Factors influencing the efficacy of IEC intervention strategies in public health: the case of a Bilharzia intervention project in Mwachinga village, Kwale district

This study assesses the efficacy of an Information, Education and Communication (lEC) intervention project initiated in Mwachinga Village, Kinango Division, Kwale District in 1996 - to control the spread of schistosomiasis (Bilharzia) in the area. The study was prompted by the fact that, like many other public health intervention projects in Kenya, the project may end up having had little or no impact on the target communities. Secondly, there seemed to have been information gaps as the place has high prevalence of the disease in Mwachinga village. Bilharzia is a human disease caused by parasitic worms called schistosomes. It is common in the tropics where ponds, streams and irrigation canals harbour bilharzia-transmitting snails. The study was therefore, an attempt to determine the factors responsible for the sustained high prevalence of the disease. It focused specifically on community knowledge levels, perceptions and attitudes pertaining to the disease and intervention work, as well as behaviour change among the residents of Mwachinga village. One of the major observations was that the presence and spread of bilharzia have largely been attributed to poor knowledge of the disease and the inappropriate behaviour towards it. Through a questionnaire administered on a random stratified sample of 200 respondents (50 men, 50 women, 50 schoolboys and 50 schoolgirls), information was collected and analyzed by statistical methods. The questionnaire administration was preceded by focus group discussions with key informants (opinion leaders) of the community in the village, which has about 200 homesteads. The results manifest widespread knowledge of bilharzia and infection prevention methods amongst all the categories interviewed. It was concluded therefore, that the sustained prevalence of bilharzia in the village is attributable to other factors other than lack of knowledge. These factors include the community's attitudes towards blood in urine - the cardinal symptom for bilharzia. There are also other unavoidable circumstances that make it difficult for the residents to keep off river water. The study recommends that Mwachinga village residents be taught to view the symptom of blood in urine (haematuria) with the gravity of the danger it portends, and not as a way of life. Health education lessons should be regular so as to create the community's understanding the factors underlying the dynamics of bilharzia infection. To help the community stay away from the infested river water, the Government should revive the water kiosk system by pumping safe water from the main water pipe that runs across the village into the old kiosks, since they are still intact. The number of kiosks should also be increased to say, 10, for more effective service.