Despite its worldwide distribution,
Health education (HE) continues to be one of the most important strategies in the fight against intestinal parasites [
In childhood giardiasis, mothers and other caregivers, are therefore, of foremost importance in recognizing the disease and seeking treatment for their wards. Very little is known about the perceptions of parents and carers when dealing with giardiasis in the paediatric setting. Their ideas and behaviours concerning giardiasis might enhance or interfere with the effectiveness of giardiasis prevention and control. Understanding their perceptions concerning this disease is an important step towards the disease control. A qualitative study in Cuba by Escobedo et al., in 2011, reported deficiencies in the children caregivers’ knowledge and practices concerning giardiasis [
It is important to assess the current knowledge about giardiasis before devising an intervention strategy for education campaigns among general population. The purpose of this study was to (1) explore the perceptions of a group of caregivers about medical aspects of giardiasis (clinical features, modes of transmission, prevention, and consequences), its prevention and treatment; (2) assess the sources and channels of information caregivers would prefer using to be informed about giardiasis. All of this might highlight areas where the support of health care professionals can be improved.
This was a descriptive cross-sectional study conducted between January and March 2010, at Academic Paediatric Hospital Centro Habana (APHCH), Havana, Cuba. This 226-bed study hospital is a government-funded and public facility which provides secondary and tertiary medical care and active ambulatory and emergency services, within all clinical and surgical specialities, for children from all over Cuba but mainly to the paediatric population from the municipalities of Centro Habana, Cerro, Habana Vieja, and Plaza municipalities.
The study included respondents aged >18 years who were willing to participate in the study and gave individual verbal consent. Only health professionals and students in the medical professions were excluded to avoid selection bias.
A structured questionnaire was designed on the basis of a qualitative research conducted in the same hospital by the authors [
All consecutive parents/carers who fulfilled the eligibility criteria for inclusion and who agreed to participate were recruited if they were either new attenders or reattending. Respondents were adult members of patients’ families (parents/carers) who visited the outpatient clinic of APHCH for gastrointestinal problems. After the interviewers, who were three of the research team authors (Y. Salazar, M. Alfonso, and I. V. Dawkins), explained the purpose of the study and obtained individual verbal consent from the respondents, they administered the questionnaire to parents/carers, while waiting for the consultation of their child. The interviews were conducted in private to maintain confidentiality and to reduce the influence of relations of peers.
The study was approved by the APHPC’s Ethics for Research Committee. Verbal informed consent was obtained from the study participants before the research instruments were administered. Confidentiality of all information obtained from participants was maintained by not allowing information to be accessible to nonmembers of the research team.
Database was prepared using Epi Info Version 6.0, and accordingly data entry was done. Frequency distributions were obtained. In the exploration of possible associations between respondent characteristics and awareness about transmission and prevention, analysis was done taking into account education of respondents, which was categorized into two categories (less than 12 years of formal education or ≥12 years of formal education) and age of respondents (less than 40 year of age and ≥40 years of age). Crude odds ratio (OR), their 95% confidence intervals (CIs) and
The response rate of this study was 100%. Of the 202 caregivers interviewed, 177 (87.6%) were females and 25 (12.4%) were males. The mean was 35.9 years (range 18–70). A substantial proportion of caregivers, 157 (77.7%), had received 12 years of formal education or more, and 128 (63.3%) were employed outside home.
Of the 202 caregivers, more than half (72.7%) considered that giardiasis is a modern problem, and, although almost half (47.5%) stated that this disease could not lead to death, 39.1% did, and 13.4% did not know. Small intestine was correctly identified as the site of giardiasis by 125 (61.9%) of the caregivers. However, more than one organ was mentioned as a possible target of
Responses to questions on communicable nature, mode of transmission, possibility of cure, and knowledge about symptoms of giardiasis among 202 caregivers.
Response to questions | No. | (%) |
---|---|---|
Is it a modern problem? | ||
Yes | 147 | (72.7) |
No | 45 | (22.3) |
Do not know | 10 | (5.0) |
May lead to death | ||
Yes | 79 | (39.1) |
No | 96 | (47.5) |
Do not know | 27 | (13.4) |
The organ affected by |
||
Small intestine | 125 | (61.9) |
Gallbladder | 66 | (32.7) |
Liver | 54 | (26.7) |
Stomach | 11 | (5.4) |
Lungs | 1 | (0.5) |
Bones | 1 | (0.5) |
Colon | 1 | (0.5) |
Do not know | 39 | (19.3) |
If one is infected by |
||
Not necessary feel or know about it | 127 | (62.9) |
Not have symptoms | 0 | (—) |
Have symptoms | 39 | (19.3) |
Do not know | 36 | (17.8) |
Symptoms and signs of giardiasis | ||
Abdominal paina | 132 | (65.3) |
Diarrhoeaa | 120 | (54.4) |
Loss of weighta | 101 | (50) |
Hivesa | 88 | (43.5) |
Itchinga | 66 | (32.6) |
Spots in the skina | 55 | (27.2) |
Tirednessa | 23 | (11.3) |
Fevera | 16 | (7.9) |
Blood in faecesa | 12 | (5.9) |
Do not know | 32 | (15.8) |
Most effective diagnostic tool | ||
Microscopy of duodenal aspirate | 171 | (84.6) |
Microscopy of faeces | 18 | (8.9) |
Biopsy | 2 | (0.9) |
Do not know | 9 | (4.4) |
Is giardiasis preventable? | ||
Yes | 175 | (86.6) |
No | 19 | (9.4) |
Do not know | 8 | (4) |
Is giardiasis curable? | ||
Yes | 191 | (94.5) |
No | 9 | (4.4) |
Do not know | 2 | (0.9) |
aPercentages are of the persons that knew at least one symptom.
