Africa: 'Worms and Ladders' Game Cuts Infection Rates in Kids

Building resistance with deworming tablets (file photo).
21 October 2020

Accra — Researchers have developed an educational board game called Worms and Ladders that can teach school-aged children basic hygiene to help reduce soil-transmitted intestinal worms called heminths.

The World Health Organization says that over 600 million school-aged children live in areas where soil-transmitted intestinal worms abound. About 24 per cent of the world's population are infected, with the highest numbers occurring in regions including Sub-Saharan Africa.

Researchers created the health educational board game Worms and Ladders, and assessed its potential for controlling soil-transmitted intestinal worms in Nigeria.

"We found that the prevalence of soil-transmitted intestinal worms reduced from 25 per cent to 5.6 per cent in the intervention group and 49.4 per cent to 37.2 per cent in the control group at six months post-treatment," says Uwem Ekpo, co-author of the study and a professor of parasitology and epidemiology at the Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria.

Ekpo adds that the board game was more user-friendly to school-aged children than the use of posters, health talks which are currently being used as health education strategies for children.

According to the study published in the PLOS Neglected Tropical Diseases last month (25 September), researchers randomly assigned three schools to play Worm and Ladder game and three other schools to play the Snake and Ladder game as a control.

With the aid of a questionnaire, researchers obtained data on knowledge, attitudes and practices relating to intestinal worms using a questionnaire from 372 pupils of ages five to 15 years old across in six schools in Abeokuta, Nigeria on three occasions: before the intervention, three months and six months after the intervention.

Ekpo tells SciDev.Net the board game was used to teach school children in a user-friendly approach what to do to avoid reinfection after deworming exercises.

"The location of the schools was spatially wide, to prevent interaction between the intervention and control schools," he says.

Ekpo explains that the game improved knowledge, attitude, and practices about soil-transmitted intestinal worms, promoting good hygiene behaviours among school children thereby reducing the rate of reinfection. The games were given for playtime during break.

According to the study, the board game was modelled after the popular Snakes and Ladders game, with the head indicating unhygienic behaviours that aid the transmission of intestinal worms, and the tail end of the ladder indicating statements showing the results of unhygienic behaviours.

Six months after the deworming exercises, about 98 per cent of children in the intervention group knew at least one way of acquiring intestinal worms compared with only seven per cent of children who did not receive the intervention.

"I now beat my siblings, and even shout on my elder brother if they walk barefooted," says a child cited in the study. "I do tell them worms will suck all their blood... if they don't wear slippers or shoe outside." Ekpo says that reducing reinfection rates after deworming could accelerate the elimination of soil-transmitted intestinal worms as a public health concern.

African policymakers looking for innovative tools to deliver health education in an exciting way to school children should consider the board educational, Ekpo says.

Akinwale Oyejoko, a physician and managing director of Jayden Medical Centre in Lagos, Nigeria, says that the underlying principle of the game is commendable because of its involvement of patients to play an active role in their care while at the same time shifting attention from curative to preventive medicine.

"If people enjoy their work, if they see it as fun, then their compliance generally tends to be higher," Oyejoko tells SciDev.Net.

"These kids will also go on to teach other kids about it and this will serve the local communities well."

This piece was produced by SciDev.Net's Sub-Saharan Africa English desk.


Dorcas B. Bassey and others The impact of Worms and Ladders, an innovative health educational board game on soil-transmitted helminthiasis control in Abeokuta, Southwest Nigeria (PLOS Neglected Tropical Diseases, 25 September 2020)

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