Ahmed Khalaf S, Al-Delaimy (2014) Development and evaluation of health education learning package (help) to control soil-transmitted helminthiasis among orang asli school children in Lipis, Pahang, Malaysia / Ahmed Khalaf S. Al-Delaimy. PhD thesis, University Malaya.
Abstract
Soil-transmitted helminth (STH) infections, also known as soil-transmitted helminthiasis, are highly prevalent among Orang Asli communities in Peninsular Malaysia. This study was carried out to develop a health education package for STH infections, and to evaluate what impact such a package could have in terms of reducing the incidence and intensity of STH infections among Orang Asli schoolchildren in Pahang, Malaysia. To identify the key risk factors of STH in Orang Asli communities, we applied an extensive mixed methods approach which relied on PRECEDE-PROCEED and Health Belief models and involved an intensive literature review, as well as community-based discussions with children, their parents, teachers and health personnels, whilst also placing the children under direct observation. To evaluate the package, children from two schools (Sekolah Kebangsaan Pos Betau; SKPB and Sekolah Kebangsaan Kuala Koyan; SKKK) in Lipis, Pahang were screened for STH infections, treated by a 3-day course of albendazole and then followed up over the next 6 months. The knowledge of teachers, parents and children towards STH infections were assessed by pre-tested questionnaires at baseline and after 3 months. Demographic, socioeconomic, environmental and personal hygiene information were also collected by using a pre-tested questionnaire. Overall, fecal samples were collected from 498 schoolchildren (50.6% boys and 49.4% girls) and examined by using direct smear, formalin-ether sedimentation, trichrome stain, modified Ziehl Neelsen stain, Kato Katz and Harada Mori techniques. Overall, 98.4% of the children were found to be infected by at least one parasite species. Of these, 71.4% had polyparasitism (the concurrent infection with multiple intestinal parasite species) while 28.6% had monoparasitism. The overall prevalence of trichuriasis, ascariasis, hookworm infection, giardiasis, amoebiasis and cryptosporidiiosis were 95.6%, 47.8%, 28.3%, 28.3%, 14.1% and 5.2%, respectively. For the evaluation of the package, 317 students were involved (172 from SKPB and 145 from SKKK). The developed package was named “HELP”. It consisted of a half-day workshop for teachers, a teacher’s guide book to STH, posters, a comic book, music videos, a puppet show, drawing activities and an aid kit. The package was well-received with effective contributions from the teachers, children and their parents. The incidence rates of hookworm infection at different assessment points were significantly lower among children in the intervention school compared to those in the control school. Similarly, the intensity of trichuriasis, ascariasis and hookworm infections were found to be significantly lower among children in the HELP group compared to those in the control group (P < 0.05). Moreover, the package significantly improved the knowledge, attitude and practices (KAP) of Orang Asli people and the knowledge of teachers towards STH infections. A school-based health education learning package (HELP) was developed and displayed a significant impact in terms of reducing the intensity of all three main STH infections, as well as in reducing the prevalence of hookworm infections. Moreover, the knowledge levels of both teachers and the Orang Asli population regarding STH was significantly improved, a fact which greatly helped in attracting community participation and thus raising the general level of awareness regarding these forms of infections. Integrating HELP with school curriculum targeting rural areas could bring promising effects on the health status of the children that can help in the overall efforts to improve the quality of life in these communities. However, a further study using cluster randomized trial in large sample set nationally is recommended to evaluate the impact of HELP on STH among rural communities.
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