Leeds Health Education Database 2015

Database entries with complete fields

11. Infectious including tropical diseases

September, 2015

11.1 General

11.2 Worms

11.3 Onchocerciasis (river blindness)

1.4 Dengue

11.5 Leprosy

11.6 Tuberculosis (TB)

11.7 Filariasis

11.8 Guinea Worm

11.9 Malaria (general, insecticide impregnated bed nets, uptake of medicines and schools

11.10 Schistosomiasis (Bilharzia)

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11.1 General

Akogun, O.B. The effect of selected health education schemes on knowledge and attitude of the Kanuri towards certain parasitic diseases. Journal of the Royal Society of Health 112(6):280-285, 1992.  Ref ID : 2407

Target Group/Country Men and women in rural Nigeria from the Kanuri ethno-linguistic group

Intervention Methodology Still pictures and card games, drama, songs, storytelling, and discussions and a combination of both were used to influence knowledge and attitude of people toward malaria, diarrhoea, and dysentery and intestinal. The posters, wall charts and cut-off pictures described life cycles of intestinal protozoans and parasites . They were posted in places such as the headman's place, school walls, market places. 20 sets of UNESCO Snakes and Ladders board games and picture cards were adapted and made available for 20 households who then passed them to others when they finished. Schoolchildren were taught songs and 8 plays, each of which was acted during fortnightly meetings in the headman's compounds.  One community had the materials, another the drama and songs and the third community had both. The fourth community had no intervention.

Evaluation Method 3 experimental and one control community of total 1383 respondents were compared over a twelve month period using quarterly applied likert scale assessments of knowledge and attitude. Blood samples were taken at the beginning and end of the study to determine prevalence of helminths, amoebiasis and giardiasis.

Impact Achieved Significant gains in at p<0.01 level knowledge and attitudes towards malaria, diarrhoea and intestinal worms were achieved using both methods separate and combined. No significant decrease in malaria prevalence was achieved but % infected with Amoebas/Giardia  and Helminths in the villages receiving both interventions decreased from 39.7 to 8.22% ( control 32.8 to 39.5%) and 57.5 to 6.3% (40.6 to 19.05) respectively. Authors claimed that more impact was achieved using songs and drama than using cards and pictures but the data to support this is not clear. It is also not stated what attitudes were actually measured and what specific control behaviours were targeted. The latter information would have been particularly helpful in order to assess the relevance of the advice presented and likely impact on transmission.


11.2 Worms including hookworms and roundworms

Lansdown,R., Ledward,A., Hall,A., Issae,W., Yona,E., Matulu,J., Mweta,M., Kihamia,C., Nyandindi,U. and Bundy,D. (2015) Schistosomiasis, helminth infection and health education in Tanzania: achieving behaviour change in primary schools. Health Education Research 17, 425-433.Ref ID 9004 (Borderline)

Target Group/Country Schoolchildren in 50 rural primary schools in Lushutu District, Tanzania

Intervention Methodology A 4-day workshop in Feb 1998 for 50 teachers introduced knowledge of parasitology, prevention of parasite infection and active teaching methods. A second 3-day workshop was held 4 months later in June 1998 for teachers to share experiences and being problems. Each school produced materials which had been developed by children and teachers including songs, stories and pictures. Songs, poetic dramas, short plays, visits and discussion were used and a short play was often used as lesson starters.

Evaluation Method Baseline survey of 168 children in the intervention area and 112 in comparison area carried out March 1998. Follow-up survey carried out 9 months after start of intervention interviewed same subjects (less 84 stu7dents who had left school). A second follow-up survey was carried out 15 months after end of the project year in April 2011. Focus groups with children, parents, teachers and other community members were conducted during the three school terms. Observations of practice in schools and of the school environment were carried out throughout the project. Details of methodology of questionnaires, observational study and focus group discussion were not provided.

Impact Achieved Each school produced materials which had been developed by children and teachers including songs, stories and pictures. Songs, poetic drams, short plays, visits and discussion were used and a short play was often used as lesson starters. Children in the intervention area had a better grasp of the obvious risks to health e.g. from mosquitoes and human faeces and about health action such as using latrines and eating fruit compared with children in comparison area (p<0.0000), Events organized over the 5 month period included cleaning school paths, planting fruit trees, plastering the school toilet with mud, disinfecting school toilet, preparation of new toilet hole, boiling drinking water and litter collection. The follow-up survey showed that health education teaching was continuing and also many of the behaviours noted in the first survey had been maintained. The authors have taken great pains to set up a sustainable programme using local resources. While claiming to show a significant change in knowledge, little information is provided of the knowledge score upon which that claim is based. More information on the methodology of observational visits would have been helpful alongside a more critical assessment of the comparison data on practices. The lack of discussion of the methods used to ensure validity of observational studies is disappointing and limits the value of of authors conclusions on the impact of the programme on health education methods and health practices. Given that the disease schistosomiasis is specifically mentioned in the title it would have been useful to have had more focus on the specific issues involved with that disease including bathing in infected water and urinating/defaecating in standing water.

Lefroy, J.E., Swai, S., Hoopman, R. and van Hell, L. (1995) How effective is community health education in preventing worm infestation? . Trop. Doct. 25, 194. Ref ID : 4248

Target Group/Country Schools in Northern Tanzania

Intervention Methodology The pupils in  two schools were de-wormed and health education was started in on school (Magadini) and the homes of that village. The emphasis was on worms, avoiding faecal contamination of the environment and the practicalities of hand-washing. The methods used were regular visits and discussions in the homes by the Parish Health Educators, the showing of a film about worms to the community and classroom teaching of the children their school teachers.

Evaluation Method Nine months after deworming, the children in both schools who originally brought samples were all asked to bring another sample

Impact Achieved At the outset the numbers/percentage of parasitized children in the test school was 18 out of 37 (49%) and similar to the control school Karansi was 20 out of 39 (51%). However nine months later after the health education there was a difference. Few of the children in Magadini school (5 (19%) were parasitized whereas 18 (46%) in the control school had parasites. 13 of these (33%) had become re-infected 5 (13%) of the original uninfected children had become infected. The value of this study is severely limited by the small sample size and the consequent lack of statistical significance tests

Mascie-Taylor,C.G., Karim,R., Karim,E., Akhtar,A.T., S and Montanari,R.M. (2013) The cost efectiveness of health education in improving knowledge and awareness about intestinal parasites in rural Bangladesh. Economics and Human Biology 1, 321-330. Reference ID: 9115

Target Group/Country Children aged 2-8 yr living in rural area about 80 km from Dhaka, Bangladesh

Intervention Methodology The 4 regimens over an 18-mo period were (1) only chemotherapy to all household members at the commencement of the study (i.e., at an interval of 18 mo), (2) same as group (1) and regular health education throughout the study period, (3) chemotherapy to all household members at the commencement of the study and subsequent chemotherapy to all children at intervals of 6 mo, and (4) same as group 3 with the addition of regular health education throughout the study period. Health education (through home visits once a month, visits to schools and group discussions) was aimed at increasing awareness of worm transmission and the disabilities caused by intestinal helminths. Simple ways of improving personal hygiene and sanitation through hand washing, nail trimming, wearing of shoes, and use of a latrine and clean water supplies were encouraged

Evaluation Method 550 children aged 2-8 years were randomly selected from four study areas were randomly selected on a household basis. Before the initial albendazole treatment, each child provided a faecal sample so that prevalence and intensity of infection (eggs/g in faecal samples, using the Kato-Katz method) for the three worms (round-, whip- and hookworm) could be determined. All children in the four areas had their height, weight and mid-upper arm circumference (MUAC) measured using standard anthropometric techniques at 6-month intervals commencing at the baseline survey. They also provided a faecal sample at 6, 12, and 18 months for determination of egg counts. Basic socio-demographic and household data were collected by questionnaire at the beginning of the study and a KAP questionnaire was administered at the beginning and end of the study to monitor changes in attitudes, awareness, and changes in practices
over the 18 months of fieldwork. A cost survey was conducted at the end of the study.
The cost effectiveness of the 4 interventions were compared by the weighted percentage reduction in prevalence and the weighted percentage reduction in intensities of infection as measured by geometric mean egg loads of of Ascaris lumbricoides, Trichuris trichiura, and hookworm combined.

Impact Achieved Highly significant (p < 0.001) improvements in knowledge were found in the health education areas compared with the control areas.. The percentage of households with a tube-well in the compound increased by nearly 20% and access to a latrine by over a third in the health education areas while in the control areas there was a decrease of just over 5% in households with a tube-well while latrine access only increased by 11% (p< 0.001). In the health education areas there were significant improvements in washing with soap after defecation and before food preparation and serving, At the 18-month follow-up two-thirds of the index children in the health education areas were wearing shoes compared with only one-third of children in the control areas.
The most cost-effective strategy was the single albendazole mass chemotherapy at an interval of 18 mo. The 2 regimens involving health education were the least cost effective. The health education package used in this study was relatively expensive in terms of manpower, with a 1% improvement in costing between US$ 0.75 and 1.57 per household, and unlikely to be cost-effective at the national level. Chemotherapy alone was much more cost-effective in reducing prevalence than a combination of health education and chemotherapy (3% versus 1.1% reduction respectively per US$) However the authors point out that not all health measures are expensive. For example, the cost of a nail trimmer is about the equivalent of 4 US cents and respondents indicated that they remained sharp for between 2 weeks and 2 months with an average life of 4/5 weeks. Consequently, nail trimming of the family costs about 50-60 US cents/year. As a result of this research, the Government of Bangladesh has proposed that simple messages on the importance of hand washing before food preparation, regular nail trimmingand wearing of shoes should be given at the time of mass chemotherapy as part of its health service delivery strategy. This study provides a good example of the use of cost effectiveness analysis but does raise some questions. A critical issue is the long term sustainability of the intervention which is not discussed. Very little information is provided on the health education intervention which is described in only a few lines of text Also the question arises of whether the health education could have been delivered cheaper. In particular, whether health education on worms could be integrated with other health education rather than being carried out on its own.See also: Mascie-Taylor,C.G., Alam,M., Montanari,R.M., Karim,R., Ahmed,T., Karim,E. and Akhtar,S. (1999) A study of the cost effectiveness of selective health interventions for the control of intestinal parasites in rural Bangladesh. J. Parasitol. 85, 6-11. Ref ID 8648

Muennoo, C., Achwanichkul, W., Sanguankiat, S., Pubampen, S., Maipanich, W., Anataphruti, M., and Waikagul, J. The impact of primary health care intervention on reinfection of soil-transmitted helminths in the community. Southeast Asian J.Trop.Med.Public Health 28(4):816-819, 1997.  Ref ID : 7751. (Borderline for inclusion in database)

Target Group/Country Rural community in Nakhon Si Thammarat Province, southern Thailand.

