Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria

Transcription

1 DEVELOPING NEW BEHAVIOURAL CHANGE INTERVENTIONS FOR SCHISTOSOMIASIS CONTROL Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria

2 SCHISTOSOMIASIS Disease of poverty caused by infection with trematode parasites belonging to the genus Schistosoma Over 200 million people affected worldwide (WHO, 2010). One of the 17 identified Neglected Tropical Diseases 85% of them are resident in sub- Saharan Africa (WHO, 2010). Nigeria is the leading country in Sub-Saharan Africa for schistosomiasis with over 29 million affected people (Hotez et al, 2012) in which 11.3 million are estimated to be school-aged children (Ekpo et al, 2013) Most vulnerable group: School aged children

3 LIFE CYCLE

4 TRANSMISSION OF SCHISTOSOMIASIS IS LINKED WITH HUMAN BEHAVIOUR Children/adults urinating in streams and ponds, or defecate outside homes, which permit the eggs of Schistosoma to reach fresh water sources Disposal of urinal/fecal waste into fresh water bodies permitting Schistosoma eggs to reach fresh water sources Children/adults engaging in passive or active water contact practices which permit exposure and contact with Schistosoma cercaria.

5 SCHISTOSOMIASIS TRANSMISSION: A COMPLEX? Transmission of schistosomiasis is the result not only of interplay between humans, snails and parasites, but also of complex demographic, environmental, biological, technological, political, socioeconomic and cultural processes (Birgitte Bruun and Jens Aagaard-Hansen (2008): The social context of schistosomiasis and its control: an introduction and annotated bibliography.

6 SCHISTOSOMIASIS CONTROL PROGRAMME Current control of schistosomiasis is through preventive chemotherapy with Praziquantel either school-based or community-based (WHO, 2006). Although mass drug administration is the cornerstone of morbidity control, It is now widely believed that to sustain the gains of mass drug administration for the control of schistosomiasis; there is the need for complementary intervention such as improvement in water, sanitation and health education (Ejike et al. 2017)

7 WHO RECOMMENDED PC FOR SCHISTOSOMIASIS Due to the threshold for MDA defined by WHO, preventive chemotherapy is unlikely to reach all individuals that need treatment! WHO (2006)

8 BEHAVIORAL CHANGE INTERVENTION Behavioral Change Intervention involve sets of techniques, used together, which aim to change the health behaviours of individuals, communities or whole populations (National Institute for Health and Care Excellence, 2014) Health Education is such an intervention TARGETS Individuals Communities Systems

9 BEHAVIOURAL CHANGE INTERVENTIONS STUDIES In Ghana, to discourage school-aged children from going to the local river, a water recreation area was built as an alternative swimming area, and this resulted in a significant decrease in incidence of the disease (Konsinki et al., 2012) In China, multimedia educational videotapes and comic books were used to increase children s knowledge of schistosomiasis and encourage them to reduce their contact with unsafe water sources (Yuan et al., 2000)

10 BEHAVIOURAL CHANGE INTERVENTIONS In China, educational materials was used to investigate improvement in schistosomiasis knowledge, attitudes towards infection testing and treatment, use of personal protective equipment, reducing defecation in the field and reducing dermal contact with potentially contaminated water sources. The results indicated improvement in knowledge, attitudes and reduction in field-defecation in follow-up surveys (Wang et al., 2013)

11 SCHOOL-BASED HEALTH EDUCATION Health education as defined by WHO is any combination of learning experiences designed to help individuals or communities improve their health by increasing their knowledge or influencing their activities (WHO, 2014).

12 HEALTH EDUCATION MESSAGES SHOULD ADDRESS Mode of transmission of the infective stage (cercaria) Behavioural risks associated with transmission (risk factors for transmission of infection) Sign and symptoms of infection Information on what to do to seek treatment Information on school-based deworming for schistosomiasis Easy to use, cheap and user friendly

13 SCHOOL-BASED HEALTH EDUCATION TO COMPLEMENT CHEMOTHERAPY Recent studies in Mali and Kenya have shown the persistent prevalence of schistosomiasis in school children after repeated preventive chemotherapy up to 4 years (Landouré et al, 2012, Lelo et al, 2014). This suggest that mass chemotherapy alone is unlikely to lead to the elimination of schistosomiasis. Complimentary intervention are therefore needed to support school-based MDAs. The challenge is how to deliver long-term school-based health education that can significantly change behaviour? In many MDA campaigns, health education messages such as posters, bill boards, radio jingles are expensive, non-interactive.

