Assessing the knowledge, attitudes, practices, and perspectives of stakeholders of the deworming program in rural Rwanda

ABSTRACT Background Worm infections are among the most prevalent neglected tropical diseases worldwide. Schistosomiasis and soil-transmitted helminths infections, most common worm infections affecting Rwandan school-aged children, are addressed by the national deworming program since 2014. To date, no published studies have assessed the knowledge, attitudes, and practices of the key implementers of the national deworming program conducted at village and school level. This study aimed to assess key stakeholders’ knowledge, attitudes, practices, and perspectives about the decentralized national deworming program. Methods/ Principal Findings We carried out a quantitative, cross-sectional study with complementary in-depth interviews in two districts of Rwanda in June 2021. From the 852 surveyed community health workers and teachers, 54.1% had a knowledge score considered good (≥80%). The mean knowledge score was 78.04%. From the multivariate analysis, lack of training was shown to increase the odds of having poor knowledge (OR 0.487, 95% CI: 0.328 – 0.722, p <0.001). The in-depths interviews revealed poor water access and hesitance from caregivers as perceived challenges to the success of the deworming program. Conclusion Our findings demonstrate the importance of training community health workers and schoolteachers on worm infections as they are the key implementers of the deworming program. This would enhance their capacity to provide health education and sensitization on misconceptions and misinformation towards deworming. Moreover, research is needed to assess the impact of poor access to water, sanitation and hygiene facilities on the prevalence of worm infections in Rwanda. AUTHOR SUMMARY Worm infections affect over 2 billion people worldwide, and the most common are schistosomiasis and soil-transmitted helminth infections. In Rwanda, the prevalence of soil-transmitted helminth infections can be as high as 45%, while the prevalence of schistosomiasis is 2.7% among school-aged children. The government of Rwanda continues to develop initiatives to eradicate worm infection, among which, the national decentralized deworming program, implemented at village and school level. In this program, community health workers collaborate with teachers and local leaders to administer deworming tablets, community sensitization and health education. To date, no published studies have been conducted to understand the experiences and perspectives of key stakeholders in the national deworming program in Rwanda. We conducted a quantitative analysis of the Knowledge, Attitudes and Practices (KAP) of teachers and community health workers, and a qualitative assessment of the perspectives of local leaders in two of the most food insecure districts of Rwanda. The results show a gap in the knowledge of community health workers and teachers on worm infections. The study also revealed that there were some misconceptions about deworming tablets, which highlights the need to train key implementers of the program for them to transfer their knowledge to the broader community.