Intervention Methodology Treatment with a three-day regimen of albendazole (400 mg). Training of health volunteers, implementation of a health education program through village broadcasting system including demonstrations, games, powers, videos and discussion  provided twice weekly. The village health communicator (VHC) - one per 100 households - is responsible for health related activities in the village including primary health care  provision of health education, coordination of health activities and registration of births. There is also a village health volunteer (VHV per village). The specific contribution of the village level communicator and volunteer is not clearly described.

Evaluation Method Pre- and post intervention stool examination results were compared. Fecal samples from the inhabitants of Ban Paruhas, the implementing village, and Ban Pungsing, the control village, were examined.

Impact Achieved After one year of implementation, prevalence and intensity of STH in both villages were determined using Kato-Katz's method. The overall prevalence of STH at post-intervention decreased in both villages, with a greater degree of reduction appearing in trichuris and hookworm infections in the village where PHC was implemented. There was no decline in ascaris infection which were low at the outset. Significance tests are not provided. It is not possible to tell the role of the educational input compared to that of treatment from the data provided.

Sarti, E., Flisser, A., Schantz, P.M., Gleizer, M., Loya, M., Plancarte, A., Avila, G., Allan, J., Craig, P., Bronfman, M. and Wijeyaratne, P. (1997) Development and evaluation of a health education intervention against Taenia solium in a rural community in Mexico. American Journal of Tropical Medicine & Hygiene 56, 127-132. Ref ID: 6750

Target Group/Country Taenia solium in rural Mexico

Intervention Methodology An educational program was developed to promote recognition and knowledge of the transmission of the parasite and to improve hygienic behavior and sanitary The health education strategy was implemented with the active participation of the population based on the information obtained from a sociologic study conditions that foster transmission

Evaluation Method The effects of educational intervention were evaluated by measuring changes in knowledge and practices and prevalence of human taeniasis and swine cysticercosis before and after the campaign. A questionnaire was designed and used before, immediately after the intervention, and six months later

Impact Achieved Statistically significant improvements occurred in knowledge of the parasite, its life cycle, and how it is acquired by humans; however, changes in behavior related to transmission were less dramatic and persistent. The prevalences of cysticercosis in pigs at the start of the education intervention were 2.6% and 5.2% by lingual examination and antibody detection (immunoblot assay), respectively, and approximately one year after the intervention they were 0% and 1.2% (P < 0.05). These changes were accompanied by significant reductions in the reported access of pigs to sources of infection and freedom to roam. Authors conclude that health education, developed along with community involvement, reduced opportunities for transmission of T. solium in the human-pig cycle.

Udonsi, J.K. and Ogan, V.N. (1993) Assessment of the effectiveness of primary health care interventions in the control of three intestinal nematode infections in rural communities. Public Health 107, 53-60. Ref ID : 6512

Target Group/Country Rural communities in Nigeria

Intervention Methodology Programme to reduce the prevalence of three common intestinal nematode infections. The method involved  training school leavers as microscopists, health inspectors and field assistants and deploying them to provide health education, screening, surveillance, environmental sanitation, and mass-expulsion chemotherapy (MEC). Community health education was carried out in the area by the use of posters, town criers, organised community fora and encouraging health demonstration corners in schools. Weekly community sanitation education was carried out on Saturdays in addition to the normal national sanitation day all over the country. In schools teachers were encouraged to establish demonstration corners showing the parasites' life-cycles, transmission patterns and control measures.

Evaluation Method Baseline survey of 5,451 persons from 3 communities and follow-up two years after the start of the 12 month health education programme. Determination of levels of Ascaris lumbricoides, Trichuris trichiura and Necator americanus). There were no controls.

Impact Achieved Post-control surveillance confirmed that the prevalence of these infections had been greatly reduced. The prevalence of Ascaris lumbricoides had declined from 49.3% (pre-intervention) to 10.5% (post-intervention). Hookworm had fallen from 31.4% (pre-intervention) to 4.1% (post-intervention) and whipworm from 40.7% (pre-intervention) to 6.5% (post-intervention). Overall percentage decreases of 78.7%, 86.9% and 84.0% were recorded for Ascaris lumbricoides, Necator americanus and Trichuris trichiura respectively. Significance tests are not reported for the data to support the apparent falls. The health education was considered to play a role in preventing re-infection but no data available on its contribution.


11.3 Onchocerciasis

Brieger,W.R., Ramakrishna,J., Adeniyi,J.D. and Kale,O.O. (1988)  Health education interventions to control onchocerciasis in the context of primary health care. In: Carlaw,R. and Ward,B., (Eds.)  Primary health care: the African experience, pp. 341-371.  Oakland, California:  Third Party Publishing Company Ref ID: 8658 (Borderline for inclusion in database)

Target Group/Country Rural communities in South West Nigeria

Intervention Methodology A base line survey was carried out in 1981 on local beliefs and the resulting intervention was developed  based on principles of health belief synthesis, community organisation, primary health care worker training and resource linkage. 70 Village Health Workers (55 from villages and 15 from towns) selected from 18 hamlets in Idere, Nigeria and provided 12 two-hour lessons on onchocerciasis.The methods used included stories, proverbs and practical demonstration sessions looking at microfilariae in their own skin snip and a booklet consisting of pictures

Evaluation Method Initial baseline survey of 187 villagers (details of data collection not provided). The training was evaluated though an end of course test of knowledge of prevention and treatment of Onchocerciasis (25 VHWs). There was also a nine month follow-up test of trainees and of 223 villagers in communities served by the village health workers (1984).

Impact Achieved The average score on the end of course test was 64.7% (the pass mark was 40). Knowledge declined over the nine-month follow-up. Residents in the villages surveyed had only slight increases in knowledge from the baseline study and 60% of the residents said that while their PHW had given a talk on his return, these were not sustained. There was an increase in the number of villagers who could identify tablets as a form of treatment (1.6% to 19.3%) showing the bias of the PHW to concentrate on the treatment aspect of their job. Significance tests were not presented. Sampling data on the base-line data/follow-up not provided and % only - not raw data - provided

Oladepo, O., Okunade, A., Brieger, W.R., Oshiname, F.O. and Ajuwon, A.J. (1996) Outcome of two patient education methods on recruitment and compliance with ivermectin in the treatment of onchocerciasis. Patient Education and Counseling 29, 237-245. Ref ID:7278

Target Group/country Rural communities in South West Nigeria

Intervention Methodology The programme explored the use of two educational approaches in supporting passive ivermectin distribution from primary health care clinics. Information Media (IM) approach used posters, hand megaphones at markets, meeting places and mosques/churches and town criers and Social Network (SN) approach worked through existing organisations including churches, farmers associations and cooperatives.

Evaluation Method Two communities each were randomly assigned to the IM intervention group (n=679), 2 to the SN group (n=505) , and 2 served as controls (n=81). Data was collected on persons presenting themselves to the clinics for ivermectin after the interventions and for follow-up six months later.

Impact Achieved The percentages of eligible persons presenting for ivermectin after initial education were SN group 30.3% (n=679), IM group 29.9% (n=679) and control 7.3%(n=88) but the differences between intervention groups were not significant. The drop-off in attendance at the 2nd round of ivermectin distribution. From the original attenders was 43.3% n=219 for SN and 47.4% n=322 for IM), while few control patients came back for their 2nd dose (12.3%).. Ref ID : 7278

Richards, F.O., Jr., Klein, R.E., Gonzales Peralta, C., Zea Flores, R., Gongora Roman, S., Castro Ramirez, J. and Zea Flores, G. (1995) Knowledge, attitudes and practices during a community-level ivermectin distribution campaign in Guatemala. Health Policy and Planning 10, 404-414. Ref ID:6620

Target Group/Country Ivermectin distribution in four communities in Guatemala consisting mainly of Mayan Indians.

Intervention Methodology Health workers presented three basic messages to administrators/local leaders and then directly to communities during surveys and while they were gathered together to receive examinations and then when receiving ivermectin at clinics. Also health workers carried out health education using poster-sized diagrams at women’s sewing groups, men’s football teams and village health committees.

Evaluation Method Questionnaire surveys using closed and open-ended questions were given to more than 100 male and female heads of households in four communities (about 30% in each community and 340 interviews in total) after each of three ivermectin treatment rounds. (There was no baseline or control)

Impact Achieved After 3rd round only 33% could name ivermectin, 67% correctly stated that it should be taken twice a year and 46% incorrectly thought that they would still require noduleectomies. Overall 74% of the respondents said that they had taken ivermectin when last offered. In one community over 50% of residents initially refused to take ivermectin Qualitative data showed that respondents did not realise that goal of ivermectin treatment programs was to prevent visual loss. There was confusion about the life cycle and the relationship of microfilaria and filaria.. The principal reason identified for refusal to take ivermectin was anxiety about drug-related adverse reactions

Shu,E.N., Okonkwo,P.O. and Onwujekwe,E.O. (1999)  Health education to school children in Okpatu, Nigeria: impact on onchocerciasis-related knowledge.  Public Health  113, 215-218. Ref ID: 8644

Target Group/Country Pupils aged between 11 and 17 years in a school in Okpatu, Nigeria

Intervention Methodology The pupils received health education in both English and Igbo (local language) for two 45 minute sessions per week for three months on the transmission, clinical manifestations, treatment and prevention of onchocerciasis. The education was given in English by the project investigators with teachers translating into local language. Local language expressions were used for nodules, leopard skin symptom and blindness. Illustrated pictorial materials were used to support and enhance their understanding of the subject matter.

