Knowledge, attitude and practices towards cystic echinococcosis in pastoral communities in Kasese District, Uganda

Abstract

Background. Cystic Echinococcosis (CE) is a zoonotic neglected tropical disease (NTD) caused by larval stages of Echinococcus granulosus strains. It is a visceral disease that is difficult to diagnose and causes disability including brain damage, epilepsy, severe liver disease, and fatalities. The WHO lists Uganda as one of the countries with high endemicity of disease. An average of 20 surgical cases were reported annually in hospitals in Northeastern and Western Uganda from 1990-2003. The disease is common among pastoralists; however, neither the knowledge nor the community perceptions and practices have been studied in Uganda and the Ministry of health does not prioritize the disease in its control strategies. This study aimed to determine the knowledge, attitudes, and practices of pastoral communities in Kasese district, Western Uganda towards CE. Materials and methods: In this cross-sectional study, a sample of 384 respondents was obtained from all nine sub-counties in Kasese district with pastoral communities. A semi-structured questionnaire, key informant interview, focused group discussion (FGD) guides and GPS were used to collect data on knowledge, attitude and practices and spatial distribution of respondents. Data was entered in Epi Info® and exported to STATA 11.2 for analysis. Logistic regression was used to calculate odds ratios and for multivariate analysis. Results: Out of the 384 respondents, only 3.9% knew about CE, 10.7% and 6.7% had seen the disease in man and animals respectively, only 36.9% perceived themselves at risk of acquiring CE. Practices identified as potential risk factors for CE included dog ownership (64.0%), presence of stray dogs (99.2%), no de-worming of dogs (91.7%), home slaughtering (82.8%), no hand washing (89.3%), no water boiling (78.9%), and feeding uncooked infected organs to dogs (54.4%). Close association with dogs, home slaughtering of animals and education levels, were negatively associated with knowledge while religion, meat inspection water boiling and hand washing were positively associated with knowledge about CE. FGDs revealed that people think CE is caused by witchcraft. Conclusion: The knowledge about CE is still very low and predisposing factors are many in pastoral Communities. There is need for community education for NTDs and CE targeting behavior change towards prevention of zonootic NTDs.