Improving Adherence to World Health Organization Guidelines for Pinworm Treatment in Two Primary Healthcare Centers in Misan Province: A Clinical Audit

TL;DR

This study aimed to improve adherence to WHO guidelines for treating pinworms in two healthcare centers in Iraq by implementing educational interventions.

Contribution

The study demonstrates how targeted interventions can improve adherence to WHO guidelines for pinworm treatment in low-resource settings.

Findings

Adherence to recommended dose intervals improved significantly from 11% to 37%.

Treatment of household members increased from 15% to 37% after interventions.

Hygiene advice adherence showed a statistically significant 37% improvement between cycles.

Abstract

Background: Soil-transmitted helminths, including enterobiasis (pinworm), remain a significant cause of morbidity, especially among children in moderate and low-resourced countries. Given the noticeable recurrence of this infestation in clinical practice and the distress it causes to children and their families, this audit was carried out to improve adherence to the World Health Organization (WHO) guidelines regarding pinworm treatment and prevention, specifically focusing on correct dosing, repeat dosing intervals, household contact treatment, and hygiene education.

Methodology: A clinical audit of two Plan-Do-Study-Act (PDSA) cycles was conducted in two primary healthcare centers in Iraq. Sixty patients were included in Cycle 1, and 56 patients were enrolled in Cycle 2. Data were collected through a structured questionnaire that focused on anthelmintic dose and repeating interval, treatment of family members, and hygiene advice. The intervention between the two cycles includes the redistribution of enterobiasis treatment and prevention guidelines, as well as the provision of patient leaflets and the use of posters. The statistical analysis was performed using SPSS, in which a chi-square test was utilized to measure the statistical significance in all outcomes except for the age category, where a binomial test was used because the test assumptions for Chi-square were not met.

Results: Following the measures taken, adherence to the recommended dose use showed 8% increase, but this was not statistically significant (P = 0.275). The recommended dose interval compliance levelled up from 11% to 37%, treatment of household members elevated to 37% in PDSA Cycle 2, after being 15% in PDSA Cycle 1, and hygiene advice adherence showed a 37% difference between the cycles, which were statistically significant improvements (P < 0.05).

Conclusions: This audit demonstrated that adherence to WHO guidelines for pinworm treatment improved after the implementation of several interventions designed to enhance the quality of care. This audit recommends performing similar work in other areas inside and outside Iraq and conducting larger studies focused on the pre-school age group.

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