Evaluation Method The level of knowledge of 300 children was evaluated at the beginning of the programme and nine months later using a pre-tested personal interview administered questionnaire. Details of the questions are not provided.  A control school was not used

Impact Achieved A significantly higher proportion of these children knew about onchocerciasis (chi2=260.4, df=1, P<0.0001), and its causative agent (chi2=175.0, df=4, P<0.0001), clinical manifestations (chi2=254.0, df=5, P<0.0001), diagnosis (chi2=123.9, df=2, P<0.0001), treatment (chi2=197.8, df=3, P<0.0001) and prevention (chi2=220.8, df=3, P<0.0001) in the post than in the pre-educational intervention. It is concluded that school-based health education showed an increase in knowledge about onchocerciasis


11.4 Dengue fever control

Espinoza-Gomez,F., Hernandez-Suarez,C.M. and Coll-Cardenas,R. (2015) Educational campaign versus malathion spraying for the control of Aedes aegypti in Colima, Mexico. Journal of Epidemiology and Community Health 56, 148-152. Ref ID: 8996

Target Group/Country Community in Colima city, in the State of Colima, Mexico.

Intervention Methodology The study compared the use of malathion spraying at ultra low volume alone using a 'London fog' machine mounted on a truck making two visits from a passing vehicle and an educational approach which involved the natural leaders of the community as well as the university municipal and state health authorities. It consisted of a series of visits house by house done by university students. The inhabitants - mainly housewives - were offered a talk about the importance of dengue, ways to prevent it and biological characteristics of the Aedes aegypti. Such talks were re-enforced with group meetings in which a dengue video was shown and a sociodrama was resented in the kindergarten of the area. In addition in each visit the message was supported with a small gift, consisting of sweets, stickers and calendars related to dengue and the Aedes mosquito. The community leaders facilitated the entrance t the houses and an average of 3 visits per house was made. The methods that the community were encouraged to use included both chemical and biological control e.g. piretrods, use of temefos, larvivorous fishes or Bacillus thuringensis.

Evaluation Method Householders of 187 houses, randomly selected from the west sector of the city. The intervention consisted of educational campaign alone (47 houses); low volume malathion treatment (46 houses); both treatments simultaneously (49 houses) and no intervention, or control group (45 houses). In each house, an entomological survey was done, as well as one for knowledge, attitude and practices (KAP), before the intervention and six months after. No details of the KAP survey are given

Impact Achieved The global average of the positive containers by house (C+/C) was reduced from 0.97 to 0.77. A two way analysis of variance showed that this reduction was more apparent in the houses that received educational campaign (F=8.4, p<0.005) with relation to the ones that received malathion spraying (F=0.38, p>0.5), while the combination of both treatments demonstrated a discrete negative interaction (F=6.52, p<0.05). These effects were independent of climatic changes and level of knowledge about dengue, as the KAP indicator did not show any significant changes in any group (F=1.14, p>0.1). The results indicated that the educational campaign reduced the A aegypti breeding places more effectively than the use of chemicals spraying, and that the combination of both treatments can reduce its efficiency. The authors also conclude from the findings that KAP surveys seemed to have very limited value in evaluating quantitatively the programmes of eradication of the dengue vector. While providing a convincing demonstration of the value of education, the main limitations of this study is the lack of data on what specific dengue control practices were initiated by communities as a result of the education. The lack of predictive value of the KAP study could be more of a reflection on the specific methodology used in the study and the author's generalization about unsuitability of KAP studies for evaluation is very sweeping and not justified. It is possible that a KAP study with more targeted focus on implementation of preventive behaviours and one which was based on theoretical models of health behaviour change could have had more predictive value. Another limitation is that there is no information on cost-effectiveness and therefore potential for scaling up of what is a very labour intensive method. Of particular interest and relevance to interventions for Dengue and control programmes for other insect vector diseases such as malaria and onchocerciasis the authors make an interesting suggestion that the reason why the combination of education and spraying had less impact was because that spraying may promote a false sense of security among the community who did not practice any other control methods.

Gordon, A.J. Mixed strategies in health education and community participation: an evaluation of dengue control in the Dominican Republic. Health Education Research: Theory and Practice 3(4):399-419, 1988.  Ref ID : 4381

Gordon, A.J., Rojas, Z., and Tidwell, M. Cultural factors in Aedes aegypti and dengue control in Latin America: A case study from the Dominican Republic. International Quarterly of Community Health Education 10(3):193-211, 1989. Ref ID : 3717

Target Group/Country Communities in the lower middle class urban barrio (population 6000) of Buenos Aires in the Dominican Republic

Intervention Methodology Four levels of intervention of increasing effort were explored for dengue and Aedes aegypti control were used. Level I was in a separate barrio (Los Salados) relied on the existing mass media (radio. Television and newspapers) and health programme effort; Level II relied on a multiplier effect of diffusion from the communities exposed to the intensive Level III and IV; Level III involved the inspection of breeding sites and motivation of the community to remove breeding sources; Level IV involved direct face-to-face education by heath workers with half of the community receiving larvivorous fish. The education involved intensive effort using two sessions lecture-discussion format over two days using local community health workers along with workers from the National Malaria Eradication Service. Families receiving fish were also given a 2-5 individual talk reinforcing the education and specific instructions about caring for the fish. Large quantities of pamphlets on Dengue were left in grocery stores, beauty salons, clinics and other stores throughout the barrio in order to support the intended multiplier effect.

Evaluation Method Pre-test-post test design with interval of one month; Level I (pre-test n=135, post-test n=134); Level II (pre-test n=133, post-test n=109), Level III (n=65), Level IV (fish-receiving group n=61, education-only group n=60). A core interview testing knowledge lasting 10 minutes was given to all groups and household water receptacles  in Level III and IV were examined for A. aegypti larvae

Impact Achieved Increases in knowledge of the seriousness of dengue and general preventive measures took place even in low intensity Level I and improved with increased intensity of effort (p values between 0.01 to 0.05). However, problems were encountered with communicating specific preventive measures especially keeping the lid on tanks and the risks from household water containers. Inspection visits on their own were found to increase knowledge of the importance of covering of tanks. There was a 17%decline in untopped tanks (50% à 33% p=0.15) in the enducation only group Level IV  Only a partial success was achieved in using the fish with 20 houses out of 72 still having live fish (thought not in all of their tanks). This very detailed report is of interest for its discussion of the difficulties of communicating specific concepts such as 'stagnant water' and the distinction between culex (breeding in garbage) and aedes mosquito (breeding in stagnant water). It is also of interest for the evidence presented to support the information diffusion process and an approach involving mutually-reinforcing mass media and interpersonal approaches in a cost-effective way.

Lloyd, L.S., Winch, P., Ortega-Canto, J., and Kendall, C. The design of a community-based health education intervention for the control of Aedes aegypti. American Journal of Tropical Medicine and Hygiene 50(4):401-411, 1994.  Ref ID : 2147

Target Group/Country Communities in Meridia, Yucatan, Mexico

Intervention Methodology Terminology and taxonomies for dengue were obtained from open, in-depth interviews, while baseline data were gathered via a knowledge, beliefs, and practices questionnaire. A larval study of house lots was then carried out to identify the A. aegypti larval production sites found on individual house lots, thus enabling the program to target the most important larval habitats. Community groups were organized to work on message development and production of educational materials to be used in the program. Materials developed included a photonovela

Evaluation Method 2 colonias were used for the intervention and 2 for the control. A knowledge, beliefs and practice survey was administered to 577 women in the 4 colonias. En entymological survey was carried out to document A. aegypti larval production sites on 616 individual property lots. 95% of the house lots )564) were resurveyed six months after the intervention and exactly one year post-baseline.

Impact Achieved The mean number of containers positive for A. aegypti larvae per house lot significantly decreased in the intervention group (from 1.5 to 1.2 by paired t-test p<0.05) while it increased significantly in the comparison group (from 1.2 to 1.6 by paired t test p<0.05). The difference between the two groups was nearly significant (1.2 versus 1.6 by t-test p<0.06). Note that raw data is not provided in this paper, The paper provides a very good account of the development of the educational programme. In addition they draw conclusions that a community education programme may be insufficient to support behaviour change unless it is supported by measures such as refuse collection and the need to design appropriate covers for water containers and establish biological control measures.

Ming, C.K., Thaung, U. and U, T. (1976) Dengue hemorrhagic fever: hospital reporting taken as an index of health education effectiveness. International Journal of Health Education 19, 202-206.  Ref ID : 488

Target Group/Country Health education carried out in urban population of Rangoon, Burma.

Intervention Methodology The objectives of the health education were to develop a public capable of recognizing the signs of DHF, the actions that are needed to prevent the disease and to take action. The methods used include radio using talks, panel discussion, plays and spot announcements, posters and billboards, slide shows in cinemas, newspaper articles, talks and practical demonstrations  to groups of residents and school children and advice to infected households while carrying out household spraying..

Evaluation Method The programme was evaluated by carrying out home visits to 38 confirmed hospital cases of dengue shock syndrome, their families. A further survey was carried out of 1330 neighbouring houses were visited

Impact Achieved Parents of 30 of the 38 children had brought the children in for health care on their own initiative because of a concern about the symptoms. Every member of the household of 38 patients and 1330 households had learned something from one or more of the health education media described earlier. More than 90% of persons interviewed were reached by the radio broadcasts. Newspapers were not very effective. This report is limited by the lack of description of the data-collection instruments (e.g. how they measured exposure to the educational activities), lack of presentation of any raw data, baseline information and controls.


