Knowledge, attitudes and preventive practices towards soil-transmitted helminthiases among teachers in schools implementing the home-grown school feeding program in Enugu Metropolis, Enugu State, Nigeria

Abstract

Background

Soil-transmitted helminthiases (STHs) are prevalent in low- and middle-income countries, impacting school-aged children significantly. Teachers, integral to STH control through the Home-Grown School Feeding Program (HGSFP), need adequate knowledge, attitudes, and preventive practices (KAP) for successful STH prevention. However, there is limited research on teacher KAP regarding STH in Enugu State, particularly concerning its endemic nature. This study assessed the KAP of primary school teachers involved in the HGSFP in Enugu Metropolis, Nigeria, aiming to inform targeted interventions for STH control.

Methods

This analytical cross-sectional study, conducted from September 2023 to January 2024, involved 108 primary school teachers from nine randomly selected schools in Enugu Metropolis, Nigeria. Data were collected using a structured questionnaire, which had undergone rigorous validation and reliability testing. Descriptive statistics, chi-square tests, and logistic regression analyses were performed.

Results

While 69.4% of the teachers demonstrated good knowledge and 77.8% had good attitudes towards STH, only 27.8% reported good preventive practices. Younger teachers (25–34 years) exhibited better knowledge (94.1% vs. 56.4%, p = 0.018) and practices (52.9% vs. 30.8%, p = 0.015) compared to their older colleagues (≥ 45 years). Years of teaching experience significantly influenced attitudes, with teachers having 11–20 years of experience exhibiting the most favorable attitudes (95.8%, p = 0.030). Age was a significant predictor of good practice with teachers aged 35–44 years being 7.72 times more likely to report good practices than those ≥ 45 years (AOR: 7.72, 95% CI: 5.66–35.9).

Conclusions

The study reveals a critical disconnect between high levels of knowledge and positive attitudes towards STH among teachers and their lower levels of good preventive practices. This highlights that positive attitudes alone may not be sufficient for effective implementation of preventive measures. This underscores the need for targeted interventions, particularly tailored training for older and more experienced teachers. Incorporating evidence-based behavior change strategies, addressing potential barriers to practice implementation, and improving access to resources are crucial for enhancing STH prevention efforts within the HGSFP and safeguarding the health of teachers and students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-024-21159-4.

Background

Soil-transmitted helminthiases (STH) are a group of parasitic diseases caused by intestinal nematodes that infect humans through contact with soil contaminated with fecal matter. The primary species of concern are Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), and the hookworms Necator americanus and Ancylostoma duodenale [1]. These infections represent a significant global health challenge, particularly in low- and middle-income countries where inadequate sanitation, poor hygiene practices, and limited access to clean water contribute to their prevalence [2].

The global burden of STH is substantial, with recent estimates suggesting that over 1.5 billion people are infected worldwide [2, 3]. The highest prevalence is observed in sub-Saharan Africa, the Americas, China, and East Asia, where these infections account for a considerable proportion of the neglected tropical disease burden [4]. In 2019, STH infections were responsible for an estimated 1.97 million disability-adjusted life years (DALYs), highlighting their significant impact on public health and socioeconomic development [5, 6].

School-aged children (SAC) are disproportionately affected by STH, with approximately 568 million children living in areas where these parasites are intensively transmitted [7, 8]. This vulnerability stems from various factors, including underdeveloped immune systems, frequent exposure to contaminated environments, and behaviors that increase infection risk, such as playing in soil and poor hygiene practices [4]. The consequences of STH infections in children are particularly concerning, as they can lead to malnutrition, impaired physical growth, cognitive deficits, and reduced educational attainment [9].

In Nigeria, STH remains a significant public health challenge, with prevalence rates ranging from 14.4 to 71.1%, depending on the geographical area and diagnostic methods employed [10]. This high variability underscores the complex interplay of environmental, socioeconomic, and behavioral factors influencing STH transmission in the country [11].

