Nath Tilak Chandra, Adnan Mahfuz Rahman, Sultana Nazmin, Husna Asmaul, Ndossi Barakaeli A, Kang Yeseul, Bia Mohammed Mebarek, Choe Seongjun, Park Hansol, Lee Dongmin, Eamudomkarn Chatanun, Jeon Hyeong-Kyu, Eom Keeseon S
Department of Parasitology, Parasite Research Center and Parasite Resource Bank, Chungbuk National University, Republic of Korea.
Department of Parasitology, Sylhet Agricultural University, Bangladesh.
Parasite Epidemiol Control. 2020 Jul 14;11:e00165. doi: 10.1016/j.parepi.2020.e00165. eCollection 2020 Nov.
In Bangladesh, the prevention and control strategy of soil-transmitted helminthiasis (STHs) is based on the mass drug administration (MDA) program. Despite bi-annual MDA since 2008, the reported compliance is still below the target, and the STH prevalence is high in several areas. This study was done to assess the feasibility and barriers of integrating health education (HE) intervention to achieve the target MDA compliance in the local context of Bangladesh.
A mixed-method study, utilizing PRISM (Practical Robust Implementation Sustainability Model) framework, was conducted between July 2017 to March 2018 in Dhaka and Sylhet divisions of Bangladesh. A total of 640 school-aged children selected from four different schools were divided into intervention and control groups. Eight focus group discussions (FGDs) and eight in-depth interviews (IDIs) were also conducted among 56 adults, including parents of school-aged children, school teachers, and health officers.
Quantitative findings revealed that HE intervention had a significant role ( < .05) to improve the mean knowledge score in the intervention group (3.35) compared to the control group (0.29). STH preventive behaviours and MDA participating attitudes were also significantly increased in the intervention group ( < .05) compared to the control group. Some of the major barriers associated with HE integration identified in the qualitative study were budget deficiencies, inadequate training of program implementers, and information gaps. In contrast, the school environment and positive community attitudes were observed as supportive factors for the integration of HE.
Increased knowledge score and behaviour changes due to HE intervention demonstrated in this study hint that integration of HE with MDA is feasible and can be promising to promote MDA compliance and to reduce STH prevalence in this setting. However, the allocation of adequate budget, as well as coordination and collaboration with local political context, should be addressed for the sustainability of integration.
在孟加拉国，土壤传播的蠕虫病（STH）预防控制策略基于群体药物治疗（MDA）项目。尽管自2008年起每半年进行一次MDA，但报告的依从性仍低于目标，且在一些地区STH流行率较高。本研究旨在评估在孟加拉国当地背景下整合健康教育（HE）干预措施以实现目标MDA依从性的可行性和障碍。
2017年7月至2018年3月期间，在孟加拉国达卡和锡尔赫特分区开展了一项采用PRISM（实用稳健实施可持续性模型）框架的混合方法研究。从四所不同学校选取的640名学龄儿童被分为干预组和对照组。还对56名成年人进行了八次焦点小组讨论（FGD）和八次深入访谈（IDI），这些成年人包括学龄儿童的家长、学校教师和卫生官员。
定量研究结果显示，与对照组（0.29）相比，HE干预对提高干预组的平均知识得分（3.35）具有显著作用（P<0.05）。与对照组相比，干预组中STH预防行为和参与MDA的态度也显著增加（P<0.05）。定性研究中确定的与整合HE相关的一些主要障碍包括预算不足、项目实施人员培训不足和信息差距。相比之下，学校环境和积极的社区态度被视为整合HE的支持因素。
本研究中HE干预导致的知识得分提高和行为改变表明，将HE与MDA整合是可行的，有望在这种情况下提高MDA依从性并降低STH流行率。然而，为实现整合的可持续性，应解决充足预算的分配以及与当地政治环境的协调与合作问题。
