Highlights
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A total of 5.42% and 39.42% knew about schistosomiasis (SCH) and soil-transmitted helminthiasis (STH).
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Good knowledge of targeted SCH and STHs was associated with the (30;50 years) age group.
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Overall, 9.39% and 15.61% practiced prevention well.
Keywords: Knowledge, Attitudes, Practices, Schistosomiasis, Soil-transmitted helminthiasis, Ndikiniméki
Abstract
Objectives
Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are significant public health concerns in Africa, necessitating targeted control strategies for vulnerable populations. This study assesses the knowledge, attitudes, and practices regarding these diseases among residents of the Ndikiniméki district in Centre-Cameroon.
Methods
Data were collected through a pre-designed questionnaire from June 2023 to April 2024, involving 756 respondents aged 15 years and over from 15 villages and seven neighborhoods.
Results
The majority of participants were women (55.89%), with most falling in the 30-50 years age range. Only 5.42% and 39.42% demonstrated good knowledge of SCH and STH, respectively. Logistic regression analysis indicated that good knowledge was linked to living farther from watercourses (adjusted odds ratio [aOR]: 0.98, P = 0.02), residing in permanent homes (aOR: 0.68, P = 0.04), and having a higher education level (aOR: 0.25, P = 0.01). Attitudes and practices were also low, with only 9.39% and 15.61% showing good prevention measures for SCH and STH, respectively. Men were more susceptible to these diseases.
Conclusions
The findings highlight the need for comprehensive health education programs to enhance the prevention and control of these infections in rural communities.
Introduction
Schistosomiasis (SCH) and soil-transmitted helminthiasis (STHs) are the two most common neglected tropical diseases (NTDs) [1] affecting the world's poorest and most disadvantaged communities, particularly those found in rural areas of sub-Saharan Africa, Latin America, South-East Asia, and China [2]. These diseases are mainly prevalent in hot and humid climates and are strongly associated with inadequate sanitation and a severe lack of drinking water [3]. SCH is ranked as the second most endemic parasitic disease after malaria [3] since it has been reported in 78 countries, with 90% of infected people living in Africa [4]. It is a chronic parasitic disease caused by hemophagous trematodes of the genus Schistosoma Weinland, 1858. Infection occurs when parasite larvae released by freshwater gastropods penetrate the skin of a person in contact with infested water [4]. As for STHs, it is estimated that around 1.5 billion people, or 24% of the world's population, were infected by geohelminths. They are caused by intestinal nematodes in humans, of which the three main types are: Ascaris lumbricoides Linnaeus, 1758; Trichuris trichiura Linnaeus, 1771; and two species of hookworm (Ancylostoma duodenalis Dubini, 1843; and Necator americanus Stiles, 1902) [5]. School-age children living in endemic regions are the most affected by these diseases due to their high exposure to infected freshwater during daily activities or the consumption of unsafe drinking water, fruit, and vegetables [5]. In addition, recent study shows that adult populations constitute reservoirs for these parasites in endemic areas, with an increased risk of infection for A. lumbricoides, T. trichiura, and S. mansoni [6]. Recognizing the public health importance of these diseases, resulted in a commitment to implement control strategies to reduce their burden [7].
Hence World Health Organization (WHO) launched a new NTD roadmap for 2021-2030 that aims to end the burden of NTDs by 2030, in line with the sustainable development goals. Eliminating schistosomiasis as a global public health problem through evidence-based recommendations and Water, Sanitation, Hygiene (WASH) activities for at-risk populations is a priority [5]. In Cameroon, deworming activities have been extended throughout the country since 2007 [8]. This strategy has contributed to a reduction in the prevalence of these parasitoses in endemic areas, particularly in the West in 2014, where the work of Nana Dankoni et al. [9] showed a drop in prevalence. In contrast, Tchuem Tchuenté et al. [10]’s work reported an increase in SCH transmission in 2012 in the same region. However, it is estimated that more than 2 million people are infected with bilharzia and more than 10 million with helminths in the country [11]. Furthermore, the regular lack of clean drinking water, implies that people are constantly in contact with contaminated watercourses and use of water of dubious potability for their own needs plus inadequate sanitation, could be one of the factors supporting the persistence of these diseases. Then, the mass treatments administered to school-age children have not so far led to the elimination of these parasites. In the Ndikiniméki Health District, school-age children and the whole community were considered at risk and targets for mass drug administration. Besides this, WASH measures were implemented by local NGOs together with health districts enhancing the control of these diseases [11,12]. However, the parasite prevalences remain high with a maximum of 46.94% for SCH and 62.50% for STHs [11]. The transmission becomes more complex because of the presence of a new species of schistosome never mentioned in the locality and revealed by our previous studies [13]. This persistence of disease endemicity could be attributed to various factors including the knowledge, attitudes, and practices of the populations regarding these diseases. It was therefore relevant to assess the level of knowledge, attitudes, and practices among rural and sub-urban communities of Ndikiniméki Health District.