The World Health Organization (WHO) has set an ambitious goal to eliminate STH as a public health problem by 2030, focusing on reducing the prevalence of moderate and heavy intensity infections to below 2% among SAC [12, 13]. The primary strategy to achieve this goal is preventive chemotherapy through mass drug administration (MDA) of anthelmintic drugs, particularly albendazole or mebendazole, to at-risk populations [12]. This approach is often integrated with water, sanitation, and hygiene (WASH) interventions and health education programs to create a comprehensive control strategy [14].

School-based deworming programs have emerged as a cost-effective platform for delivering preventive chemotherapy to SAC [15]. These programs leverage existing educational infrastructure and the high concentration of at-risk children in schools to achieve high treatment coverage. In Nigeria, the integration of deworming activities into school-based initiatives, such as the Home-Grown School Feeding Program (HGSFP), has shown promise in addressing both nutritional deficiencies and parasitic infections simultaneously [16–18].

The HGSFP is a school feeding program that aims to provide one free, nutritious meal per day to public primary school pupils in classes 1–3 across Nigeria. The program is overseen by the Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development [19]. The goal of the HGSFP is to increase school enrollment, improve nutrition and health of children, and provide income for smallholder farmers and cooks involved in the program [16]. As of 2022, the program reportedly reaches over 9 million children in over 53,000 public primary schools across all 36 states and the Federal Capital Territory [20].

However, the success of school-based deworming programs relies heavily on the knowledge, attitudes, and practices (KAP) of key stakeholders, particularly teachers [21]. Teachers play a crucial role in these interventions, not only in administering treatments but also in educating children, families, and communities about STH prevention and promoting good hygiene practices [22]. Teachers with inadequate knowledge about STH transmission, prevention, and control might unknowingly perpetuate practices that increase infection risk [23]. Despite the importance of teacher KAP for the success of school-based STH programs, research specifically exploring this area in Enugu State, Nigeria, where STH is endemic is currently lacking.

While global research has highlighted the importance of KAP among various stakeholders in the fight against STH, including children, parents, caregivers, and healthcare workers [24–28], there is a significant gap in understanding teacher KAP, particularly within the context of integrated programs like the HGSFP.

This study addresses this gap by assessing the knowledge, attitudes, and preventive practices of primary school teachers engaged in the HGSFP in Enugu Metropolis, Nigeria. By examining the factors influencing teacher KAP and identifying areas where knowledge and practices fall short, this research aims to provide evidence-based recommendations for enhancing teacher training and educational campaigns targeted at STH control. Ultimately, this study seeks to contribute to the global understanding of STH control by demonstrating the importance of equipping teachers with the necessary knowledge and skills to effectively promote hygiene practices and deworming compliance among students, thereby impacting student health outcomes and contributing to the achievement of the WHO’s global STH control targets.

Methods

Study area

Enugu State, situated in southeastern Nigeria, is characterized by its hilly terrain and comprises seventeen local government areas (LGAs). The state shares borders with Abia and Imo to the south, Ebonyi to the east, Benue to the northeast, Kogi to the northwest, and Anambra State to the west [29] as shown in Fig. 1 below.

Fig. 1.

Map of Enugu state metropolis

The Enugu metropolis, the state capital, consists of three LGAs: Enugu East, Enugu North, and Enugu South. Positioned between 6° 21’N and 6° 30’N, 7° 26’E and 7° 30’E, the metropolis experiences a tropical and humid climate [30]. The Enugu metropolis serves as the administrative hub of Enugu State, hosting various federal and state parastatals, and prominent health and educational institutions, alongside a mix of public and private establishments. These include schools, churches, hotels, banks, recreational centers, restaurants, shopping malls, and marketplaces [31].

This study focuses specifically on public primary schools within the Enugu metropolis that implement the HGSFP. The program’s presence in these schools provides a unique context for investigating teachers’ KAP regarding STH, given their potential role in promoting hygiene and sanitation practices among students at this early stage of life.

Study design and study population

This study employed an analytical cross-sectional school-based KAP survey, carried out from September 2023 to January 2024. The study population comprised public primary school teachers responsible for teaching primary 1–3 classes within the three LGAs of the Enugu metropolis. Teachers in preschool, nursery, and primary 4–6 classes were excluded because they are not involved in the HGSFP, making their STH KAP less relevant to the study’s focus. As the HGSFP only covers students in primary 1–3 classes.

