@article{95342,
  keywords = {Public Health, Environmental and Occupational Health, Infectious Diseases},
  author = {Rubenstein BL and Roy SL and Unterwegner K and Yerian S and Weiss A and Zirimwabagabo H and Chop E and Romero M and Ouakou PT and Moundai T and Guagliardo SAJ},
  editor = {Ngondi JM},
  title = {Community-based Guinea worm surveillance in Chad: Evaluating a system at the intersection of human and animal disease},
  abstract = {<jats:sec id="sec001">
<jats:title>Background</jats:title>
<jats:p>Guinea worm is a debilitating parasitic infection targeted for eradication. Annual human cases have dropped from approximately 3,500,000 in 1986 to 54 in 2019. Recent identification of canine cases in Chad threatens progress, and therefore detection, prevention, and containment of canine cases is a priority. We investigated associations between disease knowledge, community engagement, and canine cases in Chad to identify opportunities to improve active surveillance.</jats:p>
</jats:sec>
<jats:sec id="sec002">
<jats:title>Methods</jats:title>
<jats:p>We surveyed 627 respondents (villagers, local leaders, community volunteers, and supervisors) across 45 villages under active surveillance. Descriptive statistics were analyzed by respondent category. Logistic regression models were fitted to assess the effects of volunteer visit frequency on villager knowledge.</jats:p>
</jats:sec>
<jats:sec id="sec003">
<jats:title>Results</jats:title>
<jats:p>Knowledge increased with respondents’ associations with the Guinea worm program. Household visit frequency by community volunteers was uneven: 53.0% of villagers reported visits at least twice weekly and 21.4% of villagers reported never being visited. Villagers visited by a volunteer at least twice weekly had better knowledge of Guinea worm symptoms (OR: 1.71; 95% CI: 1.04–2.79) and could name more prevention strategies (OR: 2.04; 95% CI: 1.32–3.15) than villagers visited less frequently. The primary motivation to report was to facilitate care-seeking for people with Guinea worm. Knowledge of animal “containment” to prevent contamination of water, knowledge of rewards for reporting animal cases, and ability to name any reasons to report Guinea worm were each positively correlated with village canine case counts.</jats:p>
</jats:sec>
<jats:sec id="sec004">
<jats:title>Conclusions</jats:title>
<jats:p>Community volunteers play crucial roles in educating their neighbors about Guinea worm and facilitating surveillance. Additional training and more attentive management of volunteers and supervisors could increase visit frequency and further amplify their impact. Emphasizing links between animal and human cases, the importance of animal containment, and animal rewards might improve surveillance and canine case detection. The surveillance system should be evaluated routinely to expand generalizability of data and monitor changes over time.</jats:p>
</jats:sec>},
  year = {2021},
  journal = {PLOS Neglected Tropical Diseases},
  volume = {15},
  pages = {e0009285},
  publisher = {Public Library of Science (PLoS)},
  issn = {1935-2735},
  url = {https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0009285&type=printable},
  doi = {10.1371/journal.pntd.0009285},
  language = {eng},
}