Materials and methods
Study setting
Type of study, data collection period, and study populations
A longitudinal and descriptive study was carried out on the Ndikiniméki district population between June 2023 and April 2024. This study was longitudinal due to the seasonal assessment of the transmission of these two parasitosis that was not considered in this article. Knowledge, attitudes, and practices data were collected quarterly using a pre-designed questionnaire. The probabilistic convenience technique was used for the KAP surveys. In terms of populations, the study was carried out on people living in the 15 villages and seven urban neighborhoods selected without distinction of gender and whose age was ≥15 years. The minimum population size was randomly set at 30 per site, with at least one participant enrolled per household. The households were selected randomly. Therefore, the overall expected sample size was 660 participants in the study locality. All individuals living in the study area; those present on the day of the survey and those who had given informed consent were included in this study.
Study site
This study was carried out in the district of Ndikiniméki (Figure 1). The district is located between N 4° 5’ latitude and E 10°11’longitude, in the departments of Mbam and Inoubou, Centre-Cameroon region. It is bounded to the north by the District of Makénéné, to the west by the District of Yingui, to the south by Ngambé and Yingui, and to the east by the District of Ndom, Bokito, Nitoukou, and Kon Yambetta. It is linked by a tarmac road, National Road No. 4, which crosses the entire department on its way to the West Region. It has 32 villages and 18 urban districts. The population was estimated at 17,462 according to the 3rd general census of population and housing in 2005. Ndikiniméki has a humid equatorial climate with four seasons: a short rainy season from mid-March to mid-May, a short dry season from mid-May to mid-August, a long rainy season from mid-August to mid-November, and a long dry season from mid-November to mid-March. The average annual rainfall is 1440 mm/year. Average temperatures are between 20°C and 25°C. The hydrographic network is dense and crossed by several watercourses: Molo, Inoubou, Makénéné, Bassaben, Biadjang, Nihep, Makombé and Kiakan. The district also has natural water sources and marigots that serve as household supplies, encouraging the development of water-borne diseases such as SCH and geohelminths.
Figure 1.
Location of various study sites.
Methodology
Socio-demographic surveys
The knowledge, attitudes, and practices surveys were the main operation carried out during our study. They enabled us to assess the level of knowledge, attitudes, and practices of the population with regard to the SCH and STH in the locality of Ndikiniméki. They mainly provided updated estimates of a number of basic socio-demographic and health indicators, in particular age, sex, level of education, knowledge of transmission routes, disease consequence of geohelminths and SCH, and the hygiene and sanitation practices of the local population. The questionnaire was developed using the WHO’s model questionnaires as a reference [14]. The survey was conducted using a paper questionnaire, and the languages used were French and Banyan, which are the most widely spoken languages in this locality. Data were collected by teams of two collectors per site studied.
Data analysis
Data from the knowledge, attitudes, and practices surveys were processed in Microsoft Office Excel version 2013 and analyzed using R software version 4.0.4 (version R 4.0.4, 2021-02-15). The frequencies of the different categories of variables were calculated for descriptive statistics and compared using the chi-square test at the 5% significance level. Respondents' level of knowledge about the SCH and STH was assessed based on their answers to the questionnaire. Knowledge of the transmission, symptoms, and prevention of these diseases was considered good when the respondent had at least 59% correct answers to all the questions [15]. Furthermore, participants with good attitudes and practices were those whose response score was ≥2 [16]. Odds ratios (ORs) were calculated to estimate the probability of having good knowledge, attitudes, and practices among the groups in the study population. OR values >1.0 indicated a positive association with an increased probability of good knowledge, attitudes, and practices to prevent transmission of schistosomes or soil-transmitted helminths. Factors associated with increased probability were those with significant P-values.