Sample size consideration and sampling

The sample size was determined via Cochran’s formula: n = Z²pq/d². where n = sample size, Z = score for the desired confidence level (1.96 for 95% confidence level), p = estimated proportion of the population of teachers (89% based on a previous study by Parikh et al. in the Philippines), q = complement of p (1 - p) and d = margin of error (0.05), which yielded a minimum sample size of 150 teachers.

A multistage sampling method was employed to select participants: Out of 117 public primary schools in Enugu Metropolis (27 in Enugu South, 36 in Enugu East, and 54 in Enugu North) [32, 33], nine schools were randomly selected via a proportional allocation strategy (2:3:4 ratio for Enugu South, East, and North, respectively), resulting in the selection of two schools from Enugu South, three from Enugu East, and four from Enugu North. Within each selected school, all teachers responsible for primary 1–3 classes were included, resulting in a total of 108 teacher as shown Fig. 2. The discrepancy between the initial calculated sample size (150) and the final sample (108) was due to the actual number of eligible teachers available in the selected schools. This sample size was deemed acceptable on the basis of the post-hoc power analysis.

Fig. 2.

Sampling framework

A post-hoc power analysis using G*Power 3.1 software was conducted to ensure the adequacy of the final sample size of 108 teachers. With an effect size of 0.3 (medium effect), α = 0.05, and power (1-β) set at 0.80, the sample size of 108 was determined to be sufficient for detecting significant associations in our chi-square tests and logistic regression analyses.

Data collection and instrument development

Data were collected via a structured questionnaire designed to capture both sociodemographic and KAP information. The questionnaire development process began with a comprehensive literature review of existing KAP surveys on STH to inform question development. Following this, a panel of public health experts and educators (from the Institute of Public Health, University of Nigeria) reviewed the initial draft for content validity. To assess clarity and comprehension, the questionnaire was then piloted with a small group of teachers (5% of the total sample size) from Nsukka, a different LGA outside the study area. The reliability of the instrument was evaluated by calculating Cronbach’s alpha to assess the internal consistency of the KAP sections, which yielded satisfactory results (knowledge: α = 0.82, attitudes: α = 0.78, practices: α = 0.75). On the basis of the feedback from the pilot testing and the reliability analysis, minor revisions were made to improve the clarity and relevance of the questions.

The final questionnaire consisted of four main sections (see Supplementary file 1). The first section collected demographic information through five items. The second section assessed knowledge about STH using 30 items on a 3-point Likert scale (“Yes” or “No” or “Do not know”). The third section evaluated attitudes towards STH with 10 items on a 4-point Likert scale (“Strongly agree”, “Agree”, “Disagree” and “Strongly disagree”). The fourth and final section measured preventive practices via 13 items on a 4-point Likert scale (“Always”, “Often”, “Sometimes” and “Never”).

For the actual data collection, the questionnaire was administered directly to the selected teachers. Prior to participation, all teachers were provided with written informed consent forms and were assured of the confidentiality and anonymity of their responses. The researchers remained available throughout the process to address any questions or concerns raised by the participants regarding the study or the questionnaire itself. All questionnaires were prepared in the English language.

Outcome and independent variables

In this study, the outcome variables were the levels of knowledge, attitudes, and preventive practices regarding soil-transmitted helminthiasis (STH) among primary school teachers. Knowledge level was assessed via a scoring system based on the 30 questions. Each correct answer was assigned a score of one, whereas incorrect answers and “Don’t know” responses received a score of zero. The total knowledge score ranged from 0 to 30. Teachers with scores at or above 80% (24 out of 30) were categorized as having “good” knowledge of STH, whereas those scoring below 80% were categorized as having “poor” knowledge.

