Abstract
Porcine cysticercosis (PCC) is a food-borne zoonotic disease prevalent in resource-poor rural communities with free-range pig management systems and low sanitation practices. Various prevention and control strategies have been implemented in Tanzania, with this study highlighting the importance of community-based health education in controlling the Taenia solium parasite. The study evaluated the effectiveness of community-based health education using a cocreated health education package (HEP) on the knowledge, attitudes, and practices (KAP) of smallholder farmers, as well as on the prevalence of PCC in Kongwa and Songwe Districts, Tanzania. A cluster-randomized health education intervention was conducted between June 2019 and December 2021, with pre- and postintervention evaluations of PCC prevalence and smallholder farmers' KAP. A baseline cross-sectional study was followed by health education training utilizing the HEP, which included brochures, booklets, and posters. The training was provided to trainers (TOT) who, in turn, trained the community. A commercial Ag-ELISA kit (apDia, Belgium) was used to identify circulating antigens in pig serum and determine the PCC prevalence both before and after the intervention. A total of 692 and 486 respondents participated in face-to-face interviews during the baseline and postintervention periods, respectively. Concurrently, 692 and 317 pigs were sampled during these periods. At baseline, the seroprevalence of PCC was 10.2% in the intervention group and 9.1% in the control group. Twelve months following the health education intervention, the study observed significant improvements in knowledge (β = 1.779, p=0.004), attitudes (β = 1.024, p=0.038), and practices (β = 0.719, p=0.023) among participants. Additionally, a reduction in PCC prevalence was observed-3.9% in the intervention group and 0.9% in the control group-though this difference was not statistically significant (OR = 0.70; 95% CI: 0.27-1.83; p=0.47). The reduction in PCC is a gradual process that likely requires a longer observation period to yield a measurable impact. The limited duration of follow-up may have constrained the study's ability to conclusively attribute the observed decline in PCC seroprevalence to the intervention. Evidence suggests that a comprehensive strategy targeting both intermediate and definitive hosts is essential. Therefore, future health education interventions should integrate mass drug administration for pigs and treatment of human taeniosis-an approach that could be effective in disrupting the lifecycle of Taenia solium.