Knowledge, Attitudes and Practices Towards Onchocerciasis among Children and Adolescents in the Formerly Endemic Foci of Mexico: A Cross-Sectional Survey in the Post-Verification Period
A cross-sectional survey conducted in Mexico's formerly endemic regions of Oaxaca and Chiapas reveals that while children and adolescents hold favorable attitudes toward onchocerciasis control, their specific knowledge of the disease and its blackfly vector remains critically low, highlighting the urgent need for sustained health education to maintain elimination gains in the post-verification period.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the highlands of southern Mexico, a silent victory was declared over a disease that once caused blindness and severe skin conditions. This illness, known as river blindness or onchocerciasis, is spread by a tiny blackfly that breeds in fast-moving rivers. For decades, health workers treated entire communities with medicine to stop the parasite from spreading, and by 2015, the World Health Organization confirmed that the disease was no longer being transmitted in Mexico. However, stopping the spread of a disease is only the first step; keeping it away requires constant vigilance. If the disease were to return, perhaps carried in by a traveler from a place where it still exists, the local population needs to know what to look for and how to protect themselves. This is where the challenge lies: the children and teenagers growing up today in these former disease zones were born after the medicine campaigns ended. They have never seen the disease, never received the treatments, and may not even know the name of the insect that once threatened their neighbors.
A team of researchers traveled to the states of Oaxaca and Chiapas to see what these young people knew about the threat that had vanished from their lives. They asked hundreds of children and teenagers, aged eight to seventeen, simple questions about the disease, how it spreads, and what they would do if they saw signs of it. The goal was not to find sick people, but to understand the community's memory and readiness. The researchers found that while the young people were generally willing to help if a problem arose, their actual knowledge of the disease was surprisingly low. In Oaxaca, only about 36 percent of the young people had ever heard of river blindness, and in Chiapas, that number dropped to just 20 percent. Even fewer could correctly identify the blackfly as the culprit. Many guessed it was a generic fly or mistakenly blamed the mosquito, the insect famous for spreading malaria. Only 9.3 percent of the respondents in Oaxaca and 4.3 percent in Chiapas correctly named the blackfly.
Despite this lack of specific knowledge, the attitude of the community remained strong. When asked what they would do if they noticed a suspicious lump under the skin or felt symptoms, the vast majority said they would go to a health center. In Oaxaca, 96.4 percent said they would seek medical help, and in Chiapas, 86.3 percent agreed. Most also said they would take medicine if prescribed and would report any strange lumps to health brigades. This suggests that trust in the health system remains high, even among those who do not understand the history of the disease. However, this trust is not matched by protective habits. The study revealed that many of these young people still spend time near rivers and streams where the blackflies breed. In Oaxaca, nearly 70 percent had visited these areas, yet very few wore protective clothing or used repellent to avoid bites. While wearing long sleeves was somewhat common in Oaxaca, it was rare in Chiapas, and the use of insect repellent was low in both places.
The researchers also looked for any signs that the disease might be returning. They asked the children if they or their family members had ever been diagnosed with the illness, or if they had seen anyone with the tell-tale signs like skin nodules or vision problems. The answers were reassuringly negative. Only a tiny fraction of the participants reported ever having the disease or seeing it in their community. This lack of recent cases aligns with the official status of Mexico as free of the disease. The study concludes that while the community is ready to cooperate with health officials, the fading memory of the disease poses a risk. If the blackflies are still biting and the young generation does not know what they are biting for, the door could be left open for the disease to return. The findings suggest that to keep the victory permanent, health education must continue, teaching the next generation to recognize the blackfly and the signs of the disease, ensuring that the silence of the past does not become the ignorance of the future.
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