11.5 Leprosy

van den Broek, J., O'Donoghue, J., Ishengoma, A., Masao, H., and Mbega, M. Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania. Lepr.Rev. 69(1):57-74, 1998. . Ref ID : 7593

Target Group/Country Schoolchildren and general public in Rufiji District, Tanzania

Intervention Methodology A 7-year intensive health education campaign about leprosy delivered by workers of the Kindwitwi Leprosy Trust . A full time leprosy education officer gave talks to schools, adult education centres etc illustrated with films and slide shows. Films about leprosy and other health topics in Kisahili language were shown in every village in the district, attracting large numbers of people. Posters, T-shirts and stickers were distributed with messages in Kisahili and Arabic. Seminars were held for leaders of the ruling party. Other seminars were aimed at health workers and at traditional healers. In addition a person from the Lindwitwi Leprosy Village visited villages ahead of the education team and gave the account of his life story . Once yearly during world Leprosy day, district wide singing and drama competitions were organized among schools and youth groups contributing to the message that 'Leprosy can be cured'.

Evaluation Method Knowledge, attitude and beliefs towards leprosy were measured in Rufiji and compared to neighbouring Kisarawe District as control. The sample included school children (n=480 in Rufuji and n=584 in Kasarawe) and the general public ( n=345 in Rufuji and n=99 for Kisarawe). The interviews were partly structured and partly open. There was no baseline.

Impact Achieved Over the period 1985 to 1995 the average leprosy case detection rate/10,000 population was 2.4 in Rufuji and 1.3 in Kisarawe. They did not observe positive effects of the health education campaign on the indicators regarding early diagnosis of leprosy with less disability. Leprosy case detection was declining in both districts. The campaign had a favourable impact on the knowledge and the attitude of schoolchildren in Rufiji District which was better in Rufiji as compared to Kisarawe, There was no significant difference in knowledge and attitudes of adults in the two districts. The exact outcome of the sustained campaign in Rufiji District was difficult to assess because there was no baseline. Given the amount of effort put into education the lack of impact on knowledge of adults is surprising and it is disappointing that the study does not adequately explain this.

Cheriyan, C.S. and Roopkumar, K.S. A study about the billboards on leprosy displayed in the Pallavan transport corporation buses at Madras City. Indian J.Lepr. 56:151-157, 1984. Ref ID : 909

Target Group/Country General public in Madras, India

Intervention Methodology Billboards with the message ‘Leprosy is curable’ were placed on the entire fleet of city buses in Madras city (2500 total, 1,000 in English and 1,500 in Tamil).

Evaluation Method 500 interviews were done at major bus stands, terminals and busy traffic junctions - persons interviewed included college students (30%), factory workers (20%), office goers (30%), businessmen (15%) and housewives (5%).

Impact Achieved All the respondents had seen the posters and could correctly describe the message it displayed. On being asked to give their opinion of the message 75% (361) made positive comments - 36% said that as leprosy was curable, persons should go for treatment. 34% felt encouraged by the information that leprosy was curable and that this message should be spread.6% felt that the message dispelled the stigma attached to the disease.52.8% (264) persons indicated that they would like to know more about leprosy.

Krishnatray, P.K. and Melkote, S.R. Public communication campaigns in the destigmatization of leprosy: a comparative analysis of diffusion and participatory approaches. A case study in Gwalior, India. Journal of Health Communication 3(4):327-344, 1998. . Ref ID : 8012

Target Group/Country General public in Gwalior District in Madhya Pradesh state, India

Intervention Methodology Health education camps were carried out in three non-randomly selected villages. The diffusion approach was based on giving information but details are not provided. The participatory approach  involved dialogue and contact between community, health workers and leprosy patients. The contact included demonstrations and personal testimonials or their experiences including stigmatization from leprosy patients, and physical treatment including treatment of leprosy wounds by health workers. While details are provided of the existing programmes in India upon which the interventions were based, the actual description of the interventions used in the study are poor.    

Evaluation Method Three villages considered representative were chosen non-randomly and subjects chosen randomly from each village. Over the three day period 91 received the diffusion approach in one village, 89 received the participatory approach in the second and 89 in the third village acted as controls. The impact of the interventions was compared on knowledge of causes and spread, perception of risk and behavioural self-involvement - contact of the community with persons with leprosy. The subjects at the camp were pre-tested and post-tested each day.. The description of the actual measuring instruments is also poor. Multivariate analysis of the data was carried out.

Impact Achieved The participatory group had higher knowledge of cause and lower perception of risk than the diffusion and control groups p<0.01). The study concluded that participatory strategies promoting dialogue and interaction and incorporating people's knowledge and action component result in increased knowledge, lower perception of risk, higher behavioural involvement, and, hence, destigmatization. A detailed discussion of the implication of the results for communication theory is provided.

Navon, L. Beyond Constructionism and pessimism: theoretical implications of leprosy destigmatisation Campaigns in Thailand. Sociology of Health and Illness 18(2):258-276, 1996.  Ref ID : 5474

Target Group/Country General population in Thailand

Intervention Methodology In the 1970s an intensive educational programme was launched in Thailand to remove the stigma from leprosy and encourage persons to come for treatment. The means mobilised include radio and television broadcasts, press reports, dissemination centres where educational material can be obtained free of charge, information exhibits, visits to treatment institutions, lectures to students, soldiers, community leaders and so forth, open discussions for the general public, slides and films presented even in large department stores, posters, pamphlets and booklets distributed in schools, universities and heath centres, slogans about leprosy printed on various products such as calendars contests in writing songs, essays and slogans on leprosy and finally, lectures given and posters hung in public places in villages during case-finding activities. On International Leprosy Day - commemorated annually on 16th November - particularly widespread activities were held including radio interviews with the Minister of Public Health, press conferences with leprosy experts and exhibitions and lectures throughout the country.

Evaluation Method The author draws on data fromKAP questionnaires conducted by the Leprosy Division of Thailands Ministry of Public Health between 1978 and 1983 in Mahosaarakam province (n=1,655) and Khon Kaen Province (n=1,091). No details are provided of the studies and the author herself comments on their lack of definition of the terms used and lack of statistical analysis.

Impact Achieved The surveys indicated that despite the educational campaign many people did not understand that the disease was curable and the fear and stigma persisted. The implications of this failure are discussed in terms of sociological theory. The author suggests that such campaigns are likely to fail due to their tendency to transmit a normalizing message, & because of the stigma associated with metaphorical uses of the term leprosy in spoken language Also, educational efforts have also increased the risk of stigmatization. A critique is given of the assumptions of knowledge & power in constructionism's analysis of destigmatization. A call is made to move beyond such constructionist views.


11.6 Tuberculosis

Demissiea,M., Getahun,H. and Lindtjørn,B. (2013) Community tuberculosis care through ''TB clubs'' in rural North Ethiopia. Social Science and Medicine 56, 2009-2018. Reference ID: 9114

Target Group/Country TB patients in rural areas of Northern Ethiopia

Intervention Methodology TB patients living in rural kebeles (villages) of Este were organised according to their residential area into clubs by the TB health worker. Members of a TB club had the same clinic dates for follow up. A TB club had 3-10 TB patients and members of the club chose their leader and whenever possible a literate (able to read and write) club member led the club. The club leader communicated the activities and schedule of the club to the health worker at the clinic. The TB club leader ensured that all members of the club attended the TB clinic at the date of appointment, and informed the clinic staff about absent members. Each club had a regular weekly meeting on Sundays and the leader also co-ordinated other ad hoc meetings usually on holidays and market days. The duration of the regular weekly meetings was 1-2 h. The meetings were often conducted in places such as churches, mosques, market places or other venues for social events. The purpose of the regular meetings was for members of the TB club to support each other in adhering to treatment, and to share information about the course of the disease and possible drug side effects. Patients failing to make satisfactory progress or suffering from side effects were reported to the health centre. All the club members in the different kebeles had a monthly meeting organised by the health centre. The regular monthly meetings of the health workers with TB clubs were to maintain active participation of members and to provide technical advice. The TB club leaders also sought the help of other influential community members such as priests and Moslem religious leaders and community elders in encouraging and supporting patients to complete the full course of the treatment. The TB club leaders were provided with educational material on TB prepared by the Ministry of Health and the Regional Health Bureau, written in Amharic, the local and national language. Members of the TB clubs exchanged information on TB with other community members, through public reading (most of the time at church) and disseminated educational materials. The TB club leaders also help in identifyingand referring new TB suspects to the health centre, in which case individuals referred were exempted from the long waiting line in the health centre. There was no payment or other incentive given to members of the TB clubs or to the leaders. Nevertheless, the TB patients had easy access to the health units and were allowed to refer TB suspects. Local health workers and community health agents supervised the TB clubs by attending their weekly meetings on a regular basis.

Evaluation Method The study utilised both quantitative (cohort study) and qualitative (focus group discussion and an in-depth interview) methods. The cohort study was conducted in two rural districts of Northern Ethiopia. A total of 128 sputum positive pulmonary patients were enrolled and followed, 64 in the TB club and 64 in the comparison groups, to determine treatment outcome of anti-TB therapy. The impact of the TB clubs in changing societal attitudes and behaviour associated with TB was assessed using qualitative methods (focus group studies and in-depth interviews -11 of the 47 TB clubs were selected for fgds). Details are not provided of the analysis of the qualitative data.

Impact Achieved The treatment completion rate was signicantly better (Chi squared = 5:41; P<0:02) in the TB club group, 44 out of 64 patients (68.7%) completed treatment in TB club while only 30 of the 64 (46.8%) completed treatment in the comparison group. The defaulter rate was also signi.cantly lower (Chi squared = 11:57; P<0:001) in the TB club group 8/64 (12.5%) compared to 26/64 (40.6%) in the comparison group. The qualitative part of the study also demonstrated remarkable changes in patients' understanding of TB, patients' initial reaction to a TB diagnosis, misconceptions as to the cause and treatment of TB, the social isolation and compliance and belief in the modern health care in the TB club area.The complementary results obtained from the quantitative and qualitative components of the study indicate that the TB club approach has a significant impact in improving patients' compliance to anti-TB treatment and in building positive attitudes and practice in the community regarding TB. This study, thus, provides convincing evidences that the TB club approach is useful in delivering TB treatment successfully in rural populations. This study provides a good example of the way that a community-based activities can support clinic-based DOTS approach. It would have been good to have had some data on staffing and time inputs into the clubs to assess the feasibility of replication in other areas.