The majority of caregivers, 171 (84.6%), considered the microscopy of duodenal aspirate as the most effective diagnostic tool for giardiasis. The microscopy of faecal smears was only cited by 18 (8.9%) respondents (Table
One hundred and sixty-nine caregivers (83.6%) in this study knew that
Correctly answered questions about the transmission of giardiasis among the 202 caregivers who participated.
Answered correctly that giardiasis is transmitted |
|
|
---|---|---|
No. | (%) | |
Through drinking unboiled water (yes) | 189 | (93.5) |
Through unwashed vegetables and fruit intake (yes) | 176 | (87.1) |
Through walking barefoot (no) | 145 | (71.7) |
Through utensils used by patients with giardiasis (no) | 101 | (50) |
During delivery (no) | 185 | (91.5) |
Through drinking unboiled water; unwashed vegetables and fruit intake | 169 | (83.6) |
Score of correct answers | ||
All 5 correct answers | 63 | (31.1) |
Any 4 correct answers | 81 | (40.1) |
Any 3 correct answers | 47 | (23.2) |
Any 2 correct answers | 8 | (3.9) |
Only 1 correct answer | 0 | (—) |
No correct answer | 0 | (—) |
Answer “I do not know” to all | 3 | (1.5) |
Factors associated with the knowledge that giardiasis is transmitted by drinking unboiled water and unwashed vegetables and fruit intake.
Investigated | At least 1 incorrect answer | All 2 correct answers | ORa (95% CIb) | |||
---|---|---|---|---|---|---|
( |
( | |||||
Age | ||||||
Under 40 years | 125 | 22 | (17.6) | 103 | (82.4) | 1 |
40 years and over | 77 | 11 | (14.3) | 66 | (85.7) | 1.3 (0.6–3.0) |
Educational level | ||||||
Below high school | 45 | 16 | (35.5) | 29 | (64.4) | 1 |
High school and above | 157 | 17 | (10.8) | 140 | (89.2) | 4.5 (1.9–10.8) |
aOdds Ratio. bConfidence interval.
Nearly all caregivers (95.5%) were aware that giardiasis was a curable disease (Table
Perceived methods of prevention reported by caregivers.
Answered correctly that giardiasis is prevented |
|
|
---|---|---|
No. | (%) | |
Feeding boiled water (yes) | 175 | (86.3) |
Hand washing before feeding (yes) | 181 | (89.6) |
Washing fruits and vegetables (yes) | 185 | (91.5) |
Avoiding walking barefoot (no) | 136 | (67.3) |
Avoiding utensils used by patients with giardiasis (no) | 135 | (66.8) |
Through drinking boiled water, washing hands before | ||
eating, and washing vegetables and fruit | 150 | (74.2) |
Score of correct answers | ||
All 5 correct answers | 74 | (36.6) |
Any 4 correct answers | 72 | (35.6) |
Any 3 correct answers | 51 | (25.2) |
Any 2 correct answers | 1 | (0.5) |
Only 1 correct answer | 2 | (0.9) |
No correct answer | 2 | (0.9) |
Factors associated with the knowledge that giardiasis may be prevented by drinking boiled water, washing hands before eating, and washing vegetables and fruit.
Investigated | At least 1 incorrect answer | All 3 correct answers | ORa (95% CIb) | |||
---|---|---|---|---|---|---|
( |
( |
|||||
Characteristic | ||||||
Age | ||||||
Under 40 years | 125 | 36 | (28.8) | 89 | (71.2) | 1 |
40 years and over | 77 | 16 | (20.8) | 61 | (79.2) | 1.5 (0.8–3.2) |
Educational level | ||||||
Below high school | 45 | 19 | (42.2) | 26 | (57.8) | 1 |
High school and above | 157 | 33 | (21.0) | 124 | (79 ) | 2.8 (1.3–5.9) |
aOdds Ratio. bConfidence interval.