Results
Socio-demographic data
A total of 756 people answered the questions on our knowledge, attitudes, and practices survey form. Women were the most represented with the sex ratio M/F of 0.8 with a proportion of 55.89% compared with men (44.31%). In terms of age groups, those between (30,50 years) were the represented (36.90%). The small-scale business was the most common in this area, with farming, livestock rearing, and fishing the main activities. The majority of households surveyed were close to watercourses (67.20%). These households also had more traditional toilets.
Data on participants’ knowledge of schistosomiasis and geohelminthiasis
Data on the knowledge of the population studied about SCH and geohelminthiasis are given in Table 1. This shows that only 44.31% of respondents had heard of SCH. For the conversation group (household awareness), hospitals and awareness-raising campaigns were the primary sources of information, accounting for 66.53% of the responses (Figure 2). There was a low proportion of respondents with good knowledge of the mode of transmission (30.42%), symptoms (24.34%), and methods of prevention (17.86%) of this disease. The same was true of STHs, where 39.55% of respondents knew about modes of transmission and 30.95% about symptoms. However, 52.91% of respondents had already heard of STHs (Table 2), and the most frequently used information channel was always the same (conversation group, hospitals, and awareness-raising campaigns), with a proportion of 65.61% (Figure 2).
Table 1.
Population knowledge about schistosomiasis and geohelminthiasis in the district of Ndikiniméki.
| Categories | Answers | N | % |
|---|---|---|---|
| Heard about schistosomiasis | Yes | 335 | 44.31 |
| No | 421 | 55.69 | |
| Mode of transmission | Good answer | 230 | 30.42 |
| Bad answer | 526 | 69.58 | |
| Types of symptoms | Good answer | 184 | 24.24 |
| Bad answer | 572 | 75.66 | |
| Preventive measures | Yes | 135 | 17.86 |
| No | 621 | 82.14 | |
| Heard about soil-transmitted helminth | Yes | 400 | 52.91 |
| No | 356 | 47.09 | |
| Modes of transmission | Good answer | 299 | 39.55 |
| Bad answer | 457 | 60.45 | |
| Types of symptoms | Good answer | 234 | 30.95 |
| Bad answer | 522 | 69.05 |
Figure 2.
Sources of information about schistosomiasis (a) and soil-transmitted helminths (b) in Ndikiniméki factors associated with good knowledge of schistosomiasis.
Table 2.
Factors associated with good knowledge about schistosomiasis in study site.
| Categories | Good knowledge (%) | Bad knowledge (%) | Adjusted odds ratio (95% confidence interval) |
P-value |
|---|---|---|---|---|
| Gender (Female = ref) | 18 (4.28) | 403 (95.72) | - | - |
| Male | 23 (6.87) | 312 (93.13) | 0.19 (0.48-0.88) | 0.57 |
| Age group (<30 = ref) | 12 (4.62) | 248 (95.38) | - | - |
| [30-50] | 13 (5.10) | 242 (94.90) | 1.47 (0.32-2.82) | 0.02 |
| ≥50 | 16 (6.64) | 225 (93.36) | 0.74 (0.36-2.05) | 0.21 |
| Level of education (illiterate = ref) | 1 (2.44) | 40 (97.56) | - | - |
| Primary level | 10 (2.95) | 329 (97.05) | 0.12 (1.60-3.05) | 0.91 |
| Secondary level | 24 (7.19) | 310 (92.81) | 1.37 (0.31-4.30) | 0.19 |
| University level | 6 (14.29) | 36 (85.71) | 2.26 (0.20-5.32) | 0.06 |
| Occupation (public servant = ref) | 7(21.21) | 26 (78.79) | - | - |
| Small-scale business | 29 (4.32) | 576 (95.68) | 0.81 (1.8-0.34) | 0.14 |
| University students | 0 (0) | 19 (100) | 0.46 (3.84-9.54) | 0.98 |
| Secondary school students | 8 (7.84) | 94 (92.16) | 0.20 (1.38-1.94) | 0.80 |
| House types (earth brick = ref) | 14 (5.67) | 233 (94.33) | - | - |
| Hard | 16 (6.69) | 223 (93.31) | 0.13 (0.66-0.94) | 0.73 |
| Semi-hard | 11 (4.1) | 257 (95.90) | 0.41 (0.27-0.42) | 0.33 |
| Plank | 0 (0) | 2 (100) | 0.18 (1.22-4.23) | 0.99 |
| Watercourse (close to home = ref) | 33 (6.5) | 475 (93.5) | - | - |
| Far to home | 8 (3.23) | 240 (96.77) | 0.98 (0.90-1.18) | 0.02 |
ref = reference. Age in year; percentages are calculated by rows.
