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

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
Author summary School-aged children are the most affected group of people in terms of burden due to soil-transmitted helminth infections. Unfortunately, the available treatment programme with albendazole cannot prevent reinfection. Health and hygiene education has been recommended to be effective at reducing the rate of STH infections through increased knowledge about transmission and improved hygiene attitude and practices. We, therefore, developed a health educational board game Worms and Ladders and evaluated its potential to complement treatment and reduce reinfection rates. Our findings show that the worm burden dropped significantly among children who played the newly developed game, compared to other children who played another game. The knowledge, attitude and practices of the children as regards STH also improved significantly. The Worms and Ladders board game, therefore, has the potential to promote good hygiene behavior, which in turn translated to a reduced rate of infections. These findings present the newly developed game as a reliable tool to complement mass drug administration campaigns for STH control.