Attitudes level was measured via the 10 items on the questionnaire. A scoring system was developed for each statement, assigning higher scores to responses reflecting more positive attitudes. Three points were awarded if the participant answered “Strongly agree,” two points were awarded for “agree,” one point was awarded for “disagree” and zero points were awarded, if the answer was “Strongly disagree” - The total attitude score ranged from 0 to 30, with higher scores indicating more favourable attitudes toward STH prevention and control. Teachers scoring at or above 80% (24 out of 30) were classified as having “good” attitudes, whereas those scoring below 80% were classified as having “poor” attitudes.

And preventive practices level was measured on basis of responses to the 13 items. Each response option was assigned a score ranging from 0 to 3, with higher scores representing more frequent engagement in preventive practices. For the positive questions, three points were awarded if the participant answered “Always,” two for “often,” one for ‘Sometimes” and zero points were awarded, if the answer was “Never.” In the case of the negative questions, a reversal in point reward was given for the same answers. The total practice score ranged from 0 to 39. Teachers scoring at or above 80% (31 out of 39) were categorized as having “good” preventive practices, whereas those scoring below 80% were categorized as having “poor” preventive practices.

The 80% thresholds for categorizing knowledge, attitudes, and practices regarding STH into “good” and “poor” levels were based on existing literature [25, 34, 35] and expert recommendations. This threshold is often used in educational and public health contexts to signify a high level of proficiency or mastery, aligning with the grading scale used in many educational systems where scores at or above 80% are considered excellent or very good. Using this established criterion allowed for comparisons with findings from other STH-related studies.

The independent variables in this study included sociodemographic characteristics such as sex, age group, educational level, and years of teaching experience. These variables were selected based on their potential influence on teachers’ knowledge, attitudes, and practices related to STH.

Data analysis

Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 22. Prior to analysis, data quality checks were performed on all 108 questionnaires. Of these, 108 (100%) were found to be complete with no missing data. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the sociodemographic characteristics of the participants and their responses to the knowledge, attitudes, and practice questions. Bivariate analysis via chi-square tests was performed to examine associations between teachers’ sociodemographic characteristics and their KAP regarding STH. Logistic regression analysis was used to identify factors predicting good knowledge, attitudes, and practices towards STHs. A p-value less than 0.05 was considered statistically significant.

Ethical considerations

Ethical approval for the study was obtained from the Ethical Committee of the School of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria with reference number UNTH/HREC/2023/10/787. The study was conducted in accordance with the principles of the Declaration of Helsinki. Before participating, the teachers provided written informed consent. Confidentiality was maintained by removing any identifying information from the questionnaires and using unique codes for each participant. Participation was entirely voluntary, and participants had the right to withdraw from the study at any time without penalty.

Result

Sociodemographic characteristics of participating teachers

Table 1 presents the sociodemographic characteristics of the 108 primary school teachers who participated in the study on knowledge, attitudes, and preventive practices (KAP) regarding soil-transmitted helminthiasis. Most participants were females (106) accounting for 98.1% of the study population. None of the participants were in the 18–24 years age group, 17 (15.7%) were in the 25–34 years age group, 52 (48.1%) were in the 35–44 years age group and 39 (36.1%) were 45years or older. One hundred and four (96.3%) of the participants had NCE/NTI certifications as their highest educational qualification and only 4(3.7%) had a bachelor’s degree. No participant had a postgraduate degree. The Majority (71, 65.7%) of the participants had at least 6–10 years of teaching experience. Twenty-three (21.5%) had 11–30 years of teaching experience whereas 14(13%) had between 1 and 5 years of teaching experience.

Table 1.

