Combining Footwear with Public Health Iconography to Prevent Soil-Transmitted Helminth Infections

Sarah B. Paige Global Health Institute, University of Wisconsin–Madison, Madison, Wisconsin.

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Sagan Friant Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin.
Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin.

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Lucie Clech Department of Anthropology, Stanford University, Stanford, California.

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Carly Malavé Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin.

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Catherine Kemigabo Kabarole District Health Office, Fort Portal, Uganda.

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Richard Obeti Kabarole District Health Office, Fort Portal, Uganda.

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Tony L. Goldberg Global Health Institute, University of Wisconsin–Madison, Madison, Wisconsin.
Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin.

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Shoes are effective for blocking soil-transmitted helminths (STHs) that penetrate the skin. Unfortunately, shoe-wearing is uncommon in many areas where STHs are prevalent, in part because local populations are unaware of the health benefits of wearing shoes. This is especially true in low-literacy populations, where information dissemination through written messages is not possible. We launched a public health intervention that combines a public health image with sandals. The image is a “lenticular image” that combines two alternating pictures to depict the efficacy of shoes for preventing STH infection. This image is adhered to the shoe, such that the message is linked directly to the primary means of prevention. To create a culturally appropriate image, we conducted five focus group discussions, each with a different gender and age combination. Results of focus group discussions reinforced the importance of refining public health messages well in advance of distribution so that cultural acceptability is strong. After the image was finalized, we deployed shoes with the image in communities in western Uganda where hookworm is prevalent. We found that the frequency of shoe-wearing was 25% higher in communities receiving the shoes than in control communities. Microscopic analyses of fecal samples for parasites showed a sustained reduction in infection intensity for parasites transmitted directly through the feet when people received shoes with a public health image. Our results show that combining culturally appropriate images with public health interventions can be effective in low-literacy populations.

Author Notes

* Address correspondence to Tony L. Goldberg, Department of Pathobiological Sciences and Global Health Institute, University of Wisconsin–Madison, 1656 Linden Drive, Madison, WI 53706. E-mail: tony.goldberg@wisc.edu
† These authors contributed equally to this work.

Financial support: This research was funded by the Bill & Melinda Gates Foundation Grand Challenges Explorations Program (OPP1096725).

Authors' addresses: Sarah B. Paige, Global Health Institute, University of Wisconsin–Madison, Madison, WI, E-mail: spaige1@gmail.com. Sagan Friant, Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, WI, E-mail: sagan.friant@gmail.com. Lucie Clech, Department of Anthropology, Stanford University, Stanford, CA, E-mail: lucieclech@gmail.com. Carly Malavé and Tony L. Goldberg, Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, WI, E-mails: carlymalave@gmail.com and tony.goldberg@wisc.edu. Catherine Kemigabo and Richard Obeti, Kabarole District Health Office, Fort Portal, Uganda, E-mails: kemigabocatherine@yahoo.com and robeti42@gmail.com.

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