Dick, J. and Lombard, C. Shared vision--a health education project designed to enhance adherence to anti-tuberculosis treatment. Int.J.Tuberc.Lung Dis. 1(2):181-186, 1997.  Ref ID : 7320

Target Group/Country Tuberculosis patients at two adjacent Cape Town Local Authority health clinics, South Africa

Intervention Methodology The combined strategy of a patient-centred interview plus the issuing of a patient education booklet to increase the adherence of notified pulmonary tuberculosis (TB) patients to prescribed treatment. The intervention was based on social learning theory.  The five nurses at the clinic received training in patient-centred communication (cost 250R per nurse ($70) . A photonovel costing R1 ($0.30) was produced in Afrikaans called "Where there is a will   " based on research that also incorporated a calendar to enable patients to monitor their progress through treatment. A role model was created by the heroine of the story whose experience shoed the obstacles to adherence e.g. stigma of the disease, depression and side-effects. The message of the booklet was reinforced by the counselling provided by the nurses while the self-monitoring process of completing the calendar  was designed to give the patient a sense of cognitive control.

Evaluation Method A controlled intervention study was implemented using a cohort of the first 60 consecutive patients notified with pulmonary TB at both Clinic A (intervention clinic) and Clinic B (control clinic)

Impact Achieved The patients exposed to the educational input in Clinic A achieved a mean adherence rate to treatment of 95% with only one patient defaulting. This was a significant (p<0.0001) improvement. The mean adherence of Clinic B was 83% with 13 patients dropping out. The risk of non adherence was significantly (p=0.014 reduced at the experimental clinic versus the control. It was not possible to indicated which part of the health education approach contributed to the difference as it was delivered as a package. Another possible contributing factor was the increased motivation of the staff in Clinic A as a result of their training. Note there is some ambiguity in the data presneted for adherance as it refers to a subset of each clinic which presumably means the sample drawn for the study..

Jaramillo,E. (2012)  The impact of media-based health education on tuberculosis diagnosis in Cali, Colombia.  Health Policy and Planning  16, 68-73.Ref ID: 8878

Target Group/Country General public in  Cali, Colombia

Intervention Methodology A mass media health education campaign for TB control in. The campaign aimed at increasing case finding and reducing levels of prejudice against people with TB. The media campaign was implemented for 6 weeks April;/May 1993 and had 3 components; the television and radio components consisted of public service announcements and chat shows involving people with tuberculosis, doctors and heath educators; the printed component consisted of flyers inserted in a Sunday issue of two local newspapers and two feature articles in one broadsheet and two tabloid newspapers

Evaluation Method The programme was evaluated by counting the total number of smears examined by the laboratory network in Cali and a control population  Risaralda 200 km north which did not  receive the educational inputs.

Impact Achieved There was a sudden increase by 64%  in the number of direct smears processed by the laboratories and an increase of 52% in the number of new cases of positive pulmonary TB, with respect to the previous period. This was not shown in the control areas (no statistical tests carried out on . The effect of the campaign was lost once the radio and television public services announcements stopped raising questions about the sustainability of programmes relying on short-term mass media campaigns. It is unfortunate that no data is presented of the coverage of the campaign or impact on targeted knowledge and attitudes.

Schools and tuberculosis

Migliori, G.B., Spanevello, A., Manfrin, V., Abongomera, A., Pedretti, R.F., Ballardini, L., Neri, M., and Borghesi, A. AIDS and tuberculosis control programmes: an integrated approach at educational level. Monaldi.Arch.Chest Dis. 51(2):102-107, 1996.  Ref ID : 7251

Target Group/Country Secondary schools in Arua District Uganda

Intervention Methodology A 1.5 hour standardized heath education session (covering the key- points of AIDS and TB control. Details of the content of the sessions are not provided.

Evaluation Method A pretest (and followed 3 months later by the same questionnaire (post-test). The impact of HE on AIDS control was evaluated by comparing answers to 1,478.pre- and post-test questionnaires (multiple choice) before and three months after the intervention and evaluating TB case-finding performances in the period preceding and following the survey. A control was not used.

Impact Achieved The overall impact of the health education on the knowledge scores was significant at p<0.0001 level. In the period preceding the study 188 new cases of TB were diagnosed versus 241 in the following period (p<0.001). 19% of them were sent by one of the students or their families.


11.7 Filariasis

Sunny, P.J., Jain, D.C., and Rao, C.K. Impact of health education on voluntary participation in anti-larval measures. Journal of Communicable Diseases 16:335-337, 1984. Ref ID : 1096 (Borderline for inclusion in database)

Target Group/Country Community in rural Calicut District, Kerala, India

Intervention Methodology Community involvement in anti-larval measures was generated among 680 households and 2720 persons through public meetings, the showing of a film, house-to-house visits by project staff accompanied by local leaders and training two volunteers selected by the community in anti-larval operations. Insecticide spraying was carried out weekly.

Evaluation Method After a year 68 of the heads of households were selected randomly from that community and compared with 46 in a nearby community who had not received the intervention. There was no baseline

96% (65) of the experimental group were aware of the need for anti-larval measures

Impact Achieved compared to 48% (22) of the controls. 83% (57) expressed a willingness to participate in the anti-larval measures compared to 67% (31) of the controls. No significance tests are reported or data on changes in mosquito prevalence.


11.8 Guinea worm control

Tayeh, A., Cairncross, S., and Maude, G.H. The impact of health education to promote cloth filters on dracunculiasis prevalence in the Northern Region, Ghana. Social Science and Medicine 43(8):1205-1211, 1996.  Ref ID : 4384

Target Group/Country Three villages (91254 households, pop 12,754 persons) in Northern Region of Ghana

Intervention Methodology A health education intervention which conducted during the 1990 dry season to reduce dracunculiasis prevalence in that area by promoting the use of cloth filters for drinking water and avoidance of water contact by sufferers. Face-to-face discussion was carried out during visits to every household in the 3 villages using paid and supervised field workers. The education was based on an understanding of community perceptions of guinea work and sought to synthesis local theory of the disease with 'modern' theory.

Evaluation Method Cloth filters were demonstrated to household members in the session and the community were encouraged to buy them (US$0.45). The visits took 1-2 months per village.

The 6 month period prevalence of infection was determined from 3 bi-monthly surveys in the dry seasons of 1990 and 1991. Villages were asked to report on preceding 2 months were determined by interviewing each member of the household individually. Sales of cotton filters were monitored. There was no control but the phased nature of the programme meant that the third village was reached until late in the transmission season.

Impact Achieved Face-to-face health education was successful in persuading 56% of households to buy filters. There was a slight reduction of prevalence from 10.6% pre-intervention to 7.4%. Ownership of at least one filter for every 10 people in the household was associated with a reduction of at least 20% in the risk of dracunculiasis. (p<0.05 for one village , others n.s.). Those who said that they used the filters frequently were less infected than those who said that they used them less frequently (p<0.005). The impact of filtering on prevalence was less than expected given the intense health education effort. This may be because many households bout too few, they were not used when away from home and the heavy focus of the education on the danger of drinking infected water to the possible neglect of other messages such as the discouragement of contamination of water sources by people with the disease, particularly children.


11.9 Malaria

General programmes

Akogun, O.B. The effect of selected health education schemes on knowledge and attitude of the Kanuri towards certain parasitic diseases. Journal of the Royal Society of Health 112(6):280-285, 1992. . Ref ID : 2407

Target Group/Country Rural Kanuri communities in Nigeria.

Intervention Methodology Still pictures and card games (a), drama, songs, storytelling, and discussions (b) used to influence knowledge and attitudes about malaria, diarrhoea, and dysentery and intestinal worms.

Evaluation Method A Likert scale questionnaire was given to villages receiving intervention (a) n=372, (b) n=289, (a+b) n=365 and a control with no intervention  n=357 at beginning and every three months for a year.

Impact Achieved Significant gains in at p<0.01 level knowledge and attitudes towards malaria, diarrhoea and intestinal worms were achieved using both methods separate and combined. No significant decrease in malaria prevalence was achieved but % infected with Amoebas/Giardia  and Helminths in the villages receiving both interventions decreased from 39.7 to 8.22% ( control 32.8 to 39.5%) and 57.5 to 6.3% (40.6 to 19.05) respectively. No explanation provided of what was measured under ‘attitudes’ or knowledge and no information on how prevalence data was obtained.

Blair,A.S. and Shiels,C. (2015) Effectiveness of a health education intervention in a war environment. Tropical Doctor 32, 94-97. Ref ID: 8998. (Borderline for inclusion in database)

Target Group/Country Communities in a civil war conflict area in Wanni Region, Northern Sri Lanka

Intervention Methodology The intervention consisted of the production and distribution by the organisation Medicines Sans Frontiers (MSF) of a booklet containing health information about malaria. It was written in Singhala and Tamil with colour photographs its appeal was enhanced by including a calendar on the back page and blank pages to use as an address book. 25000 copies were distributed at clinics and other locations at a cost of £0.08 each giving a coverage of one booklet per 2.6 families. The distribution was not accompanied by any other form of health education.

Evaluation Method Impact was evaluated by interviewing parents of children under 12 years admitted to the paediatric ward sponsored by MSFA. 200 were interviewed at pre-test and a second post-test group of 200 were interviewed 6-7 months later. The interview consisted of a questionnaire of 10 true/false questions related to information provided in the booklet and a control set of 11 true-false questions on information not provided in the booklet. Analysis of data was able to distinguish between responses of respondents who reported receiving the booklet and those who did not.

Impact Achieved There was a marked improvement in knowledge levels between the pre- and post-intervention groups in those areas specifically addressed by the booklet. There were highly significant (p<0.001) increases in correct answers to questions about the risk to pregnant women, about using bed-nets, taking repeat dose of drugs after vomiting and of mosquitoes breeding in open wells. Increases were also significant (p<0.05) in terms of reported knowledge concerning risk to children under 5 years and breeding of mosquitoes in drainage ditches. For one question relating to prevalence of drug-resistant malaria the proportion of post intervention correct answers significantly decreased. The increase in scores was greater for people in the group that had seen the booklet. For items not included in the booklet there was a significant decrease in score ranks. There was no significant difference in the number of correct answers when comparing the groups who had seen and not seen booklet. The data shows that even a very simple intervention can increase knowledge of communities. While valuable in demonstrating the possibility of health education in a war zone this study has certain limitations. No explanation could be provided why increases in knowledge were found in both the post-intervention sample receiving and not-receiving the booklet (and the lack of an enhanced effect among the former). Also parents of children being admitted to a hospital ward would appear to be an inappropriate sample for evaluation compared with a sample taken directly from the communities. However, given that the front line for the conflict was continually shifting in the target community some allowances should be made for staff undergoing health education under extreme conditions.

