HEALTH EDUCATION AND THE CONTROL OF UROGENITAL SCHISTOSOMIASIS: ASSESSING THE IMPACT OF THEJUMA NA KICHOCHOCOMIC-STRIP MEDICAL BOOKLET IN ZANZIBAR

Abstract

Summary. Endeavours to control urogenital schistosomiasis on Unguja Island (Zanzibar) have focused on school-aged children. To assess the impact of an associated health education campaign, the supervised use of the comic-strip medical booklet Juma na Kichocho by Class V pupils attending eighteen primary schools was investigated. A validated knowledge and attitudes questionnaire was completed at baseline and repeated one year later following the regular use of the booklet during the calendar year. A scoring system (ranging from 0.0 to 5.0) measured children's understandings of schistosomiasis and malaria, with the latter being a neutral comparator against specific changes for schistosomiasis. In 2006, the average score from 751 children (328 boys and 423 girls) was 2.39 for schistosomiasis and 3.03 for malaria. One year later, the score was 2.43 for schistosomiasis and 2.70 for malaria from 779 children (351 boys and 428 girls). As might be expected, knowledge and attitudes scores for schistosomiasis increased (+0.05), but not as much as originally hoped, while the score for malaria decreased (−0.33). According to a Kolmogorov-Smirnov test, neither change was statistically significant. Analysis also revealed that 75% of school children misunderstood the importance of reinfection after treatment with praziquantel. These results are disappointing. They demonstrate that it is mistaken to assume that knowledge conveyed in child-friendly booklets will necessarily be interpreted, and acted upon, in the way intended. If long-term 1 Corresponding author.

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“…(19) Regarding the understanding of the educational booklet, a study conducted in the eastern region of Africa assessing the impact of education in health in schools on the reduction of cases of schistosomiasis points out that 75% of the readers did not understand the information contained in an educational booklet. (20) These findings diverge from studies conducted in Brazil: in relation to the language of the booklet, in the present study the phrases were considered attractive, clear, and objective by all teachers. Similar results are observed in other studies that validated educational materials, and their target audience also assessed the language as clear and compatible with a good understanding.…”

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“…This finding corroborates a Brazilian study that validated a booklet for prevention of vertical transmission, in which the target audience agreed on the clarity of the information presented by the material (27) . Nonetheless, such Brazilian findings are in contrast to research carried out in Africa, whose results indicate that 75% of the target audience could not understand written content on schistosomiasis (28) . The discrepancy in the results obtained in the studies points to the need to consult the target public about the clarity/comprehension of educational materials, especially those related to health issues, in which misinterpretation or unfeasibility may impact prevention, promotion and health recovery.…”

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“…Local knowledge how schistosomiasis is transmitted and prevented and view of the healthcare services available are crucial to achieve the target of effective control. In accordance with our results, previous studies highlight the insufficient knowledge about schistosomiasis in the endemic areas [21,22,25]. Although people responding to the questions in the questionnaire had a good general understanding of the disease, most of them still lacked knowledge of specifics, such as the parasite's life cycle and the high risk even of the slightest water contact.…”

“…Control of the aquatic snail intermediate host where and when transmission occurs should take precedence, and that means definition of water contact including acceptable management of sewage disposal, health education and improved water sanitation and hygiene (WASH) [20]. Indeed, several recent studies highlight the fact that knowledge and attitude about schistosomiasis remain insufficient and poor in many endemic areas [21][22][23][24]. Some people may assume that previous treatment prevents reinfection, which affects negatively water contact activity and compliance to repeated chemotherapy campaign In Zanzibar, as many as 75% of the children thought that there would be no risk of reinfection after treatment with PZQ [21].…”

“…Indeed, several recent studies highlight the fact that knowledge and attitude about schistosomiasis remain insufficient and poor in many endemic areas [21][22][23][24]. Some people may assume that previous treatment prevents reinfection, which affects negatively water contact activity and compliance to repeated chemotherapy campaign In Zanzibar, as many as 75% of the children thought that there would be no risk of reinfection after treatment with PZQ [21]. Another study in northern Côte d'Ivoire and southern Mauritania, revealed that some people believed that schistosomiasis is caused by exposure to goat or dog urine in the environment, while others thought that the disease is transmitted by environmental elements such as sunshine and dirty water [25].…”