THE IMPACT OF A COMMUNITY INVOLVEMENT APPROACH ON GUINEA WORM CONTROL PRACTICES

Abstract

In many developing countries of the world, emphasis on health care has shifted from what can be done for the people to what the people can do for themselves to improve their health. A large number of people suffer from different illnesses which they are capable of acting upon, but lack the necessary incentives and organizational support for health directed actions. There has been a high incidence of Dracunculus medinensis among the inhabitants of Idere and Tapa farming villages, but no effective action has been taken to control the infection. Though the people possessed some knowledge of the disease, were aware of its seriousness, and believed that they were susceptible to the infection, they could not transform such knowledge and beliefs into action necessary to prevent the infection. In this study, community involvement and self-help are used as educational interventions for disease control. The area of study covered a number of remote farming villages that had been left out of the mainstream of basic health services amenities in Ibarapa District of Oyo State, Nigeria. The farming villages were from ten to sixty kilometres from the nearest towns. The villagers usually spent between 3 days to 4 weeks in the villages before they would return to visit their towns. The over-all period of stay in the farm villages was about nine months per year. In the rainy season, the farmers depended on water from stagnant ponds, water holes or slow flowing streams for domestic use. Most of these sources of water become dry during the dry season so that much time was spent trekking long distances in search of water. There were 80 villages altogether in the area, 50 had Idere as their homestead and the remaining 30 had Tapa as homestead. Ten Idere villages were the experimental group, while eight Tapa villages were taken as the control groups. The villages in the experimental group were those that considered guinea worm to be a problem and voluntarily consented to participate in the health education programme to control the infection. The control group of villages was selected on the basis of having the same health problem-guinea worm, being separated by distance from the experimental group and was comparable in relevant demographic characteristics. There was no significant change in knowledge, attitudes and behaviour of the control group toward the control of guinea worm infection before intervention (time 1) and after the intervention (time 2) but the experimental group showed some changes in knowledge, attitudes and behaviour. Before the interventions, only 4(2.5%) of the 160 respondents in the experimental group had adequate knowledge of guinea worm as compared with 42(26.3%) after the intervention. On attitudes toward solving the health problem through self-reliance, more people in the experimental group were of the opinion that self-helping was preferred to depending on government to help at time 2. At the beginning of the study, 72% of the 300 villagers who responded to an interview schedule in selected Tapa and Idere villages did nothing to avoid being infected; while 26% of them employed wrong measures to control the preventable infection. In the experimental group, only 6 (3.8%) took right action to control the infection at time 1. But at time 2, the number rose to 120(75%). The experimental plan for community involvement and self-help in the selected Idere villages included: (1.) Exposure to the knowledge of guinea worm infection (2) Assessment or opinion formation about the importance of the infection (3) Decision making on what action to take to overcome the infection. (4) Organisation of the community for a specific action decided on. (5) Trial of an accepted way to promote health and protect themselves from guinea worm infection and (6) Internalization or forming guinea worm control practices. The participatory process involved a division of labour among the villagers. A number of village health workers were trained on skills to control the disease which they were to impart to other villagers, the village health committee and central health committee had responsibility for planning the action needed for achieving effective control of the disease, while the other villagers were involved in the implementation of the guinea worm control measures. The study has demonstrated that given encouragement and support through supervision, even the most deprived communities known to depend on external help could be motivated to address themselves to taking care of some of their health problems. Such problems would have remained unattended to under the present system of health care. The impact of the programme on the experimental villages as reflected in the positive changes in knowledge, attitude and behaviour of the people on guinea worm control suggested that additional study be done in future to monitor the level of the incidence of the disease and the actions people would still take to prevent the disease. The information collected would be compared with the findings of this study as well as comparing the two groups of communities involved in the study.