Exploration of knowledge gaps and misconceptions about infection with Enterobius vermicularis in Iraq

Background: Enterobius vermicularis, or pinworm, is a parasitic infection widespread in low sanitation and hygiene areas. Pinworm infection incidence, immunological responses, awareness levels, and misunderstandings must be understood to design successful intervention measures. Methods: This cohort study examined E. vermicularis infection, immunological responses, knowledge, and hygiene behaviors in Iraq. This study employed a multifaceted methodology spanning from December 2023 to May 2024. 114 participants were recruited. Sociodemographic data, misconceptions, and symptoms were collected using structured questionnaires. The prevalence of infection was evaluated using a perianal adhesive tape test before and after the intervention. Knowledge of transmission and hygienic procedures was addressed in educational seminars. A single dose of 400 mg albendazole was delivered to all baseline-positive individuals in accordance with treatment guidelines; drug consumption was tracked to evaluate its impact on prevalence decrease. Biomarkers such as eosinophil counts, C-reactive protein (CRP), immunoglobulin E (IgE), and erythrocyte sedimentation rate (ESR) were assessed before and after the intervention. The prevalence was assessed via McNemar's test, whereas biomarker alterations were evaluated through Wilcoxon signed-rank tests. Results: The baseline prevalence of 61.4% was reduced to 30.7% following the intervention (absolute reduction: 30.7%; McNemar p < 0.0001). Knowledge and hygiene practices improved markedly, exemplified by daily bathroom cleaning (+57.9 percentage points) and consistent handwashing (+41.2 percentage points). Biomarkers exhibited significant reductions: eosinophils (0.47 → 0.37 ×10³/µL), CRP (12 → 7 mg/L), IgE (117 → 86.5 IU/mL), and ESR (33 → 16 mm/hr), all with p < 0.001. However, as all positive cases were also administered albendazole, the decrease in prevalence cannot be solely ascribed to education. Conclusion: The integration of health education with supervised albendazole administration enhanced knowledge and cleanliness practices, correlating with a decrease in infection prevalence and inflammatory markers. The evidence underscores the supplementary function of health education in conjunction with routine deworming for sustainable parasite control.