14 DEVELOPING A NEW BEHAVIOUR CHANGE INTERVENTION The following questions must be answered What is the objective of the intervention? Who is our target population? What level of intervention are we considering? What are the factors influencing their current behaviour? How can we influence their behaviour? What is the best strategy to get our target population by-in into the behaviour change? How long do we need to implement this intervention to achieve our desired goals?

15 To design an intervention, the first thing to do is to identify and review the program s goals and objectives, which usually delineate the program outcomes. Next you need to design a rough outline of what the intervention might look like

16 WHO IS OUR TARGET POPULATION? Interventions can be targeted at Individuals Communities Systems You must have information about your target population and why they do what they do in terms of behavior. There is need to study and understand their beliefs, values, and attitudes about the health problem

17 Level I: building awareness These focus on increasing awareness of a disease or health problem. Level II: changing lifestyles These are designed to help individuals make lifestyle changes. Level III: creating supporting environments for change - These work toward creating environments that support the behavior changes made by individuals.

18 NEW BEHAVIOURAL CHANGE INTERVENTIONS In many African communities, there exist some form on traditional games, story telling structures, that can be leverage upon to deliver HE. Here we designed a health education board game Schisto and Ladders for the promotion of positive behavioural changes among school children and evaluated its potential for the control of Schisto among school children. Draft Board Game Ludo Board Game

19 SCHISTO AND LADDERS First version Second version Design idea: Based on Concept of reward for good health behaviours by moving up a ladder and punishment for risky health behaviours by being bitten by the Schistosoma worm.

20 WHAT S NEW ABOUT SCHISTO AND LADDERS Health education messages on the board depicting behaviours: Pictorial Self illustrating Child-friendly The messages includes; Mode of transmission of the infective stage Behavioural risks associated with transmission Symptoms of infection Information on what to do to seek treatment Prevention of reinfection and control strategies.

21 The game can elicit positive behavioural changes in players by informing and educating the players about schistosomiasis, its transmission, control, and prevention. HOW TO PLAY THE GAME Can be played by a minimum of 2 and a maximum of 4 persons, to allow for proper interaction and assimilation of the health education messages and warnings on the board. The game starts when a player throws a 1 with a dice. A player moves up when he/she gets to the foot of a ladder and goes down when he gets to the head of the Schistosoma worm. Players are self-guided by the health messages on each square of the board. The players count the number shown on the dice when thrown and the first player to get to the square marked 100 wins the game.

22 SCHISTO AND LADDERS: TESTING

23 Knowledge about schistosomiasis among intervention and control group pre-and post-playing of Schisto and Ladders Ejike et al., 2017

24 Pre and Post-assessment of daily frequency of exposure to dam water Ejike et al., 2017

25 SCHISTO AND LADDERS -A school girl when asked to choose between Schisto and Ladders and Snake and Ladders games Snakes and ladders does not have words on it. I preferred Schisto and Ladders because it has words written on it which helped me in learning

26 WORMS AND LADDERS 6 schools (3 intervention and 3 control). All schools participated in MDAs. 212 SC in the intervention schools played Worms and Ladders, while 160 SC in control schools played Snakes and Ladders for 6 months. KAP and Prevalence of STHs was assessed at 3 and 6 months. MDA Worms and Ladders : A new health educational game to complement mass drug administration for the control of soil transmitted helminthiasis in school children (Unpublished data)

27 SUMMARY Behavioral Change Interventions would be require for the elimination of schistosomiasis The Intervention must be innovative, long-term, cheap and adaptive to local setting. Traditional and local games that are popular in endemic communities can be modified and adopted to deliver behavioral change intervention either school-based or community based to complement MDAs. Behavioral Change Interventions should be tailored to local situation present in endemic communities Behavioral Change Interventions should be encouraged and promoted as complimentary measure for stopping transmission of schistosomiasis in endemic countries. More research works are needed for the development and deployment of new behavioral change intervention

28 THANK YOU Contact Address: Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Nigeria