Sociodemographic of the participants

Characteristics	Frequency (n = 108)	Percentage (%)	Mean ± SD
Sex
Female	106	98.1
Male	2	1.9
Age group			41.5 ± 7.56
18–24	0	0
25–34	17	15.7
35–44	52	48.1
≥ 45	39	36.1
Educational Level
NCE/NTI	104	96.3
B.Ed/B.Sc/B.A	4	3.7
PGDE	0	0
Years of Experience (years)			7.6 ± 3.42
1–5	14	13.0
6–10	71	65.7
11–20	23	21.3
> 20	0	0

Teachers’ knowledge, attitudes, and preventive practices (KAP) toward soil-transmitted helminthiasis

The knowledge, attitudes, and preventive practices regarding soil-transmitted helminthiasis among the 108 participating primary school teachers are presented in Table S1, S2 and S3 (see Supplementary file 2). The teachers achieved a mean knowledge score of 24.9 out of 30, indicating a good overall understanding of STH. Similarly, the mean attitude score was 26.9 out of 30, reflecting generally positive attitudes towards STH and its prevention. However, the mean practice score was 29.5 out of 39, suggesting that translating knowledge and attitudes into consistent preventive practices was a challenge as shown in Table 2 below.

Table 2.

Average scores, numbers, and percentages for knowledge, attitudes, and preventive practices regarding STH among teachers

Measure	Mean ± SD	Poor (< 80%)	Good (≥ 80%)
Knowledge Score (0–30)	24.9 ± 3.41	33 (30.6%)	75 (69.4%)
Attitude Score (0–30)	26.9 ± 4.09	24 (22.2%)	84 (77.8%)
Practice Score (0–39)	29.5 ± 3.57	78 (72.2%)	30 (27.8%)

A closer examination of the specific KAP levels revealed that 69.4% of the teachers had good knowledge of STH, whereas 30.6% had poor knowledge. In terms of attitudes, a greater proportion (77.8%) demonstrated good attitudes toward STH, with only 22.2% exhibiting poor attitudes. In contrast, only 27.8% of the teachers reported good preventive practices related to STH.

Association between teacher characteristics and knowledge, attitudes, and practices regarding STH

The bivariate analysis revealed several statistically significant associations between the demographic characteristics (age and years of experience) of the teachers and their knowledge, attitudes, and practices (KAP) related to STH, as presented in Table 3.

Table 3.

Chi-Square analysis of the relationship between demographic characteristics and knowledge, attitudes, and Preventive practices regarding STH

Characteristics	Knowledge level n (%)		P-value	Attitude level n (%)		P-value	Practice level n (%)		P-value
	Poor	Good		Poor	Good		Poor	Good
Sex
Female	33(31.1)	73(68.9)	0.344	24(22.6)	82(77.4)	0.445	77(72.6)	29(27.4)	0.479
Male	0(0)	2(100)		0(0)	2(100)		1(50)	1(50)
Age group
18–24	-	-	0.018*	-	-	0.516	-	-	0.015*
25–34	1(5.9%)	16(94.1)		2(11.8)	15(88.2)		8(47.1)	9(52.9)
35–44	15(28.8)	37(71.2)		14(26.9)	38(73.1)		43(82.7)	9(17.3)
≥ 45	17(43.6)	22(56.4)		8(20.5)	31(79.5)		27(69.2)	12(30.8)
Educational Level
NCE/NTI	32(30.8)	72(69.2)	0.806	24(23.1)	80(76.9)	0.276	74(71.2)	30(28.8)	0.206
B.Ed/B.Sc/B.A	1(25.0)	3(75.0)		0(0%)	4(100%)		4(100.0)	0(0)
PGDE	-	-		-	-		-	-
Years of Experience
1–5	1(7.1)	13(92.9)	0.125	2(14.3)	12(85.7)	0.030*	9(64.3)	5(35.7)	0.775
6–10	24(33.8)	47(66.2)		21(29.6)	50(70.4)		52(73.2)	19(26.8)
11–20	8(34.8)	15(65.2)		1(4.2)	22(95.8)		17(73.9)	6(26.1)
> 20	-	-		-	-
Knowledge
Poor				11(33.3)	22(66.7)	0.043*	30(90.9)	3(9.1)	0.004*
Good				13(17.3)	62(82.7)		48(64.0)	27(36.0)

P-value < 0.05 was considered significant

Younger teachers (25–34 years) were more likely to have good knowledge of STH (94.1%) compared to their older counterparts (71.2% for 35–44 years and 56.4% for ≥ 45 years). A similar trend was observed for preventive practices, with the youngest group displaying a greater proportion of good practices (52.9%) than the older age groups. This suggests that knowledge and adherence to preventive practices regarding STH may be associated with younger teacher age.

