EXPLORATION, ADAPTATION, REDESIGNING AND EVALUATION OF AFRICAN GAMES FOR ENHANCING HEALTH EDUCATION FOR ELIMINATING SCHISTOSOMIASIS IN OGUN STATE

Abstract

ABSTRACT Health education has been advocated by the World Health Organization as a complementary intervention to eliminate schistosomiasis. Health education games have been reported to enhance knowledge, attitudes, and practices (KAP) regarding schistosomiasis control, including participation in mass administration of medicine (MAM) campaigns. This study explored, adapted, redesigned, and evaluated traditional games as behaviour-change communication tools for schistosomiasis control. An exploration of traditional games using questionnaires and Focus Group Discussions (FGDs) was conducted in six communities in Ijebu East Local Government Area (LGA). The games were redesigned by community members and evaluated in a single-blind randomized control trial in 18 randomly selected primary schools in Yewa North, Odeda, and Ijebu North-East LGAs. The schools were randomized into three control and intervention arms, each using ballots. The control group played the commercial Ludo game, while the intervention group played the Schisto-Ludo and Schisto-Whot games for six months. A total of 1095 pupils were recruited for the study after parents consented, treated for schistosomiasis infection using praziquantel and their KAP about schistosomiasis was determined at baseline and six months after game play. Urine samples were collected from the school children into dark, sterile specimen bottles and tested for haematuria using Combi 9 test strips. The sedimentation method was used to determine the concentration of Schistosoma haematobium ova at baseline, three and six-months during gameplay. Vector snails were handpicked from rivers around schools and their infection status was determined by sunlight exposure to induce cercariae shedding. The collected data were entered into Microsoft Excel and imported into R Studio version 4.3.2 for analysis. Descriptive statistics was conducted, associations were investigated using chi-square statistics while KAP was analysed by determining the mean scores ± standard error of responses. FGDs were transcribed and analysed using NVivo 12. The effects of the redesigned games on schistosomiasis infection were reported as adjusted odds ratios (AORs) at 95% confidence intervals. Exploration of the questionnaires revealed that popular traditional games were Ludo (38.3%), Whot card (16.6%), Ayo-Olopon (14.9%), and Draft (9.1%). There was a significant (p < 0.001) increase in knowledge of schistosomiasis from 1.49 ± 0.05 to 13.9 ± 0.02 in the intervention group compared to the control group. Exposure to infection, attitudes and practices increased significantly (p < 0.001) from 1.80 ± 0.14 to 2.52 ± 0.19 and for treatment-seeking behaviour from 1.48 ± 0.06 to 2.76 ± 0.06 in the intervention group. The incidence rate of schistosomiasis increased in the intervention (1.10% - 2.52%) and control groups (0.20% - 1.03%) at 3 and 6 months, respectively. At 6 months after gameplay, the odds of being infected with schistosomiasis were lower in the intervention (AOR= 0.7, 95% CI=-1.18, -0.04) and higher in the control (AOR=1.69, 95% CI=-0.05, 2.06) groups. However, the 19 Bulinus truncatus and 5 Biomphalaria pfeifferi snails recovered from the communities were uninfected. This study demonstrated that traditional games redesigned with schistosomiasis health education messages are potential vehicles for delivering complementary interventions for the elimination of schistosomiasis.