Epilepsy has
been shown to be nearly 10 times more frequent and remains a highly stigmatized
disease in developing countries. In areas where pigs are raised traditionally
(i.e., free roaming) and where sanitation is poor, it has been shown that about
29% of people with epilepsy have lesions of neurocysticercosis (NCC) in their
brain. NCC is a zoonotic parasitic infection of the brain caused by the
tapeworm Taenia solium, which infects both humans and pigs. Humans carry
the adult form of the worm which they acquire from eating undercooked
contaminated pork meat. Pigs get infected by
directly eating feces or food contaminated with human feces. Humans may get
NCC when ingesting food (or possibly water) contaminated with human feces. Hélène
Carabin, DVM, PhD, a researcher with the OU Health Sciences Center, is pioneering a unique community-based
randomized controlled study (60 villages in 30 departments and 3 provinces of
Burkina Faso) to assess if an educational package could cut the life cycle of
the worm to prevent epilepsy.
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| Villagers in Burkina Faso raise pigs as part of their household livelihood. |
Dr. Carabin's
research team in Burkina Faso initially focused on pig management - limiting
the movement of pigs to stop them from having access to human feces as a way of curtailing the cycle of
transmission. Using focus groups and in-depth interviews, the team realized
that improved pig management was not a feasible option, given the community's
behaviors, preferences and the difficulty in finding food for the pigs. The participants,
however, were knowledgeable about the risks of open defecation and were willing
to improve sanitation. The research team then considered community-led total
sanitation (CLTS), an innovative methodology for mobilizing communities to
completely eliminate open defecation (OD). Communities are facilitated to
conduct their own appraisal and analysis of open defecation and take their own
action to become ODF (open defecation free). But CLTS is costly and requires
extensive support.
And so the
team has agreed upon a more successful and sustainable approach, and one that
is ingeniously American - make a movie! The group hired a local filmmaker to
film an educational comedy that advocates and teaches about the life cycle of
the disease and how to prevent it through improved sanitation and pig
management. To accompany the movie, they worked with Water and Sanitation for
Africa (WSA) to adapt previously used PHAST (participatory hygiene
and sanitation training) tools to emphasize the role of
pigs in the disease. They also developed a comic book to accompany the movie. The
field team has started the first follow-up visits in September and is offering
the intervention to half of the villages. The team is now analyzing the
baseline portion of the study.
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| Dr. Helene Carabin (left) with Dr. Linda Cowan on location in Pabre. |
Dr. Carabin is
a frequent collaborator with the OU WaTER Center. Her research includes study
of infectious diseases, especially zoonotic infections that are transmitted
between species of animals, including humans. Many of these diseases are
transmitted due to poor sanitation and some are water-borne, water-based; they
are significantly more problematic in regions of the world which lack sanitation
and clean drinking water. Dr. Carabin wishes to acknowledge her
colleagues in Burkina Faso (Rasmané Ganaba DVM PhD, Athanase Millogo MD,
Jean-Bosco Ouédraogo PhD, and Zékiba Tarnagda DVM PhD) and in Belgium (Pierre
Dorny DVM PhD and Nicolas Praet DVM PhD).
This study is funded by the National Institute of Neurological Disorders (NINDS) and the Fogarty International Center (FIC) under the BRAIN program.
This study is funded by the National Institute of Neurological Disorders (NINDS) and the Fogarty International Center (FIC) under the BRAIN program.