Years of teaching experience was significantly associated with teachers’ attitudes toward STH. Teachers with 11–20 years of experience demonstrated the most favorable attitudes, with 95.8% having good attitudes, followed by teachers with 6–10 years (70.4%) and 1–5 years (85.7%) of experience. This indicates a potential association between teaching experience and positive attitudes towards STH.

Furthermore, teachers’ knowledge of STH was found to be significantly associated with both their attitudes and their preventive practices. Among teachers with good knowledge, 82.7% exhibited positive attitudes towards STH, while only 66.7% of those with poor knowledge did. Similarly, 36% of those with good knowledge reported good preventive practices, in contrast to only 9.1% among those with poor knowledge.

Factors influencing teachers’ knowledge, attitudes, and preventive practices regarding soil-transmitted helminthiasis (STH)

The regression analyses revealed a statistically significant association between teachers’ age group and both their knowledge and their preventive practices related to STH as presented in Table 4. Compared with their older counterparts (those aged 45 years or above), teachers aged 35–44 years demonstrated significantly better knowledge about STH. This age group also exhibited significantly better preventive practices, being 7.72 times more likely to engage in good practices than the oldest age group was.

Table 4.

Predictors for good knowledge, attitude, and practice towards STH among teachers

Variable	Outcome Measure	N	Outcome Positive N (%)	COR (95% CI)	AOR (95% CI)
Age group
	Good Knowledge
25–34 years		17	16 (94.1)	0.53 (0.22–1.26)	0.52 (0.21–1.30)
35–44 years		52	37 (71.2)	6.49 (0.79–53.4)	4.60 (0.48–44.4)
≥ 45 years		39	22 (56.4)	1	1
	Good Attitude
25–34 years		17	15 (88.2)	1.11 (0.42–2.94)	0.79 (0.28–2.24)
35–44 years		52	39 (75.0)	2.50 (0.50–12.4)	2.65 (0.43–16.3)
≥ 45 years		39	31 (79.5)	1	1
	Good Practice
25–34 years		17	9 (52.9)	2.12 (0.79–5.71)	2.04 (0.73–5.69)
35–44 years		52	9 (17.3)	5.34 (1.63–17.7)	7.72 (5.66–35.9)
≥ 45 years		39	12 (30.8)	1	1
Years of Experience
	Good Knowledge
1–5 years		14	13 (92.9)	1	1
6–10 years		71	47 (66.2)	6.93 (0.76–9.05)	1.88 (0.16–2.83)
11–20 years		23	15 (65.2)	1.04 (0.39–2.81)	0.77 (0.27–2.19)
	Good Attitude
1–5 years		14	12 (85.7)	1	1
6–10 years		71	50 (70.4)	0.27 (0.02–3.33)	0.12 (0.01–1.99)
11–20 years		23	23 (100.0)	0.11 (0.01–0.86)	0.09 (0.01–0.76)
	Good Practice
1–5 years		14	5 (35.7)	1	1
6–10 years		71	19 (26.8)	1.57 (0.38–6.62)	0.51 (0.07–3.88)
11–20 years		23	6 (26.1)	1.04 (0.36–3.01)	1.02 (0.32–3.19)

The number of years a teacher had been teaching was found to be significantly associated with their attitudes towards STH. Interestingly, teachers with 11–20 years of experience were less likely to hold positive attitudes toward STH than those with 1–5 years of experience. This suggests a potential decline in positive attitudes as teachers gain more experience.

No significant associations were found between teachers’ age and their attitudes towards STH or between years of teaching experience and their knowledge or preventive practices.

Notably, sex and educational qualifications were excluded from the regression analyses because of a lack of significant findings in the bivariate analysis. However, it is important to acknowledge that these factors could still potentially influence teachers’ KAP toward STH. Further research with larger samples is needed to explore these relationships more comprehensively.

