Health beliefs of school-age rural children in podoconiosis-affected families: A qualitative study in Southern Ethiopia

Background Several studies have suggested investigation of health beliefs in children to be an important pre-condition for primary prevention of disease. However, little effort has been made to understand these in the context of podoconiosis. This study therefore aimed to explore the health beliefs of school-age rural children in podoconiosis-affected families. Methodology/Principal findings A cross sectional qualitative study was conducted in March 2016 in Wolaita Zone, Southern Ethiopia. Data were collected through in-depth individual interviews (IDIs) and focus group discussions (FGDs), with a total of one hundred seventeen 9 to15-year-old children recruited from podoconiosis affected families. The study revealed various misconceptions regarding risk factors for podoconiosis. Most children believed barefoot exposure to dew, worms, snake bite, frog urine, other forms of poison, and contact with affected people to be major causes of the disease. Their knowledge about the role of heredity and that of long term barefoot exposure to irritant mineral particles was also weak. Though most participants correctly appraised their susceptibility to podoconiosis in relation to regular use of footwear and foot hygiene, others based their risk perceptions on factors they think beyond their control. They described several barriers to preventive behaviour, including uncomfortable footwear, shortage and poor adaptability of footwear for farm activities and sports, and shortage of soap for washing. Children also perceived low self-efficacy to practice preventive behaviour in spite of the barriers. Conclusion/Significance Health education interventions may enhance school-age children’s health literacy and be translated to preventive action. Overcoming practical challenges such as shortage of footwear and other hygiene facilities requires other forms of interventions such as livelihood strengthening activities. Linking podoconiosis-affected families with local governmental or non-governmental organizations providing socio-economic support for households may assist school-age children in those families to sustainably engage in preventive behaviours.
Author summary Podoconiosis is an example of a lifestyle-related disease that develops after childhood and affects millions of people with little experience of preventive behaviour. It is caused by prolonged barefoot exposure to irritant mineral particles, accompanied by inherited susceptibility. Children with a family history of podoconiosis are highly vulnerable to the disease. Several studies have underscored the importance of studying health beliefs in children for the early control of diseases that arise from risky behaviour and habits established in childhood, which continue into adulthood. This study attempted to explore the health beliefs of school-age children in podoconiosis affected families. The forms of health beliefs addressed in the present study were knowledge of podoconiosis risk factors and perceptions of severity of and susceptibility to the disease, benefits of and barriers to engaging in preventive actions such as footwear use and feet hygiene, and self-efficacy to perform preventive actions regardless of perceived barriers. Various forms of misconceptions and inaccurate risk perceptions were recorded. Participant children also reported several barriers that limited their engagement in preventive actions and low confidence to overcome them. These findings imply that school-age children at high risk of podoconiosis might benefit from an intervention that improves their knowledge about podoconiosis and enhances their self-efficacy to sustainably perform preventive behaviours.