Glik,D.C., Rubardt,M., Nwanyanwu,O., Jere,S., Chikoko,A. and Zhang.W. (1998)  Cognitive and behavioural factors in community-based malaria control in Malawi.  International Quarterly of Community Health Education  18, 391-413. Ref ID 8736

Rubabt,M., Chikoko,A., Glik,D., Jere,S., Nwanyanwu,O., Zhang,W., Nknoma,W. and Ziba,C. (1999)  Implementing a malaria curtains project in rural Malawi . Health Policy and Planning  14, 313-321.Ref ID 8765

Target Group/Country 12 rural villages in Chilepa area of South Central Malawi

Intervention Methodology Prior to the baseline a child survival initiative had hired village community workers for health promotion and had established a revolving drug fund. The government had also sponsored a national campaign to increase public awareness of recommended malaria treatment and control methods. After the initial survey in eight of the 12 villages there was a demonstration project to increase mosquito control using permethrin impregnated curtains. Communications of Innovations Theory was used to guide the intervention. Concepts of capacity building, leadership, trust, ownership and empowerment were drawn upon although details are not provided. In the 8 intervention villages the village health committee and health surveillance assistant, literacy instructor, TBA and HIV/AIDS and family planning motivator jointly selected a 'malaria helper' to receive a 5 day training to  work closely with the HSAs. Families received free curtains ($28) if they were prepared to undertake qualifying household improvements including building pit latrines, drainage ditches, outbuildings, clearing and burning/burying rubbish   Little information is provided of the educational methodology used in the intervention.

Evaluation Method 16 focus groups interviews were held in 8 of the 12 villages. Household surveys were carried out of heads of all households in the 12 villages (8 intervention and  4 control)  3 months (n=2460) and 21 months  (n=2870) afterwards. The questions determined 16 behavioural items including: a)traditional methods such as burning leaves; smearing dung etc.  b) use of commercial methods such as insecticides, bednets and mosquito coils; and c) use of preventive sanitation methods including clearing brush, digging latrines, rubbish control and emptying stagnant water. Curtain adoption was measured by observation at six month intervals. Nine multiple response items were used to measure key categories of beliefs about malaria including: causes, barriers to mosquito control and general causes of beliefs. The Health Belief Model was used to generate questions. There were no control communities.

Impact Achieved 45% of intervention villages had adopted the curtains with some villages more than 60%. Adoption was higher in villages with higher levels of malaria. High levels of re-impregnation of curtains with insecticide were observed the programme (89.2%) with lack of disposable income being the main limiting factor (1-2$ per household required). No data are presented from control communities. Authors conclude that use of insecticide impregnated curtains was a highly acceptable practice but that their promotion would require continued subsidies raising questions of sustainability. Between the first and second survey there was a significant increase (p<0.001) in preventive sanitation behaviours, a decrease (p<0.001) in traditional control measures and a marginal decrease in commercial control behaviours. Attitudes were not predictive of mosquito control behaviour. Lack of presentation of data from control villages makes it difficult to attribute these changes to the effect of the intervention. The decline in traditional preventive measures is a matter of concern given that the relative efficacy of either traditional methods or preventive sanitation for mosquito control is not known. The lack of presentation of comparison data from control communities is disappointing.

Ogbudimkpa, J.E., Creswell, W., Lambert, B., and Kingston, R.E. A community health education programme on malaria in Nigeria. International Quarterly of Community Health Education 9(1):35-50, 1988.  Ref ID : 1166 (Borderline for inclusion in database)

Target Group/Country Citizens of Nkanu-local government area using a community hospital for their health care.

Intervention Methodology Community members involved in the planning, organization and implementation of educational strategies which over 3 weeks involved field trips, question and answer sessions, lectures and demonstrations. Minimal information is provided of intervention which involved nurses.

Evaluation Method 95 were in the experimental group and 107 in the control. A pretest questionnaire and inspection was given before the intervention and one week after completion of the 3 week intervention.

Impact Achieved The treatment group performed better than control group on the knowledge tests (p<0.0001). Significant differences were found between the two groups in environmental factors including: rubbish, containers with water, windows with no screens, ownership of nets. (p<0.0001). No information on sustainability of changes.

Uptake of impregnated bed nets

Marsh, V.M., Mutemi, W., Some, E.S., Haaland, A., and Snow, R.W. Evaluating the community education programme of an insecticide-treated bed net trial on the Kenyan coast. Health Policy and Planning 11(3):280-291, 1996.  Ref ID : 4161

Target Group/Country Rural community in Klifi District, Kenya

Intervention Methodology A baseline anthropological study and community survey were used to develop messages. Individuals within the existing district health care structure were trained as community educators. The intervention took place over 18 months and involved large scale public meetings and small group teaching in the intervention area. Information was also given at the time of delivery of nets, follow-up education was given at the time of re-dipping of nets. The community programme was supported by an intervention in primary schools.

Evaluation Method Interviews were held with a random sample of 100 mothers and 50 household heads and compared with 100 control mothers (no baseline).

Impact Achieved 95% of both controls and intervention sample gave prevention of malaria or febrile illness carried by mosquitoes as a reason for using ITBN. 42% correctly identified as incorrect a picture showing incorrect positioning of net. Some incorrect beliefs were identified. (comparison data with controls not given). Note: The major focus of this study is on the use of ITBN given free and not the willingness to purchase.

Schellenberg,J.R., Abdulla,S., Minja,H., Nathan,R., Mukasa,O., Marchant,T., Mponda,H., Kikumbih,N., Lyimo,E., Manchester,T., Tanner,M. and Lengeler,C. (1999)  KINET: a social marketing programme of treated nets and net treatment for malaria control in Tanzania, with evaluation of child health and long-term survival.  Trans. R. Soc. Trop. Med. Hyg.  93, 225-231.Ref ID: 8609

Target Group/Country 2 rural districts in southwestern Tanzania -population 350,000

Intervention Methodology A large-scale social marketing programme of insecticide- treated nets Formative and market research were conducted in order to understand community perceptions, knowledge, attitudes and practice with respect to the products to be socially marketed. Zuia Mbu (Kiswahili for 'prevent mosquitoes') was chosen as a suitable brand name for both treated nets and single-dose insecticide treatment sachets. Private outlets were used for sales. For net treatment 37 young people were appointed in the same villages and trained as agents. Price subsidies given at clinics to pregnant women and mothers of young children. Institutions such as hospitals, development projects and employers involved in distribution. Promotion for both products was intense and used a variety of channels including posters, leaflets, billboards and the programme was launched with community theatre, songs , a raffle and speeches from community leaders.

Evaluation Method Monitoring sales of ITBN, periodic knowledge, attitude, belief and practice studies, detailed community-based anthropological studies and  semi-structured interviews with sales agents and customers.

Impact Achieved A total of 22,410 nets and 8072 treatments were sold during the first year: The % of households with at leat one net rose from 37% at the end of 1996 to 52% mid-1998, by which time 24% (2730/11480)( had at least one treated net and 48% (4323/9040) nets were treated. 18 months after launching, 46% of 312 families with children aged under 5 years reported that their children were sleeping under treated nets.

Uptake of chemotherapy/prophylaxis

Denis, M.B. (1998) Improving compliance with quinine plus tetracycline for treatment of malaria: evaluation of health education interventions in Cambodian villages. Bull. World Health Organ. 76 Suppl 1:43-9. 43-49..Ref ID : 8466

Target Group/Country General community and malaria patients in villages in a malaria-endemic area of Cambodia

Intervention Methodology To improve compliance with a 7-day quinine and tetracycline regimen against malaria, 2 health education interventions were tested upon populations in 2 groups of  for 10 weeks during July-September 1996. Drug vendors and health care workers received training on the importance of giving advice on compliance. During the intervention period posters were displayed in the villages of both groups. Approximately 150 posters were distributed in each village for display in schools, temples, clinics, pharmacies, village chief's offices, army camps, plantation units and video parlours. The videos were shown approximately 25-30 times each week in the second group of villages in video parlours, restaurants and at ceremonial gatherings.

Evaluation Method Two groups of three villages of population about 15,000 each were selected. 103 patients were interviewed at the start and at the end of the intervention to determine recall of advice provided, purchase of anti-malarials and compliance

Impact Achieved In one group, the use of posters and video improved compliance rates from 0.5% to 20% (20% effectiveness, 95%CI, 0-12% p<0.0004), while in the other group, where only posters were used, full compliance rose from 6% to 11% (6% effectiveness; 95%CI, 0-12% p<0.09 NS). Among private health care practitioners, the effectiveness of posters plus video in reducing poor compliance was approximately 40%, compared with only 2% among drug vendors. This difference did not seem to be the result of more private practitioners giving advice to use full doses. Rather, patients were less likely to take the advice of a pharmacist/drug vendor to take full medication. Another explanation could be that the group was prone to poor compliance regardless of any advice received.

Garfield, R.M. and Vermund, S.H. Health education and community participation in mass drug administration for malaria in Nicaragua. Social Science & Medicine 22(8):869-877, 1986.  Ref ID : 3395

Target Group/Country Mass programmes in Nicaragua

Intervention Methodology A campaign approach which used a cascade model to eventually train 73,000 volunteers to mobilise the population to take a three dose chloroquine regime. Educational activities made extensive use of media including newspapers, TV and radio as well as meetings at schools with parents, in the workplace, murals/posters, street megaphones and hanging of cloth signs outside houses.

