title: Gut instincts: knowledge, attitudes, and practices regarding soil-transmitted helminths in rural China.
abstract: BACKGROUND
  Soil-transmitted helminth (STH) infections affect more than two out of every five schoolchildren in the poorest regions of rural China, an alarmingly high prevalence rate given the low cost and wide availability of safe and effective deworming treatment. Understanding of local knowledge, attitudes, and practices regarding STH infection in rural China has until now, been sparse, although such information is critical for prevention and control initiatives.
  
  
  RESULTS
  This study aims to elucidate the structural and sociocultural factors that underlie high STH infection rates as well as explain why deworming treatment is rarely sought for children. In-depth, qualitative interviews were conducted in six rural villages in Guizhou Province; participants included schoolchildren, children's parents and grandparents, and village doctors. Data analysis exposed three predominant reasons for high STH prevalence: (1) lack of awareness and skepticism about the high prevalence of STH infection, (2) local myths about STH infection and deworming treatment, and (3) poor quality of village health care.
  
  
  CONCLUSIONS
  The findings from this study reveal reasons for why deworming treatment is not sought, and inform specific recommendations for a deworming intervention that can more effectively address underlying barriers to deworming in areas of persistently high STH infection rates. The main barrier to seeking STH treatment is not availability or cost of the drugs, but rather the lack of impetus to seek the drugs. A comprehensive nationwide deworming program in China should involve annual provision of free deworming treatment in village clinics or schools, distribution of culturally appropriate educational materials to inform children and families about STH infection, and improvement of the quality of health care delivered by village clinicians.
authors: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America.
authors: Louise
authors: L
authors: Lu
authors: Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
authors: Chengfang
authors: C
authors: Liu
authors: Center for Chinese Agricultural Policy, Institute of Geographical Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
authors: Linxiu
authors: L
authors: Zhang
authors: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America.
authors: Alexis
authors: A
authors: Medina
authors: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America.
authors: Scott
authors: S
authors: Smith
authors: Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America.
authors: Scott
authors: S
authors: Rozelle
mesh_terms: D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D002648:Child; D002681:China / Q000453:epidemiology; D003150:Community Health Workers; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006373:Helminthiasis / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D012574:Schools; D012987:Soil / Q000469:parasitology*
chemical_list: D000871:Anthelmintics; D012987:Soil