Factors associated with good knowledge of schistosomiasis
Table 2 presents the proportions of “good knowledge” and “bad knowledge” about SCH for each category of respondent, and measures of association such as OR and 95% confidence intervals (CI). At all 5.42% of respondents had good knowledge about this disease and 94.58% had little knowledge. Regression logistic results showed that age group was significantly associated with knowledge of this disease. More clearly, people in the 30-50 years age bracket had better knowledge than those under 30 years (5.10% compared with 4.62%), and this association was significant. Level of education is not significantly associated with knowledge of the SCH, except for university level, which shows a trend toward better knowledge (14.29% compared with 2.44% for illiterate people). The proximity of houses to freshwater streams was also significantly associated with knowledge of SCH, with the level of knowledge of respondents living in houses far from freshwater streams being significantly lower than those living in houses close to streams (adjusted OR [aOR]: 0.98; CI: 0.90-1.18; P = 0.02).
Factors associated with good knowledge of geohelminthiasis
From this analysis, Table 3 shows that 39.42% of respondents had good knowledge of STHs, and the multivariate analyses showed that certain factors, notably sex, level of education, and type of habitat, were significantly associated with good knowledge of these diseases in our study site. With regard to gender, men had a significantly better knowledge of STH than women (35.52% vs 42.52%) (aOR: 1.48; CI: 1.09-2.03; P = 0.01). The level of education was a factor significantly associated with better knowledge of STH, with an aOR of 0.41 for secondary school graduates and 0.25 for university graduates. In relation to respondents' type of dwelling, it emerged that those living in solid houses were significantly associated with good knowledge of these parasites (aOR: 0.68; CI: 0.46-0.99; P = 0.04) compared with those living in mud or wooden houses. Finally, proximity to a watercourse was not associated with better knowledge of STH.
Table 3.
Factors associated with good knowledge about soil-transmitted helminths in study site.
| Categories | Good knowledge (%) | Bad knowledge (%) | Adjusted odds ratio (95% confidence interval) |
P-value |
|---|---|---|---|---|
| Gender (Female = ref) | 179 (42.52) | 242 (57.48) | - | - |
| Male | 119 (35.52) | 216 (64.48) | 1.48 (1.09-2.03) | 0.01 |
| Age group (<30 = ref) | 104 (40) | 156 (60) | - | - |
| [30-50] | 102 (40) | 153 (60) | 0.76 (0.47-1.23) | 0.27 |
| ≥50 | 92 (38.17) | 149 (61.83) | 0.81 (0.51-1.26) | 0.35 |
| Level of education (illiterate = ref) | 10 (24.39) | 31 (75.61) | - | - |
| Primary level | 121 (35.69) | 218 (64.31) | 0.56 (0.25-1.17) | 0.14 |
| Secondary level | 144 (43.11) | 190 (56.89) | 0.41 (0.18-0.86) | 0.02 |
| University level | 23 (57.76) | 19 (45.27) | 0.25 (0.08-0.70) | 0.01 |
| Occupation (public servant = ref) | 20 (60.61) | 13 (39.39) | - | - |
| Small-scale business | 225 (37.38) | 37 7 (62.62) | 1.92 (0.89-4.26) | 0.09 |
| University students | 8 (42.11) | 11 (57.89) | 2.43 (0.68-9.06) | 0.17 |
| Secondary school students | 45 (44.12) | 57 (55.88) | 1.58 (0.62-4.04) | 0.34 |
| House types (earth brick = ref) | 91 (38.84) | 156 (63.16) | - | - |
| Hard | 114 (47.70) | 125 (52.30) | 0.68 (0.46-0.99) | 0.04 |
| Semi-hard | 92 (34.33) | 176 (65.67) | 1.16 (0.8-1.68) | 0.42 |
| Plank | 1 (50) | 1 (50) | 0.37 (0.01-9.78) | 0.49 |
| Watercourse (close to home = ref) | 199 (39.17) | 309(60.83) | - | - |
| Far to home | 99 (39.92) | 149 (60.08) | 1.13 (0.81-1.59) | 0.46 |
ref = reference. Age in year; percentages are calculated by rows.
