The impact of Worms and Ladders, an innovative health educational board game on Soil-Transmitted Helminthiasis control in Abeokuta, Southwest Nigeria

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 PLOS NEGLECTED TROPICAL DISEASES

“The Magic Glasses Philippines”: a cluster randomised controlled trial of a health education package for the prevention of intestinal worm infections in schoolchildren

“… 18 19 The integration of health education in school-based deworming programs is recommended by WHO 6 to reduce STH infections and re-infection risks through hygiene awareness and behaviour modifications. As shown in a number of studies, health education strategies are associated with increased knowledge 19 , 20 , 21 , 22 , 23 , 24 and acceptability of deworming 21 , and uptake and maintenance of WASH interventions. 25 In addition, the positive impact of health education intervention on STH infections in children has been demonstrated in some of these reports.…”

“… 25 In addition, the positive impact of health education intervention on STH infections in children has been demonstrated in some of these reports. 19 , 20 , 22 , 23 , 24 Thus, the role of effective and low-cost health educational interventions in the long-term control of worm infections cannot be overemphasized.…”

Diarrhea, Helminth Infection, Dehydration, and Malnutrition Associated with Water, Sanitation, and Hygiene Facilities and Poor Handwashing in Schools in Metro Manila, Philippines: A Cross-Sectional Study

“…44, 45, 100 Furthermore, cluster-RCTs have measured the impact of school-based WaSH interventions on children’s self-reported KAP about STH infection. 101–103 Of note, in these cluster-RCTs, STH infection-related KAP was supported by STH infection prevalence estimates that were measured via Kato-Katz technique. One limitation of our study was that we used self-report only and did not include other measures of STH infection.…”

“…44, 45, 100 Cluster-randomized controlled trials (RCTs) measured the impact of school-based WaSH interventions on children’s self-reported KAP about STH infection and STH infection prevalence. 101–103…”

“…44,45,100 Cluster-randomized controlled trials (RCTs) measured the impact of school-based WaSH interventions on children's self-reported KAP about STH infection and STH infection prevalence. [101][102][103] Supported by evidence from the above studies, we considered self-reported diarrhea Numerous studies have used self-report to measure diarrhea prevalence, [40][41][42] and many of these studies 16,81 have used a 7-day recall period rather than one month. We conducted our study only during the end of the dry season.…”