Favre Tereza Cristina, Massara Cristiano Lara, Beck Lilian Christina Nóbrega Holsbach, Cabello Rocío Karina Saavedra Acero, Pieri Otavio Sarmento
Environmental and Health Education Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
Helmintology and Medical Malacology Research Group, René Rachou Institute, Fiocruz, Minas Gerais, Brazil.
Parasite Epidemiol Control. 2021 Mar 2;13:e00208. doi: 10.1016/j.parepi.2021.e00208. eCollection 2021 May.
Brazilian guidelines for schistosomiasis elimination recommend regular search of infection carriers and their timely treatment. This study evaluates the effect of educational actions (EAs) among schoolchildren on adherence to diagnosis and treatment, as well as on knowledge of the disease.
In April/2013, a questionnaire was applied to 6th-to-8th-grade pupils of eight public schools to evaluate prior knowledge of disease and self-reported risk behavior. Baseline parasitological survey (PS) was done in May/2013, followed by selective treatment and cure assessment. The schools were then randomly allocated to experimental (EG) and control (CG) groups, with and without EAs, respectively. EAs were conducted for 3 months from August/2013. Questionnaire was reapplied in November/2013, April/2014, October/2014, and October/2015 to evaluate changes in knowledge about the disease and self-reported risk behavior. Two further annual PSs (May/2014 and May/2015), each followed by treatment of positives, allowed to evaluate between-group differences and intra-group changes in adherence to diagnosis and treatment, and to follow-up prevalence and intensity of infection.
Adherence to diagnosis did not differ significantly between EG (84.1%) and CG (81.1%) at baseline but was significantly higher in EG in subsequent PSs. Overall, adherence to treatment was higher than 90% in all three PSs; cure was 98.4%, egg-reduction was 99.8% and reinfection, 2.8%. Prevalence fell significantly in EC (from 23.5% to 6.8%) and CG (from 21.8% to 2.4%), the same occurring with intensity (from 54.2 to 4.6 epg in EG and from 38.4 to 1.3 epg in CG). Disease knowledge increased significantly in EG and CG; knowledge about disease transmission increased significantly more in the EG. Self-reported risk behavior remained above 67% and did not differ significantly between EG and CG.
EAs increased adherence of schoolchildren and improved knowledge about the disease, confirming that EAs are an important tool to enhance schoolchildren participation in control campaigns.
巴西消除血吸虫病指南建议定期筛查感染携带者并及时进行治疗。本研究评估了针对学童的教育行动（EA）对诊断和治疗依从性以及疾病知识的影响。
2013年4月，对八所公立学校6至8年级的学生进行问卷调查，以评估他们对疾病的既往知识和自我报告的风险行为。2013年5月进行基线寄生虫学调查（PS），随后进行选择性治疗和治愈评估。然后将学校随机分为实验组（EG）和对照组（CG），分别实施和不实施教育行动。教育行动于2013年8月开始，为期3个月。2013年11月、2014年4月、2014年10月和2015年10月再次进行问卷调查，以评估疾病知识和自我报告风险行为的变化。另外进行了两次年度寄生虫学调查（2014年5月和2015年5月），每次调查后对阳性者进行治疗，以评估组间差异以及诊断和治疗依从性的组内变化，并跟踪感染率和感染强度。
基线时，实验组（84.1%）和对照组（81.1%）的诊断依从性无显著差异，但在随后的寄生虫学调查中，实验组的诊断依从性显著更高。总体而言，在所有三次寄生虫学调查中，治疗依从性均高于90%；治愈率为98.4%，虫卵减少率为99.8%，再感染率为2.8%。实验组（从23.5%降至6.8%）和对照组（从21.8%降至2.4%）的感染率均显著下降，感染强度也同样下降（实验组从54.2降至4.6个虫卵/克，对照组从38.4降至1.3个虫卵/克）。实验组和对照组的疾病知识均显著增加；实验组中关于疾病传播途径的知识增加得更为显著。自我报告的风险行为保持在67%以上，实验组和对照组之间无显著差异。
教育行动提高了学童的依从性并改善了疾病知识，证实教育行动是提高学童参与防控活动的重要工具。