General attitudes and practices of participants' regarding geohelminthiasis and schistosomiasis
Table 4, Table 5 present the results on the factors associated with good and bad practices and attitudes of respondents toward SCH and STHs. The results show that 9.39% and 15.61% of respondents had good attitudes and practices toward these diseases, respectively. Multivariate analysis showed that factors such as gender, type of housing, and proximity of houses to freshwater streams were significantly associated with respondents' good attitudes and practices toward STHs, with a high level of significance. As for the gender factor, women had better attitudes (70%) than men (48%), with an OR of 1.18, which means that women are more likely to have good attitudes and practices. However, there was no significant difference between the age groups or levels of education. In contrast, university students had better attitudes (21.43%) than in other occupations. As for the type of housing, hard houses had better attitudes and practices (23.85%) than earth brick or plank houses. In terms of the proximity of houses to watercourses, people living far from a watercourse had better attitudes (22.98%) than those living close to home. For the SCH in particular, men had better attitudes and scores (9.55%) than women (9.26%), with a very significant difference. In terms of age, people aged between 30 and 50 years and those over 50 years had significantly better attitudes and practices (9.02%) than young people under 30 years (6.92%). As for the level of education, people with a university education had significantly better attitudes (21.43%) than illiterate people (2.44%).
Table 4.
Factors associated with good attitudes and practices about schistosomiasis in study site.
| Categories | Good attprac (%) | Bad attprac (%) | Odds ratio (95% confidence interval) | P-value |
|---|---|---|---|---|
| Gender (Female = ref) | 39 (9.26) | 382 (90.74) | - | - |
| Male | 32 (9.55) | 303 (90.45) | 1.24 (0.74-2.13) | 0.00041 |
| Age group (<30 = ref) | 18 (6.92) | 242 (93.08) | - | - |
| [30-50] | 23 (9.02) | 232 (90.98) | 0.23 (0.07-0.61) | 0.0057 |
| ≥50 | 30 (12.45) | 211 (87.55) | 0.38 (0.12-0.99) | 0.06 |
| Level of education (illiterate = ref) | 1 (2.44) | 40 (97.56) | - | - |
| Primary level | 31 (9.14) | 308 (90.85) | 0.28 (0.02-1.39) | 0.22 |
| Secondary level | 30 (8.98) | 304 (91.02) | 0.22 (0.01-1.13) | 0.15 |
| University level | 9 (21.43) | 33 (78.57) | 0.10 (0.01-0.71) | 0.04 |
| Occupation (public servant = ref) | 7 (21.21) | 26 (78.79) | - | - |
| Small scale business | 51 (8.47) | 551 (92.53) | 1.86 (0.63-4.87) | 0.23 |
| University students | 3 (15.79) | 16 (84.21) | 0.74 (0.12-5.09) | 0.75 |
| Secondary school students | 10 (9.8) | 92 (90.2) | 0.73 (0.15-3.08) | 0.68 |
| House types (earth brick = ref) | 17 (6.88) | 230 (93.12) | - | - |
| Hard | 33 (13.81) | 206 (86.19) | 0.62 (0.32-1.19) | 0.15 |
| Semi-hard | 20 (7.46) | 248 (92.54) | 1.04 (0.52-2.06) | 0.92 |
| Plank | 1 (50) | 1 (50) | 0.08 (0-2.18) | 0.08 |
| Watercourse (close to home = ref) | 37 (7.28) | 471 (92.72) | - | - |
| Far to home | 34 (13.71) | 214 (86.29) | 0.62 (0.37-1.07) | 0.08 |
ref = reference. Age in year; percentages are calculated by rows.
Table 5.
