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Combining Footwear with Public Health Iconography to Prevent Soil-Transmitted Helminth Infections
Sarah B. Paige
Sarah B. Paige
Global Health Institute, University of Wisconsin–Madison, Madison, Wisconsin.
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Sagan Friant
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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Nelson Institute for Environmental Studies, University of Wisconsin–Madison, Madison, Wisconsin.
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Lucie Clech
Lucie Clech
Department of Anthropology, Stanford University, Stanford, California.
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Carly Malavé
Carly Malavé
Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, Wisconsin.
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Catherine Kemigabo
Catherine Kemigabo
Kabarole District Health Office, Fort Portal, Uganda.
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Richard Obeti
Richard Obeti
Kabarole District Health Office, Fort Portal, Uganda.
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Tony L. Goldberg
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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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
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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1.
Hotez PJ, Alvarado M, Basáñez MG, Bolliger I, Bourne R, Boussinesq M, Brooker SJ, Brown AS, Buckle G, Budke CM, Carabin H, Coffeng LE, Fèvre EM, Fürst T, Halasa YA, Jasrasaria R, Johns NE, Keiser J, King CH, Lozano R, Murdoch ME, O'Hanlon S, Pion SDS, Pullan RL, Ramaiah KD, Roberts T, Shepard DS, Smith JL, Stolk WA, Undurraga EA, Utzinger J, Wang M, Murray CJL, Naghavi M, 2014. The Global Burden of Disease Study 2010: interpretation and implications for the neglected tropical diseases. PLoS Negl Trop Dis 8: e2865.
-
2.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez M-G, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT-A, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA, 2012. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2197–2223.
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3.
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-
4.
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-
5.
Reidpath DD, Allotey P, Pokhrel S, 2011. Social sciences research in neglected tropical diseases 2: a bibliographic analysis. Health Res Policy Syst 9: 1.
-
6.
Gazzinelli A, Correa-Oliveira R, Yang G-J, Boatin BA, Kloos H, 2012. A research agenda for helminth diseases of humans: social ecology, environmental determinants, and health systems. PLoS Negl Trop Dis 6: e1603.
-
7.
Hawdon JM, 2014. Controlling soil-transmitted helminths: time to think inside the box? J Parasitol 100: 166–188.
-
8.
Rilkoff H, Tukahebwa EM, Fleming FM, Leslie J, Cole DC, 2013. Exploring gender dimensions of treatment programmes for neglected tropical diseases in Uganda. PLoS Negl Trop Dis 7: e2312.
-
9.
Asaolu SO, Ofoezie IE, 2003. The role of health education and sanitation in the control of helminth infections. Acta Trop 86: 283–294.
-
10.
Hotez PJ, Bethony J, Bottazzi ME, Brooker S, Buss P, 2005. Hookworm: “the great infection of mankind”. PLoS Med 2: e67.
-
11.
Lu L, Liu C, Zhang L, Medina A, Smith S, Rozelle S, 2015. Gut instincts: knowledge, attitudes, and practices regarding soil-transmitted helminths in rural China. PLoS Negl Trop Dis 9: e0003643.
-
12.
Bundy DA, Walson JL, Watkins KL, 2013. Worms, wisdom, and wealth: why deworming can make economic sense. Trends Parasitol 29: 142–148.
-
13.
Deribe K, Brooker SJ, Pullan RL, Hailu A, Enquselassie F, Reithinger R, Newport M, Davey G, 2013. Spatial distribution of podoconiosis in relation to environmental factors in Ethiopia: a historical review. PloS One 8: e68330.
-
14.
Tomczyk S, Deribe K, Brooker SJ, Clark H, Rafique K, Knopp S, Utzinger J, Davey G, 2014. Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis. PLoS Negl Trop Dis 8: e3285.
-
15.
Ayode D, McBride CM, de Heer HD, Watanabe E, Gebreyesus T, Tora A, Tadele G, Davey G, 2013. A qualitative study exploring barriers related to use of footwear in rural highland Ethiopia: implications for neglected tropical disease control. PLoS Negl Trop Dis 7: e2199.
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