminated food and water | 16.2 |
Don’t know | 9.2 |
Do you know anything about tapeworm (n = 283) | |
Yes | 35 |
No | 65 |
How pigs can be infected by T. solium cysticercosis (n = 288) | |
Human feaces | 33.7 |
Pigs feaces | 4.9 |
From pigs with larva | 12.8 |
Don’t know | 48.7 |
What do you do when your pig is infected with cysticercus (n = 260) | |
Selling pigs | 3.8 |
Giving the local medicine | 12.3 |
Destroying the larva | 8.1 |
Don’t know | 47.3 |
Other means | 28.5 |
Which methods are used to prevent cysticercosis infection in pigs (n = 280) | |
Using pigpen | 36.4 |
Local medicine | 3.6 |
Cleaning the environment | 30.4 |
Don’t know | 29.6 |
Have you ever diagnosed cysts in your pigs (n = 285) | |
Yes | 20.7 |
No | 79.3 |
Did you manage to sell your infected pigs (n = 59) | |
Yes | 35.1 |
No | 64.9 |
Do you prefer to slaughter pigs at your home (n = 295) | |
Yes | 22.7 |
No | 77.3 |
Do you prefer eating pork (n = 293) | |
---|---|
Yes | 89.8 |
No | 10.2 |
What type of preparation do you prefer most (n = 284) | |
Fried | 76.4 |
Boiled | 13.7 |
Roasted | 9.9 |
Where do you get pork (n = 274) | |
From known butcher | 54 |
From local clubs | 43.8 |
From people house | 2.2 |
Factors | Responses (%) |
---|---|
When did you start to suffer (n = 59) | |
Childhood | 37.3 |
Late onset | 62.7 |
Sudden falling (n = 173) | |
Yes | 91.3 |
No | 8.7 |
Health consequences of epilepsy (n = 203) | |
Falling and convulsion | 16.8 |
Physical discomfort | 67.5 |
Functional impairment | 15.7 |
Do you experience headache (n = 59) | |
Yes | 69.5 |
No | 30.5 |
The place epileptic patients seek treatment (n = 220) | |
Hospitals | 56.9 |
Traditional healer | 30.4 |
Both | 12.7 |
The reasons for the choice of a place for treatment (n = 277) | |
Family affordability of treatment cost | 80.8 |
Belief of the sick person | 19.2 |
Knowledge on causes of epilepsy (n = 267) | |
Evil spirits | 38.2 |
Food related | 24 |
Personal hygiene | 18 |
Inheritance from parents | 20.1 |
Knowledge on ways to prevent epilepsy (n = 294) | |
Yes | 29.4 |
No | 70.6 |
Do you know any other person with the disease (n = 276) | |
---|---|
Yes | 54.7 |
No | 45.3 |
Effects of epilepsy to education (n = 228) | |
Forced to stop studies | 15.4 |
Refused to be admitted in schools | 17.5 |
Absentees | 22.4 |
Poor performance | 44.7 |
Is the epileptic person cause burden to others (n = 259) | |
Yes | 73.7 |
No | 26.3 |
Why epileptic condition cause burden to others (n = 282) | |
Cost for health care | 54.5 |
Lowers family income | 45.5 |
The effects of epilepsy in marriage (n = 282) | |
Quarrels to the partner | 58.7 |
Separation | 29.1 |
Divorce | 12.2 |
Do you stay far from social functions (n = 240) | |
Yes | 52.9 |
No | 47.1 |
Effects on getting marriage (n = 260) | |
Other member of the family | 48.5 |
Epileptic individual | 51.5 |
Ways of epilepsy transmission (n = 106) | |
Sleeping with epileptic person | 56.6 |
Eating with epileptic person | 25.5 |
Shaking hands | 9.4 |
Sex and touching saliva | 8.5 |
How can you prevent (n = 305) | |
Prayers | 15.5 |
By treatment | 19 |
Don’t know | 65.6 |
other hand, non-pig producers had little understanding of the pork tapeworm (T. solium) and how it is transmitted, because such knowledge was provided by paravets through livestock seminars. The lingual muscle was the best site for ante-mortem diagnosis of cysticerci infection in pigs and was understood by most pig farmers in Iringa rural. Unfortunately, the method requires physical force and technique, this is probably the reason most pig farmers failed to diagnose the infection in pigs.
Despite that paravets provided knowledge on PCC and other animal diseases through livestock seminars, they only focused on livestock problems and did not link with human health. Additionally, while paravets insisted on indoor pig keeping, they did not include packages on the elimination of diseases. This might explain the fact that neither pig farmers nor non-pig farmers had knowledge on the prevention of cysticercosis infection in pigs and humans in the study area. Likewise, the health workers in dispensaries and health centers provided education on environmental sanitation, personal hygiene and related matters. Unfortunately, only the sick and expectant mothers attend such seminars while the large population remained uniformed. It is, therefore, justifiable to recommend the scaling up of the efforts to educate people on the causes, transmission and prevention of the T. solium parasite in Iringa rural communities.
About 62.7% of epileptic people involved in the present study developed seizures from the age of 21 years onwards. Secka et al. [
Furthermore, the social discrimination of people with epilepsy was increased by the belief that epilepsy could be transmitted through contact (e.g. touching saliva, sleeping together and shaking hands). The sudden falling accompanied with convulsions created fear among families and friends not to allow epileptic individuals into large gatherings. The segregation and discrimination experienced by epileptic people induced in them an inferiority complex that was the cause of their failure to live with their partners in marriage. Likewise, the belief that epilepsy could be transmitted through sex and that it can be inherited leads to discrimination of epileptic people and the members of their families in marriage [
Since, sudden falling and convulsions often lead into injury to epileptic individuals, care is therefore, needed to protect them as when it happens it renders them helpless. In school children, epilepsy often interrupts attendance and effective schooling, resulting into truancy, poor performances and sometimes withdrawal from school. Sanya et al. [
There was little knowledge on the causes, transmission and prevention of T. solium cysticercosis and epilepsy in Iringa rural areas. The continued persistence of PCC in the study area is contributed by absence of meat inspection and hygiene, slaughter slabs and consumption of uninspected pork. The proportion of condemned pigs due to T. solium cysticercosis was negligible because the affected pigs were slaughtered at home and pork was sold in street bars and in the community. There were more cases of late onset epilepsy than those of childhood epilepsy. People have limited knowledge on the causes and transmission of epilepsy; this has led to social segregation and discrimination of epileptic individuals. Since both pig keepers and non-pig keepers have little knowledge on T. solium infection in humans, it is imperative to provide education on the life cycle of T. solium as part of the control efforts of the disease in Iringa rural areas.
● Financial: Consistency coverage of the proposed study areas could not be achieved due to financial constrains.
● Community consent: A few people simply refused to participate in the project and thus some good information was not disclosed.
● Information on socio-demographic characteristics of the participants was not documented and hence forms one of the weaknesses to this study.
The authors acknowledge support from the consortium Afrique One “Ecosystem and Population Health: Expanding Frontiers in Health”. Afrique One is funded by the Wellcome Trust (WT087535MA).