Abstract
In most endemic sub-Saharan African countries, repeated infections with soil-transmitted helminth (STH) occur as early as six weeks after the end of mass drug administration (MDA) with albendazole. In this study, we designed a new health educational board game Worms and Ladders and evaluated its potential to complement MDA with albendazole and reduce reinfection rates through the promotion of good hygiene practices among school-aged children. The evaluation employed a randomized control trial (RCT) design. Baseline knowledge, attitude and practices (KAP) relating to STH were obtained using a questionnaire from 372 pupils across six schools in Abeokuta, Nigeria. Schools were randomly assigned into intervention and control group, with the former and latter receiving Worms and Ladders and the common Snake and Ladder board game respectively. Fresh stool samples were also collected at baseline for STH diagnosis before administering 400mg single dose albendazole. Follow-up assessments of STH burden and KAP were conducted three and six months' post-intervention. Data generated from the study were analyzed using SPSS 20.0 software, with confidence interval set at 95%. Prevalence of STH dropped from 25.0% to 10.4% in the intervention group and 49.4% to 33.3% in the control group at three months' post-intervention. The prevalence further dropped to 5.6% in the intervention group at six months' post-intervention. However, it increased to 37.2% in the control group at six months' post-intervention. There was a significant difference (p<0.05) in prevalence after intervention among the groups. KAP on transmission, control and prevention of STH significantly improved (p<0.05) from 5.2% to 97.9% in the intervention group compared to 6.2% to 7.1% in the control group. The Worms and Ladders board game shows the potential to teach and promote good hygiene behavior among SAC. These findings posit the newly developed game as a reliable tool to complement mass drug administration campaigns for STH control.
Highlights
Soil-Transmitted Helminthiasis (STH) caused by Ascaris lumbricoides, Trichuris trichiura, Necator americanus and Ancyclostoma duodenale is one of the world’s most serious public health problems [1,2,3,4]
About 24% of the world’s population (>1.5 billion people) are infected, with the highest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia [5]
For end line assessment, prevalence dropped for the intervention group to 5.6% but increased to 37.2% for the control group
Summary
Soil-Transmitted Helminthiasis (STH) caused by Ascaris lumbricoides, Trichuris trichiura, Necator americanus and Ancyclostoma duodenale is one of the world’s most serious public health problems [1,2,3,4]. Mass drug administration is the cornerstone of infection control, it is no longer news that the approach cannot prevent reinfection and calls for the need of additional public health measures, such as health education, to complement and sustain achieved efforts [13]. The health education strategy is economical as it reduces the cost of deworming, increases the level of overall health knowledge and acceptability of deworming interventions [15,16]. The inclusion of health education into school-based deworming programmes ensured that exposure and transmission to STH infections are reduced, through improved knowledge and behavioral changes [18,19]. Ejike and colleagues [24] in Nigeria has used the health education game called Schisto and Laddders to significantly improve the knowledge, attitudes and practices of school children for the prevention and control of schistosomiasis. Health education plays a significant role in helminths disease prevention, by decreasing exposure risk through behavioral change, and in increasing health-seeking behavior
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