It is unfortunately common practice for women of reproductive age to be excluded from neglected tropical disease (NTD) control programmes. This is in part due to a lack of information about how women perceive the risks and rewards of treatment. In June 2016, MSc student, Claire Gwayi-Chore joined up with the LSHTM colleagues at the TUMIKIA project in Kenya to assess how women feel about deworming during pregnancy.
In sub-Saharan Africa, approximately 38 million women of reproductive age (15-49 years), including nearly 7 million pregnant women are infected with hookworm – an intestinal parasitic worm that belongs to a group collectively known as the soil-transmitted helminths (STH). These infections can lead to poor pregnancy outcomes– namely anaemia, which can potentially lead to preterm birth or low birth weight.
In order to control the morbidity associated with hookworm in endemic areas, the World Health Organization currently identifies three groups for treatment with deworming medication: pre-school and school-aged children, women of reproductive age and pregnant women beyond first trimester. For women, this could be either through a mass treatment campaign, or as part of their routine antenatal care.
In addition to reducing rates of anaemia in treated women, deworming adult women has ancillary benefits for children in their communities. This is becaus
e untreated adults can act as reservoirs of infection; by treating women this reservoir is substantially reduced.
In spite of this recommendation, these women are often excluded from treatment programmes due to a fear of unintentional side effects. This is despite ample evidence that shows that deworming is safe for pregnant women once they are past their first trimester. Across the globe, antenatal care programmes are not consistently providing deworming treatment due to a lack of country-specific government data and guidance about the safety and effectiveness of deworming. However, the decision to exclude women has been made with very little, if any, evidence on how the women themselves perceive the risks and benefits of deworming during pregnancy.
In areas with high hookworm infection rates, this lack of treatment coupled with the substantial amount of time that women in these communities are pregnant or breastfeeding may have important health consequences and could potentially make STH elimination through deworming programmes extremely difficult.
To investigate how women perceive the risks and rewards of deworming treatment, I traveled to Kwale in July 2016 to work with the TUMIKIA project. I developed a short survey for women of reproductive age to assess their perception of antenatal deworming, which we nested within a larger cross-sectional survey assessing deworming uptake following a round of community based deworming. The survey was administered in a random sample of 4,800 households in treatment and control areas. My questionnaire looked to assess women’s perception of:
- Whether they would be willing to be dewormed during a future pregnancy
- The risk posed by worm infection on pregnant women and their foetuses;
- The safety and effectiveness of deworming medicines for pregnant women and their foetuses;
We collected data from 3,810 women. Of these women, 1,599 (42.0%) reported that they would be willing to take deworming tablets during antenatal care. Analysis showed that women were more likely to accept antenatal deworming if they:
- had been dewormed previously (11 times more likely);
- perceived deworming to be safe for pregnant women (10 times more likely);
- perceived deworming to be safe for the unborn baby (5 times);
- perceived it to be effective against parasitic worms during pregnancy (4 times).
As a public health researcher interested in community engagement and health promotion, I believe that if we package health information correctly and in an understandable format using information collected from the community, we have a greater chance of improving health outcomes. My hope is that these findings will help build a better understanding of the perceptions of antenatal deworming amongst women of reproductive age. This evidence – coupled with overall findings from TUMIKIA – provides programme managers and policy makers with the information they need to design and implement effective community-based deworming and antenatal care programmes.
It was a great learning experience being able to conduct this research with support from the TUMIKIA team and I look forward to building upon this experience and continuing my career in research and community-based implementation. I would like to thank the team in London and in Kwale who supported me to complete my project – tuangamize minyoo Kenya, imarisha afya (eradicate worms in Kenya to improve health)!
Claire Gwayi-Chore recently completed her MSc, Public Health for Development at London School of Hygiene & Tropical Medicine. She completed her summer project with TUMIKIA, titled: Assessing acceptance & coverage of antenatal deworming in Kenya: analysis of perceptions of treatment & socioeconomic & sociodemographic factors associated with treatment uptake amongst women of reproductive age