Factors associated with good attitudes and practices about soil-transmitted helminths in study site.
| Categories | Good attprac (%) | Bad attprac (%) | Odds ratio (95% confidence interval) | P-value |
|---|---|---|---|---|
| Gender (Female = ref) | 70 (16.63) | 351 (83.37) | - | - |
| Male | 48 (14.33) | 287 (85.67) | 1.18 (0.77-1.81) | 0.04 |
| Age group (<30 = ref) | 38 (14.62) | 222 (85.38) | - | - |
| [30-50] | 42 (16.47) | 213 (83.53) | 0.75 (0.37-1.46) | 0.4 |
| ≥50 | 38 (15.77) | 203 (84.83) | 0.69 (0.36-1.30) | 0.26 |
| Level of education (illiterate = ref) | 3 (7.32) | 38 (92.68) | - | - |
| Primary level | 54 (15.93) | 285 (84.07) | 0.46 (0.11-1.39) | 0.22 |
| Secondary level | 52 (15.57) | 282 (84.43) | 0.43 (0.10-1.34) | 0.19 |
| University level | 9 (21.43) | 33 (78.57) | 0.49 (0.08-2.05) | 0.32 |
| Occupation (public servant = ref) | 5 (15.15) | 28 (84.85) | - | - |
| Small scale business | 92 (15.28) | 510 (84.72) | 0.85 (0.26-2.32) | 0.76 |
| University Students | 5 (26.32) | 14 (73.68) | 0.41 (0.08-2.13) | 0.29 |
| Secondary school students | 16 (15.69) | 86 (84.31) | 0.87 (0.07-0.31) | 0.84 |
| House types (earth brick = ref) | 10 (4.05) | 237 (95.95) | - | - |
| Hard | 57 (23.85) | 182 (76.15) | 0.16 (0.07-0.31) | 4.09e−07 |
| Semi-hard | 50 (18.66) | 218 (81.34) | 0.19 (0.09-0.38) | 5.59e−06 |
| Plank | 1 (50) | 1 (50) | 0.06 (0-1.75) | 0.06 |
| Watercourse (close to home = ref) | 61 (12.01) | 447 (87.99) | - | - |
| Far to home | 57 (22.98) | 191 (77.02) | 0.62 (0.40-0.95) | 0.03 |
ref = reference. Age in year; percentages are calculated by rows.
Discussion
This study presents the level of knowledge, attitude, and practices of Ndikiniméki populations on SCH and geohelminthiases. It appears that the people in the Ndikiniméki area have a relatively low level of knowledge about the causes, symptoms, and preventive measures for SCH and STHs. A study conducted in Ingwavuma in the uMkhanyakude district of South Africa found that people in this locality had a knowledge level of less than 50% about these parasitoses [17]. Our observations indicate a lack of health education among the population of Ndikiniméki regarding these two diseases, despite the awareness campaigns implemented in this locality. This would suggest that they are not receptive to the information conveyed by this channel or that they do not consider it. Television was the channel through which few people in this population received information about these diseases. These results could be due to the lesser dissemination of health education programs on these diseases, or to people's accessibility to this channel, given that this locality is a rural area where electrification and connections are not always favorable for the use of these devices. Furthermore, the results of this work suggest that certain demographic and environmental factors are associated with good knowledge of these diseases, but it should be noted that the associations were not significant. It is therefore important to target these groups namely the population of Ndikiniméki to improve their knowledge and prevent the disease. In this context, the level of education is a crucial factor that contributes to a better knowledge of SCH. This is due in part to the integration of lessons on SCH and STHs into school curricula in Cameroon. These results are not consistent with those of Midzi et al. [18] where schools are not a major channel of information because lessons on these diseases are not integrated into school curricula. Schools are thus becoming a strategic channel for communicating health information, especially to schoolchildren who are the most affected by these diseases, enabling them to change their behavior in favor of prevention. In contrast, people admitted to hospital wards because of these illnesses would be susceptible to the good knowledge recommended by the staff, and so also constitute a strategic channel for education. In addition, people living in solid houses have a better knowledge of SCH than those living in mud or wooden houses. Logically, people living in healthier housing conditions should be more aware of these diseases. However, no link has been established between the level of education and the economic status of this group. Our results suggest that SCH awareness and education campaigns should particularly target men, people with little education, and those living in poor housing conditions. It is also important to note that distance to a waterway does not guarantee greater awareness of these diseases. These people's lack of knowledge about SCH and STHs makes them susceptible to transmission and therefore constitutes a risk factor associated with infection. It is in this regard that Opara et al. [19] have shown that this factor constitutes a risk significantly associated with SCH infection. The data from our study on attitudes and practices toward SCH and STHs show that Ndikiniméki populations in the majority of cases have poor practices and attitudes which further expose them to diseases.
