Development of Schistosomal

School-Based Health Education Model for Yemeni

Schoolchildren

Hassan K. Bassiouny MD, Dr.PH., Hassan K. Bassiouny MD, Dr.PH., Tropical Health Dept. High Institute of Public Health, Alexandria Tropical Health Dept. High Institute of Public Health, Alexandria University, Egypt.University, Egypt.Latifa A. Al-Shibani Bsc., Dr.PH Latifa A. Al-Shibani Bsc., Dr.PH Faculty of Medicine and Health Sciences, Sana'a University, Faculty of Medicine and Health Sciences, Sana'a University, Yemen.Yemen.

2006

IntroductionIntroduction

Republic of Yemen is about 17 millions of which 2-3 millions are infected by schistosomiasis. The disease is predominantly affects rural populations and its high incidence is among schoolchildren around 10 years. The disease is largely caused by human behavior, principally contamination and incorrect water use practice.

Schoolchildren form a major target for health education on schistosomiasis, because they play an important role in water contamination and infection transmission, besides, they are the most susceptible to infection.

In Yemen , there is no health education activities directed to schoolchildren especially those concerning the endemic diseases.

Aim of the StudyAim of the Study

The present study aims at developing a simple and effective schistosomal school-based health education model for Yemeni schoolchildren.

Subjects & Methods Subjects & Methods

A cross sectional study was conducted on 20% of the A cross sectional study was conducted on 20% of the families (527 inhabitants, 251 males & 276 females) of two families (527 inhabitants, 251 males & 276 females) of two Schistosoma mansoniSchistosoma mansoni endemic villages in Taiz Governorate. endemic villages in Taiz Governorate. Besides 152 students (90 males & 62 females) of primary Besides 152 students (90 males & 62 females) of primary ( 52 males & 30 females) and preparatory ( 38 males & 32 ( 52 males & 30 females) and preparatory ( 38 males & 32 females) schoolchildren of different age and sex group. females) schoolchildren of different age and sex group.

A pre-coded interview questionnaire was designed A pre-coded interview questionnaire was designed and pre-tested to collect personal and socio-economic data and pre-tested to collect personal and socio-economic data from both villagers and students. from both villagers and students.

Another pre-coded questionnaire was also Another pre-coded questionnaire was also designed and pre-tested to collect data on designed and pre-tested to collect data on knowledge, attitude and practice (KAP) concerning knowledge, attitude and practice (KAP) concerning schistosomiasis from students only to be used as a schistosomiasis from students only to be used as a base line data to develop a health education model.base line data to develop a health education model.

This model composed of three modules: This model composed of three modules:

Module I: focused on the orientation of the Module I: focused on the orientation of the disease, mode of the infection, water risky and disease, mode of the infection, water risky and contamination behavior. contamination behavior.

Module II: directed to the identification of the Module II: directed to the identification of the life cycle, symptoms and complications.life cycle, symptoms and complications.

Module III: stressed on the importance of Module III: stressed on the importance of health behavior and seeking medical care when health behavior and seeking medical care when necessary. necessary.

These modules were implemented through These modules were implemented through formats: as lectures, discussions and questions, and formats: as lectures, discussions and questions, and media: as slide projector and pictured booklets. The media: as slide projector and pictured booklets. The questionnaires were filled by face-to-face interview questionnaires were filled by face-to-face interview after obtaining informed consent from the after obtaining informed consent from the participants in case of the villagers or the parents of participants in case of the villagers or the parents of the schoolchildren.the schoolchildren.

Early evaluation of the impact of the model Early evaluation of the impact of the model was done one month after the implementation of the was done one month after the implementation of the program to assess early changes in KAP. program to assess early changes in KAP.

The second post-intervention was done one The second post-intervention was done one year later using the same questionnaire. It included year later using the same questionnaire. It included only 143 schoolchildren because 9 students (4 males only 143 schoolchildren because 9 students (4 males & 5 females) were left school.& 5 females) were left school.

Stool samples were collected from every Stool samples were collected from every villager and student during the base line survey and villager and student during the base line survey and after one year post-intervention. Three Kato thick after one year post-intervention. Three Kato thick smears were examined from every individual for smears were examined from every individual for detection of detection of S.mansoniS.mansoni eggs and to estimate the eggs and to estimate the intensity of infection (geometric mean egg count intensity of infection (geometric mean egg count GMEC= No. of eggs/ gram stool). GMEC= No. of eggs/ gram stool).

The infected cases were received praziquantel The infected cases were received praziquantel treatment with a dose of 40 mg/kg body weight.treatment with a dose of 40 mg/kg body weight.