Discussion

The study findings reveal a significant disparity between the participants’ generally high knowledge and attitudes, and their less-than-ideal preventive practices regarding soil-transmitted helminthiasis (STH). This knowledge-practice gap aligns with prior studies conducted in various regions such as Thailand [25], Pakistan [35] and Rwanda [36]. The literature suggests that structural barriers, such as inadequate water, sanitation, and hygiene (WASH) facilities in schools, can hinder the application of knowledge in practice [37, 38]. For instance, a study conducted in China found that despite improved knowledge among participants, the lack of access to proper handwashing facilities and clean water limited their ability to consistently implement preventive behaviors [37]. Similarly, research in Peru has shown that integrating education with practical skills training and improving WASH infrastructure can significantly enhance both knowledge and preventive practices [38].

The study’s findings on age-related differences suggest that tailored interventions may be necessary to address the specific needs and knowledge gaps of different teacher demographics. Younger teachers (aged 25–34 years) exhibited greater knowledge and were more likely to engage in good preventive practices compared to their older counterparts. This aligns with research by Priyanka et al. [39] in India, which revealed that younger teachers were more receptive to new health information and practices. The authors posit that younger teachers’ enthusiasm and adaptability to change may make them more responsive to educational interventions, enabling them to quickly translate their knowledge into practical preventive behaviors [39, 40]. In contrast, older teachers may require targeted refresher courses and updated training materials to address their unique knowledge gaps and support the maintenance of positive attitudes over time [22, 24]. A study in South Africa found that while older participants had better baseline knowledge, they were less likely to adopt new health practices, highlighting the importance of tailoring interventions to this demographic [24].

Interestingly, teachers with less experience (1–5 years) displayed more positive attitudes toward STH than did those with 11–20 years of experience. This finding echoes research by Rwamwejo et al. [36] in Rwanda, who reported a decline in positive health attitudes among teachers over time. This suggests a need for continuous engagement and motivation strategies for experienced teachers to maintain their interest in and commitment to health initiatives. While younger teachers may not be suitable for direct peer-education initiatives among non-peers, their strengths in innovative teaching approaches could be leveraged in other ways. For example, successful initiatives have involved younger teachers serving as champions or role models, showcasing how to effectively integrate STH prevention practices into their teaching methods [39]. By highlighting these successful examples, program designers can inspire and support the younger generation of teachers to become agents of change within their schools and communities. Furthermore, integrated approaches that combine education with practical training and ongoing support have been shown to be more effective in sustaining positive behavioral [38, 41]. Younger teachers, with their adaptability and enthusiasm, may be well-positioned to champion and drive the implementation of such comprehensive interventions, which can then be tailored to the needs of their older counterparts.

The strong positive correlation found between knowledge and both attitudes and preventive practices underscores the crucial role of education in tackling STH. This relationship has been consistently observed across diverse regions, including the Philippines [23], South Africa [24]. Thailand [25], Bangladesh [42] and Kenya [43]. For example, Narkkul et al. [25] reported that participants with higher knowledge scores were two times more likely to practice good hygiene behaviors. These findings emphasize the need for comprehensive educational programs that not only enhance knowledge but also cultivate positive attitudes and encourage the adoption of recommended preventive behaviors. Successful models, such as the school-based deworming program in Kenya described by Mwandawiro et al. [41], demonstrate how integrated education and health interventions can lead to sustained improvements in both knowledge and practices.

This study has several notable strengths, including its comprehensive approach to assessing knowledge, attitudes, and practices regarding soil-transmitted helminthiasis among primary school teachers, and its use of a validated, reliable research instrument. The study’s multi-stage sampling method and rigorous ethical considerations enhance its methodological rigor. However, some limitations must be acknowledged. First, the study was conducted in a single metropolitan area, which may limit the generalizability of findings to other regions of Nigeria. Second, the study relied on self-reported data, which could be subject to social desirability bias. Additionally, the overwhelming majority of participants were female (98.1%), which may introduce gender-specific bias. The cross-sectional design also prevents establishing causal relationships between variables. Future research should address these limitations by employing more diverse sampling strategies, utilizing objective measurement tools, and considering longitudinal study designs.