Similar results were observed in 2018 in Ibadan in south-west Nigeria [20]. It should also be noted that certain demographic and environmental factors are associated with good attitudes and practices in the face of these parasitoses. For example, in the case of STHs, women have better attitudes and practices than men in terms of preventing this disease. This could be due to differences in social roles or family responsibilities. However, the level of education did not have a significant impact on attitudes and practices, which is surprising since we might expect better-educated people to have better attitudes toward prevention. In contrast, people living in solid houses have better attitudes and practices than those living in mud or wooden houses, which could be due to the quality of the housing and access to adequate sanitary facilities. With regards to the factor of proximity to watercourses, people living far from a watercourse had better attitudes than those living nearby, which could be due to less exposure to the potentially infected water. These results could help target public health interventions toward improving attitudes and practices with regard to SCH prevention, particularly among men, people living in mud or wooden houses, and those living near watercourses. Data on attitudes and practices toward the SCH were influenced by gender, age, and level of education. People aged between 30 and 50 and those aged 50 and over had better attitudes toward SCH prevention than young people under 30. This could be because older people have more experience and knowledge of the disease, and a greater awareness of the associated risks. In addition, people with university education have better attitudes toward SCH prevention than illiterate people. This is consistent with the fact that education is a key factor in awareness and the adoption of healthy behaviors. These results were similar to those of Sady et al. [21] in populations from 10 rural districts of Yemen. However, no significant difference between house types was shown highlighting the fact that other factors, such as access to adequate sanitation facilities, play a more important role in preventing SCH. Similarly, the results do not show any significant difference between people living near a watercourse and those living far from a watercourse, which could be because other factors, such as individual behavior and knowledge about the disease, play a more important role in preventing SCH. For example, the severe shortage of drinking water in this locality means that people are forced to use freshwater streams of dubious quality to meet their various household needs (drinking water, washing up, etc.). In addition, WASH methods could not be respected. Phillips et al. [22] argued that in communities where there is an improvement in the availability of drinking water, people are more likely to adopt good practices and, as a result, the risk of infection is significantly lower.
Limitations of the study
This study was conducted in a rural area and therefore presents the main limit that the results obtained cannot be ruled for the Ndikiniméki the general population. In addition, participants were selected based on their accessibility and representativeness could introduce a selection bias into this study. Finally, the study did not take into account other factors such as cultural and religious beliefs and traditional practices that could influence knowledge and attitudes toward SCH prevention.
Conclusion
This study revealed a low level of knowledge about SCH and STHs among Ndikiniméki district studied population with the majority displaying poor attitudes and practices in relation to these diseases. The people of Ndikiniméki therefore need greater awareness and education about these parasites. Public health interventions need to be stepped up and targeted at specific groups such as women, young people under 30 years, and the illiterate, and those who do not have access to adequate sanitation facilities. Education and awareness programs through community meetings or community health workers, and initiatives to improve access to adequate sanitation facilities such as construction of boreholes and laundry points, should be more effective in improving knowledge, attitudes, and practices for the prevention of SCH and STHs.
Declarations of competing interest
The authors have no competing interests to declare.
Acknowledgments
Funding
This work received financial support from ISID/BMGF.
Ethical considerations
The research protocol was approved and signed on 11 July 2023 by the Regional Human Health Research Ethics Committee of Centre-Cameroon under ethical approval document N°-00427/CRERSHC/2023. Administrative authorities and household heads gave their authorizations for the study at the subdivision and community levels, respectively. All participants signed a consent to participation form after being informed of the purpose and objectives of the study.
Acknowledgment
We thank all authors and reviewers for their significant contribution to the completion of this research article. We thank all residents who agreed to participate in this study.
Author contributions
The study design was carried out by BB and AAHP. The KAP surveys were carried out by BB, FCT, DNL, FTJC, TBCA, and DNT. Data processing and conservation were carried out by BB, DJ, and JS. The geographical map was produced by JS. Original droughting by BB and editing by AAHP, CU, TJ, DJ, ANC, and KFAC. All authors have read and approved the final manuscript.
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