EFECAB: 10 years of research on cysticercosis in Burkina Faso using the One Health concept

Abstract : EFECAB (Epidémiologie et Fardeau Économique de la Cysticercosis au Burkina) was initiated in 2006 with a grant funded through the Brain Disorders in the developing world - Research Across the lifespan program of the National Institutes of Health in the United States (R21NS055353) followed by a more substantial grant in 2010 (R01NS064901). The pilot grant showed that human and porcine cysticercosis were not only present in Burkina Faso, but more prevalent in two of three pilot villages. A cluster randomized controlled trial was subsequently conducted to estimate the effectiveness of a community-based educational intervention to reduce the frequency of cysticercosis in 60 villages located in 3 provinces where pigs were raised. The intervention was developed using an implementation research method which resulted in offering the Participatory Hygiene And Sanitation Transformation - Self-esteem Associative strengths Resourcefulness Action planning Responsibility approach, adapted for cysticercosis, and the viewing of a 52-minutes comedy movie explaining the disease and ways to prevent it to the 30 intervention villages. In each village, 60 of 80 participants accepted to provide a blood sample on three occasions over a three year period. Blood samples were analysed with the B158/B60 AgELISA test to detect active cysticercosis. Data were analysed using Bayesian hierarchical log-binomial models adjusting for the clustering of cysticercosis by village, the change in cysticercosis prevalence prior to randomization and the fact that the intervention was offered at the village level. The intervention reduced the prevalence and cumulative incidence of active cysticercosis in 2 provinces, but had no or little impact in the 3rd province. Answers to other research questions regarding factors associated with cysticercosis, measurement of epilepsy and headaches in resource-poor settings, and the cross-reaction of the AgELISA test with T. hydatigena in pigs will be summarized.