**5.1 Farmer education**

This four-part study included baseline data collection using individual farmer interviews followed by a workshop. Approximately half of any group of farmers is expected to attend one-day workshops. The farmers included in the data collection were randomly chosen within each selected village whereas the workshops were open to all pig farmers, village elders and village chiefs who wished to attend. Two subsequent farm visits followed the workshop, each 5 months apart. During these farm visits, a questionnaire was completed followed by one-on-one training. Farmers were asked if they attended the workshop and if not, they were given the education about the lifecycle of *T. solium* and prevention of the disease in people and in pigs. All farmers were encouraged to ask questions about *T. solium*, pig management or disease. The farmer was not limited in the number of questions they could ask or the time the researchers spent answering questions. During each visit, the farmer was interviewed in their native tongue by a local person who was hired by the research team and trained to conduct the interview. These research assistants translated for the English speaking researchers who were experts in pig production and disease. Phase 3 of the program was to provide a 2nd set of workshops for the farmers two years after the first farm visit. The workshop was based on the research results obtained during the longitudinal project and provided an opportunity to discuss *T. solium*. The final phase was to return to the community four years after the start of the study, which was two years after the phase 3. During this phase the researchers conducted one-on-one interviews to determine what behaviours the farmers adopted in response to the education (Wohlgemut et al., 2010).

#### **5.2 Government staff education**

A Training of the Trainers model was used in this project. The advantage of this model is that the government staff are taught the material that the researchers hope to spread to the entire community. The education program is longer term and more widespread because the staff can continue to disseminate the information for years after the project has ended. It is also important that the staff are given the same information that the farmers receive. Finally, the staff are able to converse with the farmers in their own local language. The researchers

Educating People Participating in the Pig

Industry to Reduce Epilepsy due to Taenia Solium 217

messages (Flisser & Lightowlers, 2001). The connection between former education and knowledge acquisition illustrates the potential advantage of introducing this information into the late primary school education curriculum. If people who are used to learn in a classroom are more likely to understand and retain this material, a large number of families can be accessed through the educational system. This may be the most appropriate educational model

Understanding the lifecycle of the tapeworm enables the farmer to determine how to interrupt the transmission through regular use of a pit latrine, improved personal hygiene and confining the pig. It is important that farmers understand the connection between the tapeworm and epilepsy so that they have a reason to make management changes to the pig rearing operation. Pigs that are tethered or housed must be fed on a daily basis. This takes time and money. Farmers who are not used to feeding their pig must also be taught about the locally available foods that can be used in combination to provide a complete ration for the pigs (Mutua et al., 2011). By using waste food stuff such as fruits that are spoiled, weeds, kitchen waste, and inexpensive sources of protein, farmers are able to reduce the costs of feeding the pig. All famers, from the beginning of the study knew that they should seek medical treatment if they saw worms in their stool. The educators should encourage whole

in countries with a high uptake of primary school education among the poor.

families to use anti-parasiticides if one family member has proglotids in their stool.

The information about the life cycle of T. solium was rarely conveyed from one family member who attended the workshop to another family member who was interviewed five months later. This fact was frustrating for the researchers. One report from the United States Agency for International Development noted that it is of special importance to ensure access of education and training to women, as they are key contributors to the agricultural workforce, and could further contribute if recognized as a priority audience.23 However, when looking at the long-term behaviour changes from the educational program, four years after the project began, farm families had adopted preventative management changes. Regardless of whether it was a man or woman who attended the training, four years after the start of the study, women were boiling the pork for 20 minutes prior to frying. Also, all the pigs were either in barns or tethered. A few farmers also mentioned either repairing or building pit latrines for the family to use. One study found that the prevalence of porcine cysticercosis was higher in pigs reared in households lacking latrines than pigs raised in households that had latrines (Ngowi et al., 2004). Similarly, the decline in *T. solium*  infections in parts of Europe over the past century was due to improved public sanitation, rather than any specifically targeted control measures (Mahajan, 1982). Approximately 18% of families that did not participate in the educational project adopted behaviour changes

After the initial farmer training workshop, the number of farmers that tethered their pigs increased from 32% to 51%. This rate increased to 62% after the one-on-one training. Four years after the study began, 100% of the farmers who had either participated in the research program or attended one of the workshops were either housing or tethering their pigs. This illustrates the long-term behaviour changes that results from these educational opportunities.

**7. Extension of knowledge to the community** 

because their neighbours had shared the information.

**8. Confining pigs** 

provided three, one-day workshops for government staff and local community leaders including teachers and village chiefs. The workshops occurred at the start of the project and then two and four years later. At each workshop, the staff were given 20 to 30 page booklets that summarized the information taught and gave the background scientific information to justify the content. Staff who attended the workshops included veterinary, livestock, public health, and adult education specialists, veterinarians and social workers. The workshops included sections of the lifecycle of T solium, the cause of neurocysticercosis and pig management, housing, breeding, feeding, diseases, and care. Each participant was required to participate in at least 3 workshops for the farmers in the local villages. At the end of the government workshop, the researchers assisted the staff in the preparation and planning for the farmer workshops (Wohlgemut et al., 2010).

#### **5.3 Butcher education**

The workshops for the pig butchers were facilitated directly by the researchers (Levy et al., 2009). The workshops focused on a study of the fixed and variable costs of a pig butcher business, income and profit calculation. The workshop also included a section on enhancing pork safety that included the life cycle of *T. solium*, the recognition of larval cysts in pig muscle, the importance of having every carcass inspected, and personal and butchershop hygiene. Finally, each butcher determined the cost of slaughtering the pig at a slaughter slab and government inspection based on the required kilogram of pork sales per pig to cover the cost. Many butchers were not able to leave their work to attend the workshops. One-onone training was given to these butchermen. This format was not likely as valuable because during the workshops, the butchers discussed many of the issues presented and shared information with one another.