One hundred and fifty-nine of the caregivers stated that they did not receive information on giardiasis during the last year from any source or channel. Caregivers were asked which methods they would prefer to know or to improve their knowledge about giardiasis. Among the suggested sources and channels, television was mentioned by 130 (64.3%), nurses and medical doctors 107 (52.9%), printed materials—leaflets, posters, and pamphlets—94 (46.5%), and radio 35 (17.3%).
The goals of treating symptomatic giardiasis properly are to minimize the duration of illness, ensure cure, stop transmission of infection, and could also be to prevent the emergence of drug resistance. Caregivers’ input, as in other areas of medicine involving children, seems to be critical to clinical management in paediatric giardiasis. The importance of providing caregivers with appropriate information is to enable them to participate effectively in giardiasis recognition, and preventative measures should be recognized.
Even when there were some important gaps in various issues, it was encouraging to observe that in most issues caregivers’ perceptions on giardiasis closely paralleled that of the biomedical understanding. This coincidence should be used as an entry point for a broader HE activity, which is then expanded to also accommodate other disease aspects, that is, its mode of transmission, signs and symptoms, and appropriate prevention methods, to provide accurate and complete knowledge on giardiasis.
Internationally, this disease is gaining increasing attention, first as a reemerging infectious disease in industrialized countries and, second, as a part of the “Neglected Disease Initiative” by the World Health Organization [
The intermittent excretion of
The caregivers demonstrate a general knowledge of giardiasis transmission and prevention. However, there were some important gaps concerning these two issues which indicate that people today tend to combine all of the general preventive measures against intestinal parasitic infections, maybe, as a reflection of a result of previous activities directed at intestinal parasites control. Additionally, there exists a link between hygiene and infection, which is a common theme in the lay literature, and caregivers could be able to make connections and draw inferences from previous similar experiences.
In the present study, the higher educational level of the caregivers had a positive influence on the knowledge of transmission and prevention of giardiasis. The parents’ educational level is one of the factors of health inequalities among children [
To target populations for prevention messages, it is important to know which sources and channels of information are most frequently reported as being used to keep informed about a specific topic. Consistent with a previous study [
HE materials such as posters and brochures may be an effective way to disseminate health information, providing such information in the local language that could be displayed at prominent places, such as health facilities and community centres. At present, access to culturally appropriate and easy-to-understand educational materials on giardiasis is lacking. Based on this study, it may be recommended that HE materials oriented towards increasing the knowledge in different issues of giardiasis should be developed. An interesting experience comes from a study carried out in schools in south Tehran. The case group and their mothers were separately covered by the HE programmes that included washing hands with soap, cutting nails, washing vegetables, and making the families knowledgeable about giardiasis and its effects on their children. All the programmes were performed by HE methods, that is, poster, video film, face-to-face meetings, and pamphlets. The control group had not undergone any health education programme. Three months later, a triple stool examination was done in both groups to check reinfection. After the implementation of the programmes, the mean of the mother’s awareness about controlling of giardiasis increased from 6.54% to 27.16% (
The interpersonal communication, which is the most effective method of communicating health information [
Study participants were restricted to caregivers who were recruited from only one health facility, and, therefore, their views may be biased by contact with the same paediatric gastroenterology team and their standard educational practices. Participants were recruited among parents/carers attending to the hospital (a majority resided in Havana), and thus we likely failed to capture the views of people in other provinces. As parents were recruited from those taking their children to the outpatient clinic for gastroenterology and within population are likely to be a large group of children who have giardiasis, it is reasonable to assume that parents of these children are more likely to know what giardiasis is than parents from the general population. Additionally, it should be noted that people attending health facilities at a hospital are expected to have a relatively greater awareness about common health issues. There is not a previous study in this area, and hence this questionnaire survey was the first to explore some of the issues in detail. Face-to-face administration of the questionnaire might have led to some degree of bias in the interviewees’ responses.
The study has revealed reasonable knowledge of the symptoms of giardiasis; however, there is a need for educational intervention directed towards correcting misconceptions. There was a need for an effective education programme focusing on giardiasis transmission and prevention which should be emphasised in order to avoid reinfections. The central necessity of caregivers’ involvement in developing educational strategies that reflect their understandings and interpretations of this disease should not be overlooked.
P. Almirall, A. A. Escobedo, and S. Cimerman conceived the study; P. Almirall, A. A. Escobedo, M. Alfonso, and S. Cimerman designed the study; P. Almirall and I. Ávila supervised data collection; Y. Salazar, I. V. Dawkins and M. Alfonso collected the data; all authors analyzed and interpreted the data; A. A. Escobedo, P. Almirall, and S. Cimerman drafted the paper; M. Alfonso, I. Ávila, Y. Salazar and I. V. Dawkins critically revised the paper. All authors read and approved the final paper.
The authors are grateful to the caregivers who participated and to the hospital staff for providing support and cooperation.