Educational cartoon boosts worm infection prevention

Researchers in China have found that a health education package targeted at schoolchildren can improve hygiene behaviors and reduce the incidence of soil-transmitted helminth infection.

The study, published in the New England Journal of Medicine, included 1718 school children aged 9 to 10 years, of whom 893 attended control schools (n=19), and 825 attended intervention schools (n=19). The research was conducted in rural Linxiang City District, Hunan province, where there is a high prevalence of helminth infection but limited awareness or educational activity about the risks.

Both control and intervention schools displayed an awareness poster. However, in the intervention schools, students also took part in an educational package, including a 12-minute cartoon promoting knowledge and prevention awareness, followed by classroom discussions. They also took part in drawing and writing competitions that reinforced the cartoon's messages, and received a pamphlet summarizing the main points. All students received albendazole treatment at baseline.

Over 9 months, the rate of helminth infection fell from 10.0% in the intervention schools to 4.1%, which was 50% lower than the rate observed in control schools (8.4%), report Donald McManus (Queensland Institute of Medical Research, Herston, Australia) and colleagues.

Results from a questionnaire measuring knowledge, attitudes, and practices around soil-transmitted helminths, showed that students in the intervention group scored significantly higher at 63.3% than students in the control group at 33.4%. Additionally, students without infection at follow-up scored on average 9.9 percentage points higher than patients who were infected.

In 10 control and 10 intervention schools where researchers covertly observed hand washing behavior, 98.9% of students in the intervention schools washed their hands after using the toilet compared with 46.0% at baseline. In contrast, the rate of hand washing showed no change in the control group (54.2 vs 54.0% at baseline). Hand washing practices also significantly correlated with questionnaire scores.

The authors also note that the intensity of infections fell in both groups during the study period. They also found that, overall, boys were significantly more likely to be infected than girls at follow-up, and that girls scored slightly but significantly higher on the questionnaire than boys (1.7 percentage points on average).

While the World Health Organization currently advocate mass drug administration, McManus and colleagues say it is inevitable that the parasites will develop drug resistance. They believe strategies such as theirs can complement pharmacologic treatment and reduce the number of treatment cycles required.

"Efforts to reduce the overall incidence of infection with soil-transmitted helminths require an integrated approach consisting of pharmacologic treatment to reduce morbidity and the prevalence of the infection and other interventions (e.g., improvements in hygiene achieved through health education) to prevent reinfection," they conclude.

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Kirsty Oswald

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Kirsty Oswald

Kirsty has a B.Sc. in Human Sciences from University College London. After several years working as medical copywriter, she became a medical journalist and is now freelance. Kirsty also works part-time as an editor for a London-based charity. She is particularly interested in the social and cultural aspects of science.

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