#### **6. Knowledge acquisition**

The educational opportunities enabled the farmers to learn about the life cycle of *T. solium*. However, the life cycle is complicated and the one-on-one training was more effective than the workshops in the longterm retention of the knowledge. One-on-one training enabled the farmer to ask the researcher questions as she explained the lifecycle of *T. solium*. Further, the farmer was able to hold a picture of the life cycle during the training rather than relying on following a poster at the front of the classroom. One-on-one training was also associated with having heard of the tapeworm in people and having seen the proglotids in a person's stool. This may have been because the researcher showed a picture of the proglotids during the training. Although one-on-one training is expensive, it is worth the cost if it results in long-term behaviour changes in a community that then reduce the incidence of *T. solium* due to epilepsy. That too has a high societal cost (Wohlgemut et al., 2010).

All farmers who had some education were more likely to correctly describe how pigs and people became infected and how people developed epilepsy from *T. solium* than before the study began (Wohlgemut et al., 2010). However, farmers who had been taught one-on-one were more able to correctly describe how people and pigs became infected than farmers who had only attended the workshop. Farmers who had completed primary school were also more likely to retain this information than farmers with less formal education. Leonard (1977) found that the level of education and prior knowledge of Swahili impacted the Kenyan farmers' capacity to understand complex messages. This puts an extra responsibility on the educators who must first be well educated to understand, and subsequently convey clear and accurate

provided three, one-day workshops for government staff and local community leaders including teachers and village chiefs. The workshops occurred at the start of the project and then two and four years later. At each workshop, the staff were given 20 to 30 page booklets that summarized the information taught and gave the background scientific information to justify the content. Staff who attended the workshops included veterinary, livestock, public health, and adult education specialists, veterinarians and social workers. The workshops included sections of the lifecycle of T solium, the cause of neurocysticercosis and pig management, housing, breeding, feeding, diseases, and care. Each participant was required to participate in at least 3 workshops for the farmers in the local villages. At the end of the government workshop, the researchers assisted the staff in the preparation and planning for

The workshops for the pig butchers were facilitated directly by the researchers (Levy et al., 2009). The workshops focused on a study of the fixed and variable costs of a pig butcher business, income and profit calculation. The workshop also included a section on enhancing pork safety that included the life cycle of *T. solium*, the recognition of larval cysts in pig muscle, the importance of having every carcass inspected, and personal and butchershop hygiene. Finally, each butcher determined the cost of slaughtering the pig at a slaughter slab and government inspection based on the required kilogram of pork sales per pig to cover the cost. Many butchers were not able to leave their work to attend the workshops. One-onone training was given to these butchermen. This format was not likely as valuable because during the workshops, the butchers discussed many of the issues presented and shared

The educational opportunities enabled the farmers to learn about the life cycle of *T. solium*. However, the life cycle is complicated and the one-on-one training was more effective than the workshops in the longterm retention of the knowledge. One-on-one training enabled the farmer to ask the researcher questions as she explained the lifecycle of *T. solium*. Further, the farmer was able to hold a picture of the life cycle during the training rather than relying on following a poster at the front of the classroom. One-on-one training was also associated with having heard of the tapeworm in people and having seen the proglotids in a person's stool. This may have been because the researcher showed a picture of the proglotids during the training. Although one-on-one training is expensive, it is worth the cost if it results in long-term behaviour changes in a community that then reduce the incidence of *T. solium* due

All farmers who had some education were more likely to correctly describe how pigs and people became infected and how people developed epilepsy from *T. solium* than before the study began (Wohlgemut et al., 2010). However, farmers who had been taught one-on-one were more able to correctly describe how people and pigs became infected than farmers who had only attended the workshop. Farmers who had completed primary school were also more likely to retain this information than farmers with less formal education. Leonard (1977) found that the level of education and prior knowledge of Swahili impacted the Kenyan farmers' capacity to understand complex messages. This puts an extra responsibility on the educators who must first be well educated to understand, and subsequently convey clear and accurate

to epilepsy. That too has a high societal cost (Wohlgemut et al., 2010).

the farmer workshops (Wohlgemut et al., 2010).

**5.3 Butcher education** 

information with one another.

**6. Knowledge acquisition** 

messages (Flisser & Lightowlers, 2001). The connection between former education and knowledge acquisition illustrates the potential advantage of introducing this information into the late primary school education curriculum. If people who are used to learn in a classroom are more likely to understand and retain this material, a large number of families can be accessed through the educational system. This may be the most appropriate educational model in countries with a high uptake of primary school education among the poor.

Understanding the lifecycle of the tapeworm enables the farmer to determine how to interrupt the transmission through regular use of a pit latrine, improved personal hygiene and confining the pig. It is important that farmers understand the connection between the tapeworm and epilepsy so that they have a reason to make management changes to the pig rearing operation. Pigs that are tethered or housed must be fed on a daily basis. This takes time and money. Farmers who are not used to feeding their pig must also be taught about the locally available foods that can be used in combination to provide a complete ration for the pigs (Mutua et al., 2011). By using waste food stuff such as fruits that are spoiled, weeds, kitchen waste, and inexpensive sources of protein, farmers are able to reduce the costs of feeding the pig. All famers, from the beginning of the study knew that they should seek medical treatment if they saw worms in their stool. The educators should encourage whole families to use anti-parasiticides if one family member has proglotids in their stool.