Evaluation Method Monitoring of distribution of chloroquine and surveillance for malaria

Impact Achieved About 70% of the population received anti-malarials in November, 1981 . The malaria incidence reduced for four months following the campaign and but improvements were not sustained. This programme can be seen as a classic example of a campaign approach which met short-term objectives.

Helitzer-Allen, D.L., Macheso, A., Wirima, J., and Kendall, C. Testing strategies to increase use of chloroquine chemoprophylaxis during pregnancy in Malawi. Acta Tropica 58(3-4):255-266, 1994. . Ref ID : 4952

Helitzer-Allen, D.L., McFarland, D.A., Wirima, J.J., and Macheso, A.P. Malaria chemoprophylaxis compliance in pregnant women: a cost-effectiveness analysis of alternative interventions. Social Science & Medicine 36(4):403-407, 1993. . Ref ID : 1856

Target Group/Country Pregnant women at ante-natal clinics in Malawi

Intervention Methodology Following an ethnographic study the traditional health education messages were revised to take into account local terminology and stress the seriousness of malaria for pregnant women. To overcome opposition to the bitter taste of chloroquine, a sugar-coated version was used.

Evaluation Method 3 interventions were tested on 1035 women in 4 ante-natal clinics: (A) the revised health education (n=116) (B) distribution of a sugar-coated chloroquine tablet with traditional health education (n=67) and (C) sugar-coated chloroquine and revised health education. (n=73) Data collection included reported chloroquine use and measurement of chloroquine in urine at the initial antenatal visit and on first return visit

Impact Achieved For those women who were not taking chloroquine at outset, the % taking chloroquine on return visit were: A -57% (revised health education message)  B 84% (coated chloroquine p<0.00007) and C 91% (coated chloroquine and revised health education p<0.04). The study shows that improving the product was the most important factor in increasing the use of the programme, and that changing the health education message can also make an impact on use. Cost-effectiveness analysis showed that the cost per compliant women using coated chloroquine or improved health education separately or combined was lower than the existing method.

Kidane,G. and Morrow,R.H. (2011)  Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial.  Lancet  356, 550-555. Ref ID 8735

Target Group/Country Mothers of under-fives in Tigray, Ethiopia

Intervention Methodology Mother coordinators were trained to teach other local mothers to recognise symptoms of malaria in their children and to promptly give chloroquine. Pictorial charts were designed and produced for use and reference by mother coordinators giving standard chloroquine doses by age.

Evaluation Method Of 37 tabias (cluster of villages) in two districts with hyperendemic to holoendemic malaria, tabias reported to have the highest malaria morbidity were selected. A census was done which included a maternity history to determine under-5 mortality. Tabias (population 70506) were paired according to under-5 mortality rates. One tabia from each pair was allocated by random number to an intervention group and the other was allocated to the control group.  In both intervention and control tabias, all births and deaths of under-5s were recorded monthly. For every third child who died, a structured verbal autopsy was undertaken to ascribe cause of mortality as consistent with malaria or possible malaria, or not consistent with malaria

Impact Achieved From January to December 1997, 190 of 6383 (29.8 per 1000) children under-5 died in the intervention  tabias compared with 366 of 7294 (50.2 per 1000) in the control tabias. Under-5 mortality was reduced by 40% in the intervention localities (95% CI from 29.2-50.6; paired t test, p<0.003). Of the 190 verbal autopsies, 13 (19%) of 70 in the intervention  tabias were consistent with possible malaria compared with 68 (57%) of 120 in the control tabias. While the study does demonstrate that a major reduction in under-5 mortality can be achieved in holoendemic malaria areas data is not provided to attribute that reduction to improved case management by mothers. Very little detail is provided on the educational intervention and training methods used.

Kroeger, A., Meyer, R., Mancheno, M., and Gonzalez, M. Health education for community-based malaria control: an intervention study in Ecuador, Colombia and Nicaragua. Tropical Medicine & International Health 1(6):836-846, 1996. Ref ID : 6342.

Target Group/Country 98 rural communities of the Pacific coast of Ecuador (n = 14), Colombia (n = 22) and Nicaragua (n = 62)

Intervention Methodology On the basis of information from a baseline study, an educational programme was set up which included the training of village health promoters and community workshops organized by the health workers and used a set of methods of interactive learning carried out 3-4 months in Nicaragua and 9 months  in Ecuador and Colombia

Evaluation Method Base-line study consisting of in-depth interviews on people's knowledge and practice regarding malaria aetiology, symptoms and treatment were conducted and complemented by formal After the baseline survey the communities were paired and randomly allocated to the intervention (n=2290) and control groups (n=1570) and given household interviews.

Impact Achieved The knowledge of malaria aetiology and symptoms was 33-61% better in the intervention group than in the control group . Knowledge of the recommended doses of chloroquine increased significantly p<0.05 (34% in Ecuador, 93% in Colombia but not in Nicaragua) and correct use of chloroquine in the treatment of malaria episodes also improved p<0.05 (26% in Ecuador, 85% in Colombia). In Nicaragua the results were less satisfactory due to the short period of promotional activities and the health services' policy of delivering only supervised treatment to the population.

Marsh,V.M., Mutemi,W.M., Muturi,J., Haaland,A., Watkins,W.M., Otieno,G. and Marsh,K. (1999)  Changing home treatment of childhood fevers by training shop keepers in rural Kenya.  Trop. Med. Int. Health   4, 383-389 Ref. ID: 8604

Target Group/Country Community in a rural area of coastal Kenya

Intervention Methodology The programme involved formative research followed by a training programme for 43 shopkeepers from 23 shops serving a population of approximately 3500. Shopkeepers were trained  in a series of three workshops each lasting three days. They were trained to use two types of materials to give information to purchasers; dosage charts for chloroquine and aspirin/paracetamol-based drugs and sets of rubber stamps depicting the correct way of using chloroquine in children of different ages. These stamps printed a visual reminder of the verbal advice given and were retained by the drug purchaser

Evaluation Method At baseline April 1996 structured observations were made at shops (n=289) and interviews with purchasers outside the shop and a follow-up interview of parents of children three days afterwards (n=109). This was repeated for similar sample sizes during peak malaria seasons in June-July 1996 and December 1996/January 1997. Training was evaluated by measuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhood fevers given an adequate amount of chloroquine. The programme was assessed qualitatively in the community following the shop keeper training.

Impact Achieved The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the training to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The percentage of antimalarial drug sales where an adequate amount of drug was purchased rose from 31.8% (95% CI 26.6%- 37.6%) to a minimum of 82.9% (95% CI 76.3%-87.3%). The percentage of childhood fevers where an adequate dose of chloroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before the training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which represents an increase in the appropriate use of over-the-counter chloroquine by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, he large shifts in behaviour observed indicate that the approach of training shop keepers as a channel for information to the community is both feasible and likely to have a significant impact.

Pribadi, W., Rukmono, B., Santoso, S.S., Soeripto, N., Lokollo, D.M., and Soeharyo Decrease of malaria morbidity with community participation in central Java. Southeast.Asian.J.Trop.Med.Public Health 23:389-396, 1992. Ref ID : 4727

Target Group/Country 3 villages in Central Java, Indonesia

Intervention Methodology Health education about malaria with a learning module was conducted by key persons as an element of community participation. 10 Persons from each village were trained to distribute chloroquine as prophylaxis – each person visited 20 households per week to detect fever, take blood and give health education.

Evaluation Method 3220 villagers from 322 households were given clinical examination at 0, 12 and 19 months (no controls).

Impact Achieved After the intervention the spleen rates, parasite rates and fever cases dropped to nearly zero in the three study villages. The data from a KAP study was not presented to substantiate author’s claim that there was an increase in knowledge and positive change of attitude.

Malaria - school-based programmes

Bhati, P.G., Rajni-Kant, Srivastava, H.C., Malaviya, V.S., Pujara, P.K., and Kant, R. Role of health education in schoolchildren with particular reference to malaria. Indian Journal of Malariology 32(3):93-98, 1995.  Ref ID : 4823

Target Group/Country School children at primary, secondary and higher secondary levels in Gujarat State, India

Intervention Methodology Posters showing transmission of malaria were displayed at an exhibition. Slide shows and live demonstrations of aquatic stages of mosquitos, adult malaria parasite and larvivorous fishes. 12 college students were also involved in carrying out the health education.

Evaluation Method Knowledge of malaria and the effect of health education were evaluated by questions given to 489 pupils who attended sessions and compared with responses of 79 children who did not attend. There was no base line.

Impact Achieved School children exposed to the health education gave a higher correct score average (47.88%±23.12) compared to a control group (26.56%±16) P<0.05. Note: The nature of the knowledge involved in compilation of the test score is not explained.

Ekeh, H.E. and Adeniyi, J.D. Health education strategies for tropical disease control in school children. Journal of Tropical Medicine & Hygiene 91(2):55-59, 1988. .Ref ID : 1446

Target Group/Country Rural secondary schools in Nigeria

Intervention Methodology Teachers were provided a four day orientation course carry out health education to pupils on in the control of malaria, schistosomiasis, dracunculiasis and onchocerciasis  using demonstrations, story telling, role playing and visual aids.

Evaluation Method 10 secondary schools grouped into two equal clusters (five each) to form experimental and control groups. Self-completed questionnaire testing knowledge given as pre-test (exp n=632, controls n=678) and post-test (exp. n=343 and control n=234).

Impact Achieved Pre-test scores were similar in experimental and control. After intervention there was significantly higher score in intervention compared to control for knowledge of cause (0.829 cf. 0.583), prevention(0.573 cf, 0.329) and treatment (573 cf. 0.300). No information is provided on the nature of the measuring instrument or what was considered as correct knowledge.

Lopes, J., Kumar, A., Fernandes, F.S., Thavaselvam, D., Sumodan, P.K., and Baruah, K. Promotion of bioenvironmental control of malaria through the junior Red Cross in Goa. In: Community participation in malaria control, edited by Sharma, V.P.India:Malaria Research Centre, 1993, Ref ID : 4159 (Borderline for inclusion in database)

Target Group/Country Schools in Goa, India

Intervention Methodology A target oriented health education campaign on malaria and its bioenvironmental control was launched in Goa, India,  through the Junior Red Cross (JRC) counsellors and volunteers, supported by school authorities, the department of education and religious and business institutions. JRC counsellors were trained and these trained JRC student volunteers in schools who subsequently carried out programmes in the community. JRC counsellors also organized school seminars on malaria. They also invited the teachers and students from the neighbouring school. JRC counsellors and the school authorities issued press releases on the programme and made public announcements in the church and though the gram panchayat.