ResultsResults

Prevalence and intensity of S.mansoni infection among villagers

Male44%Female

56%

Male

Female179.7 eggs/g stool

200.3 eggs/g stoolX1

2=3.71, p> 0.05

Prevalence of Prevalence of S.mansoniS.mansoni infection among infection among schoolchildrenschoolchildren

pre and post- intervention with health pre and post- intervention with health education programeducation program

45%55%

Postive

Negative

Pre-intervention

23%

77%Post-interventionX2

2=15.4, p<0.01

Some Remarks on the Some Remarks on the Intervention Study & Intervention Study &

ConclusionConclusion

1. The mean knowledge score one month and one 1. The mean knowledge score one month and one year and mean practice score after one year were year and mean practice score after one year were significantly higher among children aged 14years significantly higher among children aged 14years and more who completely cured which may indicate and more who completely cured which may indicate that older age group understand the health that older age group understand the health education program, not only caught knowledge but education program, not only caught knowledge but also change their practice.also change their practice.

2. The mean knowledge score after one month and 2. The mean knowledge score after one month and one year and mean attitude score after one month one year and mean attitude score after one month of the program were significantly higher among of the program were significantly higher among females than males. This may be attributed to that females than males. This may be attributed to that females gained knowledge more rapidly and more females gained knowledge more rapidly and more interested about their health which in turn affect interested about their health which in turn affect their attitude but had no effect on their practice. their attitude but had no effect on their practice. Despite of the increase in the knowledge level, yet Despite of the increase in the knowledge level, yet change in behavior in relation to the disease change in behavior in relation to the disease remained low.remained low.

3. There was a significant high mean attitude score 3. There was a significant high mean attitude score after one month among students who had latrine in after one month among students who had latrine in their houses. This may indicate that health education their houses. This may indicate that health education program affect their feeling towards the importance program affect their feeling towards the importance of latrine and as a result changed their attitude but of latrine and as a result changed their attitude but unfortunately this change didn't last for one year unfortunately this change didn't last for one year indicating the importance of continuous program at indicating the importance of continuous program at least every month.least every month.

4. The mean practice score after one month of the 4. The mean practice score after one month of the intervention was significantly higher among students intervention was significantly higher among students with uneducated mothers. The only explanation is with uneducated mothers. The only explanation is that the students lacked role model by their mothers that the students lacked role model by their mothers so the health education program affects them more so the health education program affects them more rapidly.rapidly.

5. A significant change in mean practice score among 5. A significant change in mean practice score among students who had at least one information tool students who had at least one information tool mainly radio. This could be explained on the basis mainly radio. This could be explained on the basis that this group may lack the information source, so that this group may lack the information source, so they were more affected by the program especially they were more affected by the program especially that the role of Yemeni TV is still insufficient in that the role of Yemeni TV is still insufficient in transferring comprehensive information about transferring comprehensive information about schistosomiasis.schistosomiasis.

6. Although the prevalence rate of schistosomiasis 6. Although the prevalence rate of schistosomiasis declined one year following the implementation of declined one year following the implementation of the health education program by approximately the health education program by approximately 50%, the infection still recorded in the study area 50%, the infection still recorded in the study area indicating that knowledge, attitude and practice of indicating that knowledge, attitude and practice of the students concerning water contact had not the students concerning water contact had not completely changed. Insufficient improvement in completely changed. Insufficient improvement in environmental sanitation may be a contributing environmental sanitation may be a contributing factor.factor.

7. It is worthy to mention that no significant change 7. It is worthy to mention that no significant change in mean KAP scores in relation to in mean KAP scores in relation to S.mansoni S.mansoni infection one year of the program. This could be due infection one year of the program. This could be due to various interacting factors: in Yemen there is no to various interacting factors: in Yemen there is no formal or systemic health education activities formal or systemic health education activities directed to schoolchildren especially those directed to schoolchildren especially those concerning with prevention of endemic diseases. concerning with prevention of endemic diseases.

Absence of community participation and non Absence of community participation and non involvement of the NGOs may be another factor involvement of the NGOs may be another factor affecting non significant change in KAP. affecting non significant change in KAP.

In conclusion, intestinal schistsomiasis continues In conclusion, intestinal schistsomiasis continues to be a major public health problem in rural areas in to be a major public health problem in rural areas in Yemen. Villagers can not expected to change their Yemen. Villagers can not expected to change their behaviors unless there are some change in local behaviors unless there are some change in local environmental conditions, provision of safe water supply environmental conditions, provision of safe water supply and snail control measures supported by provision of and snail control measures supported by provision of appropriate information and health education. appropriate information and health education.

Inserting a relatively low cost behavioral Inserting a relatively low cost behavioral intervention program into routine screening and intervention program into routine screening and treatment of schoolchildren may result in reduction of treatment of schoolchildren may result in reduction of schistosomal infection among them. schistosomal infection among them.