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

Abstract

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.

The Correlation of No Footwear Use and Soil Helminth Incidence among Elementary School Children in Musi Rawas, South Sumatera, Indonesia

“…The overall incidence and unhygienic behaviors revealed suggest the importance of identifying the best solution to address the STH problem in North Sumatra 26 . In parallel with the increased educational activities, footwear deployment has successfully minimized STH infection in endemic locations 27 . Children of respondents who wear shoes/slippers outside the house had a significantly reduced prevalence of STH infections (72.8%; 95% CI= 62.6, 80.5 vs. 87.0%; 95% CI= 81.4, 91.1).)…”

Prevalence and molecular characterization of Strongyloides stercoralis, Giardia duodenalis, Cryptosporidium spp., and Blastocystis spp. isolates in school children in Cubal, Western Angola

“…A number of epidemiological, clinical, environmental, and behavioural factors have been linked to a higher risk of infections by GHPI. These include walking barefoot [ 56 , 65 , 66 ], having a low socio-economic status [ 67 , 68 ], living in rural areas [ 68 , 69 ], having contact with livestock [ 69 – 71 ], drinking untreated water [ 69 , 72 ], eating unwashed/raw fruit [ 73 ], belonging to a given age group [ 25 , 74 ], having diarrhoea [ 73 ], having a poor nutritional status [ 74 , 75 ], and having anaemia [ 8 , 73 ], among others. A number of studies have demonstrated that wearing shoes considerably reduce the risk of infection by STHs [ 56 , 65 , 66 ].…”

A first nation-wide assessment of soil-transmitted helminthiasis in Fijian primary schools, and factors associated with the infection, using a lymphatic filariasis transmission assessment survey as surveillance platform

“…These findings underscore the need for studies to explore whether local populations are unaware of the health benefits of wearing shoes or whether there are socio-economic barriers, e.g. poverty, that lead children to wear shoes occasionally or not at all in this Fijian setting [32].…”