Knowledge and Attitude of Newly Graduated Doctors towards Soil Transmitted Helminthic Infections- Sudan-2017

Introduction

Parasite helminthes (worms) that infect humans belong to two phyla, phylum Platyhelminthes (flat worms) and phylum nematode (round worms). The main soil transmitted nematode species are Ascaris lumbricoides, Trichuris trichiura and the hookworms (Necatoramericanus and Ancylostoma duodenal) [1, 2]. In the vast majority of developing tropical and subtropical regions of the world, helminthes parasite infections, particularly those soil transmitted helminthes and schistosomes, constitute to be major public health and developmental challenges. They are associated with poverty and underdevelopment is most prevalent in the poorest communities of the developing world [3]. Intestinal helminthic infections often lead to iron deficiency anemia (IDA), protein-energy malnutrition, stunting (a measure of chronic under nutrition), wasting (a measure of acute under nutrition), listlessness and abdominal pain and may negatively affect class- attentiveness of school children. The tropical climate and

Results

poor hygienic conditions under which the socio- economically deprived rural dwellers live facilitate the development and transmission of these helminthes infections [4, 5]. The burden of these helminthes parasite infections has been consistently underestimated in the past, but there was now a general consensus that STH infections and schistosomiasis represent an important public health problem especially for children. Although light helminthic infections are often asymptomatic, the adverse health and nutritional impacts of severe worm infections on children. Without chemotherapeutic treatment, the infections may also have more serious medical consequences in a minority of cases: roundworm infections sometimes lead to fatal intestinal obstruction, hookworm infection can cause severe anemia, and whipworm is associated with chronic dysentery [6, 7].

Research Methodology

This was institutional-based descriptive cross – sectional study design. Concerning knowledge and attitude of the soil transmitted helminthes among (218) newly graduated doctors with 100% response rate. The data were collected in December 2016.

About 21.1% of the participants were males while 78.9%, of them were females with 1:4 males to females’ ratio. 90.4% of the participants studied six years in their medical schools. 51.8% of the participants were Type of curriculum Count 7 24 73 9 113 Expected Traditional Count 5 11 4 1 21 Expected Innovative Count 1 9 5 0 15 Expected Hybrid Count 10 16 43 0 69 Expected I don’t know Total graduated from medical schools adopting traditional curricula while 31.7% of them reported that they did not know the type of their currciulula. 99% of the participants were graduated from Sudan.

Intervention strategy to control the spread of the helminthes in a high-risk group Total Child nutrition Selective mass chemotherapy Treatment for I don’t individual know.

Count 11.9 31.1 64.8 5.2 113

Count 2.2 5.8 12 1 21

Count 1.6 4.1 8.6 0.7 15

Count 7.3 19 39.6 3.2 69

Count 23 60 125 10 218 Expected

Count 23 60 125 10 218

Drug of choice of an adult patient with Ascariasis

Total Levamisole 150mg tablets

Traditional Count 42 0 62 9 113

Expected Count 34.2 13 42.5 23.3 113

Innovative Count 3 3 13 2 21

Expected Count 6.4 2.4 7.9 4.3 21

Hybrid Count 12 0 3 0 15

Expected Count 4.5 1.7 5.6 3.1 15

I don’t know Count 9 22 4 34 69

Expected Count 20.9 7.9 26 14.2 69

Total Count 66 25 82 45 218

Expected Count 66 25 82 45 218

P value=0.00 The type of curriculum versus knowledge of the participants about primary prevention for Ancylostoma doudenale, yielded statistically significant difference (P value=0.00). Table 4: Curriculum versus knowledge of participants about primary prevention for Ancylostoma doudenale.

Discussion

21.1% of the study participants were males, while 78.9%, of the participants were females with 1:4 male to female ratio. Sudan HRH Survey revealed that the percentage of the female among the total health workers is 51%. This could be a result of the increasing female Intake to the health training institutes, especially the medical and nursing schools [8]. Only37.6% of the study participants answered drug of choice of an adult patient with Ascariasis praziguntel tablet 600mg, and 30.3% of them answered as Levamisole 150mg tablet. There was statistically significant difference (P-value = 0.00), between type of curriculum and drug of choice for treatment of an adult patient with Ascariasis which indicates that curricula studied by the participants were traditional and mostly theoretical [9]. Only 40.8% of the study participants identified the primary prevention of ancylostomiasis as construction of pit latrines and 28% identified shoes wearing while 22.9% said avoiding of swimming in river. There was statistically significant difference (P-value = 0.000) between type of curriculum and participants’ knowledge of primary prevention for ancylostomiasis. This may reflect the curricular variation in addressing the topic. Nevertheless, only 20.2% of the participants identified the primary prevention of ancylostomiasis as shoes wearing [10].

About 64.7% of the study participants identified health education as the main intervention to control the spread of helminthes in a community with high intensity of infection. About 57.5 of the study participants identified treatment of individual cases as the main intervention strategy that can be applied to control the spread of the helminthes in a high-risk group. There was statistically significant difference (P-value = 0.00) between the type of curriculum and drug the main intervention strategy that can be applied to control the spread of the helminthes in a high-risk group such as school age children. WHO has recommended three interventions measures to control morbidity due to STH infections. This includes regular drug treatment of high-risk groups for reduction of the worm burden over time, health education and sanitation supported by personal hygiene aimed at reducing soil contamination [11]. 42.7% of the study participants studied about soil transmitted helminthes in the Parasitology, 38.1% studied in Epidemiology, and 18.3% studied in Community Medicine/Preventive Medicine. There was statistically significant difference (P-value = 0.000) between type of curriculum and subjects related to soil transmitted helminthes studied by the participants at under graduate level. The study indicates that soil transmitted helminthes is scattered between different subjects without integration and mostly at the pre-clinical level [12].

Conclusion

Participants from medical colleges in Sudan seems to be studied in theoretically 81.2%, and 51.8% of participants studying on traditional curriculum and the level of their knowledge regarding soil transmitted helminthes was negative in terms of treatment, prevention and control.