Helminth control as an entry point for health-promoting schools in KwaZulu-Natal

Objectives. To use a health promotion model to investigate the risk factors (predisposing, enabling and reinforcing for geohelminth and schistosomiasi s infections, in order to develop and implement effective intervention stra tegies. Design. Phase 1: Qualitative study using focus group discussions (FGDs) wit h parents, pupils and teachers; and interviews with health workers. Phase 2: Quantitative study using a semi-structured questionnaire to invest igate whether the determinants identified in phase 1 were generalisable. Setting. Rural primary schools in Vulamehlo magisterial district, southern KwaZulu-Natal. Study population: Qualitative study: 9 schools with 179 pupils, 93 parents and 82 teachers; and local clinics (4 fixed, 1 mobile), with 7 professional nurses. Quantitative study: 2 other schools, with 730 pupils. Results. Predisposing factors: Respondents were familiar with symptoms, but did not know the cause or mode of transmission of helminth infections. Man y respondents perceived food to be the cause of geohelminth infection and s wimming in the river to be the cause of schistosomiasis. Although 649 (88.9 %) pupils had toilets at home and at school, only 218 (29.9%) were motivate d to 'always' use the toilet for faecal disposal (rural communities previou sly did not have toilets). Six hundred and seventy-eight pupils (92.9%) und erstood that it was necessary to wash their hands after using the toilet, b ut many schools lacked water. Personal cleanliness was a problem despite th e emphasis on hygiene by health workers and teachers. Few pupils admitted t o eating soil, but it was agreed that geophagia affected young children bet ween the ages of 8 months and 6 years. Enabling factors (positive/negative) . Barriers to health promotion frequently included inadequate toilet facili ties at school and home, and river-water contact resulting from a lack of c lean water. a dearth of recreational facilities resulted in children swimmi ng and playing in the river. Positive factors were the health-seeking behav iour of the majority of the target group, who identified helminth infection s as a health problem and sought treatment. Parents and pupils in the FGDs unanimously supported health education and 655 (89.8%) questionnaire respon dents indicated that they wished to learn how to avoid helminth infections. Conclusions. Although the Government strategy is to provide dean water and adequate sanitation, provision of services does not necessarily ensure usag e. A comprehensive approach to health promotion is required and the complem entary development of the health-promoting school' would support, reinforce and sustain a helminth control programme.