Epidemiological Outcomes of a Game-Based Intervention on Parasitic Worm Infection in a Tanzanian School

Abstract

Current global health interventions tend to focus on the “big 3” diseases: malaria, AIDS, and tuberculosis. This focus has led to a dearth of funding for and research into diseases that are also endemic in areas where the big 3 tend to strike. Due to their relative lack of priority, these underfunded and underresearched diseases have been termed, “Neglected Tropical Diseases” (NTDs). This neglect is alarming as NTDs, which “blind, debilitate, deform, or maim” (ICL 2013), affect more than 1 billion people worldwide (Hotez et al 2008). Of the 17 NTDs, those caused by worms (helminthiases and schistosomiasis) affect over one billion people worldwide (Hotez et al. 2008). For reasons that are not completely clear, these diseases tend to strike children from ages 5 to 15 (Hotez et al 2008). Thus, due to the low cost of worm drugs and the high incidence of worm infection in children, the World Health Organization (WHO) currently recommends repeated, school-based, mass-drug administration (MDA) as a worm management strategy (WHO 2006). WHO’s MDA recommendation has led to concerns in the global health community. For one, MDA places worms under selective pressure to develop resistance to chemotherapy (Geerts and Gryseels 2000) & (Albonico et al. 2004). Second, MDA occurs in schools in which absenteeism may be very common (Standley 2013), which often leaves those who bear the largest burden of disease untreated. Methods: In this paper, we research the efficacy of coupling MDA with an easy-toimplement, game-based educational interventional. By designing it to be easy-to-replicate outside of schools, we hope to demonstrate that our intervention, unlike MDA, will not be limited by absenteeism. We also hope to demonstrate that an educational intervention decreases worm infection rate to a greater extent than MDA alone. Such a result would suggest that coupling MDA with an intervention similar to our will decrease the need for repeated MDA and thus allay fears about the evolution of drug resistant parasites. Our results demonstrate that a low-cost, game based intervention does lead to intake and retention of health knowledge (p < 0.5 | Fisher’s Exact Test). Additionally, our results demonstrate that coupling MDA with educational intervention decreases infection rate to a greater extent than an MDA-only intervention (p < 0.5 | Fisher’s Exact Test), suggesting that health workers and NGOs might be able to achieve more significant gains in worm burden reduction were they to couple current interventions with a culturally-appropriate, behaviorfocused intervention. Thus we recommend that similar, low-cost, and culturallyappropriate, behavior-focused, educational interventions be integrated into to the healthcare worker arsenal as a means to achieve more significant reductions in worm burden.