Impact of a Novel, Low-Cost and Sustainable Health Education Program on the Knowledge, Attitudes, and Practices Related to Intestinal Schistosomiasis in School Children in a Hard-to-Reach District of Madagascar.

Stephen Andrew Spencer ,J Russell Stothard,Amaya L Bustinduy,Zafera A Rohe,Antsa Andrianiaina,Jemima Henstridge-Blows,Cortland Linder,Benedicte Sjoflot,Isla L Young,Caitlin Sheehy,Sheena M Cruickshank,Gina U Raderalazasoa ,James M St John Penney ,Glenn Edosoa ,Anjara Mihaja Nandimbiniaina ,Daniel A L Rakotomampianina ,K Hyde ,Rasolofomanana S M Michèle ,Tahiry N Ranaivoson ,Emmanuel Harizaka Andriamasy ,Hannah J Russell ,Alain Marcel Rahetilahy

doi:10.4269/ajtmh.21-0220

Abstract

ABSTRACT.Schistosomiasis control requires multisectoral approaches including praziquantel treatment, access to safe water, sanitation and hygiene, and health education. Community input can help ensure health education programs are culturally appropriate to effectively direct protective behavior change. This study reports on the three-stage development of an education program for Malagasy children, with an impact evaluation on their knowledge, attitudes, and practices (KAP) related to intestinal schistosomiasis. A cross-sectional study took place in 2017 with follow-up in 2018 in the hard-to-reach Marolambo district, Madagascar. A novel schistosomiasis education program (SEP) was designed in collaboration with researchers, stakeholders, and local community and included cartoon books, games, songs, puzzles, and blackboard lessons, costing $10 USD per school. KAP questionnaires were completed by 286 children pre-SEP and 273 children post-SEP in 2017, and by 385 and 337 children pre-SEP and post-SEP, respectively, in 2018. Improvements were observed in responses to all questions between pre- and post-education answers in 2017 (53–77%, P < 0.0001) and 2018 (72–98%, P < 0.0001) and in the pre-education answers between years (53–72%, P < 0.0001). Praziquantel mass drug administration attendance improved, rising from 64% to 91% (P < 0.0001), alongside improved latrine use, from 89% to 96% (P = 0.005). This community-consulted and -engaged SEP resulted in substantial improvements in children’s understanding of schistosomiasis, with improvements in praziquantel uptake and latrine use. Socioculturally tailored education programs can help gain schistosomiasis control. Continued investment in SEP will help promote the future well-being of children through increased participation in control and treatment activities.

Highlights

Effective health education is a vital component of any integrated public health campaign due to its role in driving health-related behavior changes.[1]
After the schistosomiasis education program (SEP), improvements were observed in understanding of schistosomiasis, mass drug administration (MDA) attendance, and latrine use
The three-stepped, community-engaged methodological approach discussed in this study provides a framework that can be followed to adapt the SEP to allow for scale-up to other communities and can enable expansion to tackle the information and education of other neglected tropical diseases

Summary

Introduction

Effective health education is a vital component of any integrated public health campaign due to its role in driving health-related behavior changes.[1]. Active community encouragement and participation, with facilitation, is necessary for better tailoring of sustainable approaches to targeted communities.[8,9]

Methods

Results

Discussion

Conclusion