Implications for practice and policy recommendations

Addressing the knowledge-practice gap in soil-transmitted helminthiases (STH) prevention requires a multifaceted approach that spans educational, infrastructural, and collaborative domains. Firstly, educational interventions should focus on developing tailored, age-specific training modules for teachers that bridge the divide between theoretical knowledge and practical implementation. This necessitates integrating comprehensive STH prevention education into both pre-service and in-service teacher training curricula, with a particular emphasis on creating continuous professional development programs that highlight practical skills and behavior change strategies [44]. Secondly, infrastructural improvements are equally crucial in supporting STH prevention efforts. Schools require significant investment in water, sanitation, and hygiene (WASH) facilities to enable the practical implementation of preventive practices [45]. This includes ensuring consistent availability of essential resources like deworming medications and developing clear school-level protocols for STH prevention and management Such improvements create the necessary environmental conditions for effective intervention [46].

Thirdly, Collaborative approaches represent another critical strategy. Stronger intersectoral collaboration between education and health departments is essential for designing and implementing effective school-based STH control programs. By creating platforms for knowledge sharing and establishing robust monitoring and evaluation mechanisms, stakeholders can track the effectiveness of prevention interventions and continuously refine their approaches [47]. Fourthly, research and monitoring efforts should be expanded to provide deeper insights into STH prevention. Longitudinal studies tracking changes in teachers’ knowledge, attitudes, and practices over time will be invaluable. Researchers should aim to extend studies to diverse geographical settings within Nigeria, developing context-specific strategies that can be adapted to different community needs. Developing standardized assessment tools for measuring STH prevention effectiveness in school settings will further support these efforts.

Lastly, recognizing the demographic diversity among teachers is also crucial. Support programs must be designed to address the unique needs of different age groups and experience levels. While younger teachers can be leveraged for their adaptability and enthusiasm as change agents, older and more experienced teachers require specialized support to maintain their motivation and update their knowledge. This targeted approach ensures that all educators can effectively contribute to STH prevention efforts. By implementing these comprehensive recommendations, stakeholders can create a sustainable, holistic approach to reducing the burden of soil-transmitted helminthiases. The ultimate goal is to improve the overall health and well-being of students and teachers in Nigeria, transforming schools into environments that actively promote health and prevent parasitic infections.

Conclusion

This study reveals a critical disconnect between the high levels of knowledge and positive attitudes towards STH among teachers and their lower levels of good preventive practices. This highlights that positive attitudes alone may not be sufficient for the effective implementation of preventive measures. This emphasizes the need for targeted interventions, particularly tailored training for older and more experienced teachers to address age-related differences in knowledge and practices. Incorporating evidence-based behavior change strategies, addressing potential barriers to practice implementation, and improving access to resources like WASH facilities and deworming medication are crucial for enhancing STH prevention efforts within the HGSFP. Ultimately, these efforts can safeguard the health of teachers and students and contribute to achieving the WHO’s global STH control targets.

Electronic supplementary material

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Abbreviations

AOR

Adjusted Odds Ratio

CI

Confidence Intervals

COR

Crude Odds Ratio

HGSFP

Home-Grown School Feeding Program

KAP

Knowledge, Attitudes and Preventive Practices

STH

Soil-Transmitted Helminthiases

WASH

Water, Sanitation, And Hygiene

WHO

World Health Organization

Author contributions

D. C. O. conceptualized and designed the study. Data collection was conducted by D. C. O and S. C. U. D. C. O. and B. H. N. performed data analysis. D. C. O. drafted the initial manuscript, and all authors contributed to revisions before approving the final version for submission.

Funding

Not applicable.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for the study was obtained from the Ethical Committee of the School of Medicine, University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria with reference number UNTH/HREC/2023/10/787. The study was conducted in accordance with the principles of the Declaration of Helsinki. Before participating, the teachers provided written informed consent. Confidentiality was maintained by removing any identifying information from the questionnaires and using unique codes for each participant. Participation was entirely voluntary, and participants had the right to withdraw from the study at any time without penalty.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.