Evaluation Method Description of activities

Impact Achieved No data are presented on the impact of the programme.It is claimed that the programme received an overwhelming response during the training and implementation phases and is expected to result in creating awareness and motivation in the community and sustained self-action for mosquito and malaria control in Goa.

Ogutu, R.O., Oloo, A.J., Ekissa, W.S., Genga, I.O., Mulaya, N. and Githure, J.I. (1992) The effect of participatory school health programme on the control of malaria. East. Afr. Med. J. 69, 298-302.  Ref ID : 8392

Target Group/Country Primary school children in Kisumu, Western Kenya

Intervention Methodology Pupils attend a 45-60 minute educational session using LEPSA approach (Learner centred problem posing/solving action-oriented approach).

Evaluation Method Two hundred primary level school children, aged between 7 and 18 years. An experimental cohort of 100 pupils as compared with 100 controls. An initial KAP, blood film malaria diagnosis and self-reported morbidity survey repeated at end of 3 months

Impact Achieved No significant change occurred on the knowledge of the disease between the groups after 3 months. Authors claim positive improvement in attitudes, sickness and absenteeism rates but data presented are unclear and there are no significance tests.

(the component of this programme directed at householders is described in the section on insecticide treated bed nets above)

Marsh, V.M., Mutemi, W., Some, E.S., Haaland, A., and Snow, R.W. Evaluating the community education programme of an insecticide-treated bed net trial on the Kenyan coast. Health Policy and Planning 11(3):280-291, 1996. Ref ID : 4161

Target Group/Country Primary school children in Klifi District of Kenya

Intervention Methodology Their first objective was to use school children as a channel for communication to the surrounding community. A second objective was to teach the bed net message to primary school children themselves. The first input to each school was a morning programme incorporating the delivery of the bednet messages in the form of a drama and giving children activities they could do that week which included a poster competition and a survey form to take home. The follow-up visit reinforced the message, discussed the results of the home survey and awarded prizes for the poster competition.

Evaluation Method In a sample of six schools evaluation questionnaires were given to random samples of children immediately before and after the teaching programme and to a third sample 3 months later. Following completion of the programme meetings were held with the committees of Parent Teachers' Association (PTA) in six of the schools.

Impact Achieved A total of 2040 children were reached in this educational programme from 40% of families in the project area. 54% of the children (1105) had nets at home. Responses to the pre- and post-test questionnaires showed improvements in knowledge scores from 58% to 90% by the pupils and a level of 80% with the three months follow-up.


11.10 Schistosomiasis (Bilharzia)

11.11.1 General programmes

Cline, B.L. and Hewlett, B.S. Community-based approach to schistosomiasis control. Acta Tropica 61(2):107-119, 1996.  Ref ID : 6353 (Borderline for inclusion in database)

Target Group/Country Kaele subdivision, Extreme North Province, Cameroon

Intervention Methodology Health education was carried out within the context of a schistosomiasis control programme whose other components include diagnosis and treatment, snail control and cost recovery. The health education was designed following a KAP study (details not provided) an messages build on existing understandings of schistosomiasis incorporating the local language name for the condition. Activities included development of materials (flipchart), posters and brochures, training of elementary school teachers and health centre personnel, and the development of health education plans for health centres for each of the two transmission seasons in a year which involved religious and political leaders and also community groups including women's associations. Teachers introduced sessions on schistosomiasis twice yearly during the transmission seasons, children took home brochures, drawing and writing competitions were held.

Evaluation Method 4 out of 14 villages in Kaele subdivision with health centres were selected as assessment villages and a fifth was selected as a comparison village for health education (but still received treatment). 651 residents were exaimined parasitologically in 1991 (before) and in 1993 after control interventions had started. A survey of knowledge was carried out in the intervention and control villages but no information on this is provided.

Impact Achieved Overall prevalence of infection declined from 21% to 7% and the number of heavy infections (>50n eggs /10ml urine) in the assessment villages dropped from 23 to 8. (significance tested not reported). Knowledge of pupils in the intervention villages about the role of snails increased from 16 to 76% and knowledge about water contact as the source of infection increased from 11 to 72%. However raw data/significance tests are not provided nor comparison data with control schools. Specific lessons for health education reported were 1) that the nurse's aid at the health centre was often the most effective health education agent; 2) that health centre staff had no skills in effective health education; 3) that teachers were very enthusiastic; 4)  reaching remote villages and female schoolchildren was difficult; 5) the brochure was the most useful and posters the least useful materials with flipcharts of intermediate value; 6) screening for urinary schistosomiasis at schools coupled with health education was particularly valuable. Lack of details on the data collection and absence of raw data/statistical tests severely limits the value of this publication in demonstrating effectiveness of health education.

El-Hawey, A.M., El-Akabawy, A.S., Abdel-Rahman, M.M., Amer, M.M., Agina, A.A., and Ahmed, M.M. The role of change of knowledge and attitudes in the control of schistosomiasis. Journal of Tropical Medicine 2(5):73-80, 1993. . Ref ID : 5057 (Borderline for inclusion in database)

Target Group/Country Two villages with high prevalence (26-28%) Sharkia Governorate, Egypt

Intervention Methodology Both villages received treatment of schistosomiasis-infected cases with single oral dose of praziquantel (40mg/Kg body wt.). Individuals in village A were subjected to health education in the form of group discussion for three two hour sessions over three days. The size of groups was not more than 30 individuals of the same age - men separated from women. The education was supported by visual aids, demonstrations and storytelling.

Evaluation Method Before the study clinical examination, urine analysis, KAP questionnaire were provided to a sample of persons between 10 and 60 in one out of 20 households in each village A(n=408) and villae B (n=416). 6 months afterwards the same sample were given a stool and urine analsysis (village A n= 385, village B n=405) and Vilage A was given a repeat of the KAP study.

Impact Achieved At the follow-up study prevalence of schistosomiasis was significantly reduced (p<0.05) in village A than village B for individuals below 30 years but there was no significant difference for persons above 30. There was a highly significant increase in knowledge score in Village A (no data from control village). The group who had the highest knowledge score showed the greatest decline in Schistosomiasis (p<0.0001) Authors report that for older persons, water contact practice especially irrigation in the fields was not given up (data to support this not provided). This study is of interest in that it demonstrates a greater impact of health education on younger persons however it is disappointing that more information not provided on the nature of the knowledge test and that control community was excluded from a follow-up KAP study.

Uchoa,E., Barreto,S.M., Firmo,J.O., Guerra,H.L., Pimenta,F.G., Jr. and Costa,M.F. (2011)  The control of schistosomiasis in Brazil: an ethnoepidemiological study of the effectiveness of a community mobilization program for health education.  Social Science and Medicine  51, 1529-1541. Ref ID: 8773

Target Group/Country Two rural villages in Minas Gerais State, Brazil

Intervention Methodology Both villages were beneficiaries of the National Schistosomiasis Control Programme which in 1984, 1985, 1988, 1994 and 1994  provided snail surveillance (except in 1994) and treatment of affected areas with molluscicide, examination of stool samples, free treatment and person-to-person explanation of the disease cycle and prevention. The educational programme provided to the intervention community targeted school children aged 7-14 yrs and community organizations and took part from May to November 1989. Following discussions and data-gathering to determine knowledge of schistosomiasis lectures were given to school children, teachers, training courses for teachers, preparation of a booklet on prevention for reading comprehension activities, children's plays and a public parade with Schistosomiasis as the theme.

Evaluation Method The epidemiological component of the evaluation involved drawing on records of Schistosomiasis surveys carried out by the Brazilian Ministry of health and a population-based survey in 1995 of the intervention village (n=390) and control villages (n=302) to determine water contact behaviour and knowledge of schistosomiasis and its control. The was supplemented by an anthropological study involving an initial 1 week stay in each village carrying out observation and interviews with 30 informants in each locality to obtain general understandings of schistosomiasis followed by a longer period of 50 days ethnographic study including 36 interviews with key informants.

Impact Achieved In both communities the age adjusted prevalence of infection decreased sharply after the beginning of the control programme, but in the control area increased rapidly. The initial and final age adjusted prevalence rates in the study area were 33.2.% in 1984 and 19.2% in 1994, in the control village the corresponding prevalence was 38.2% in 1984 and 33.7% in 1994 (no significance data provided). From the survey, the 4.1% of the sample reported no water contact, 11.6% once a week and 84.2 at least once a week, while in the intervention area the corresponding percentages showed lower contact at 41.5%, 36.4 and 22.1% (p<0.001). The survey and ethnographic study showed that this lower level of infection and water contact could not be attributed to the heath education programme and must be a result of other factors e.g. water supply. Water contact was not associated with awareness of schistosomiasis or disease transmission, there were no important differences between the two communities in their concepts/discourses on schistosomiasis. Despite knowing the dangers of water contact many members of the community persisted in contacts with water for leisure (swimming and fishing) and domestic duties (dishwashing and laundry) and work (farming and gardening). Most informants considered medical treatment the most effective approach and it was likely that widespread availability of free treatment led to individuals persisting in high-risk water contact patterns. This study provides a very good example of the value combining quantitative and qualitative data in evaluating health promotion.

Schistosomiasis programmes in schools

Bausch, D. and Cline, B.L. The impact of control measures on urinary schistosomiasis in primary school children in northern Cameroon: a unique opportunity for controlled observations. Am.J.Trop.Med.Hyg. 53:577-580, 1995. Ref ID : 4097

Target Group/Country Northern Cameroon

Intervention Methodology A program to integrate schistosomiasis control into the primary health care system in northern Cameroon. Programme activities involved the village schools with 'extensive interaction' between village health workers and teachers. These activities consisted of vigorous, culturally appropriate health education about schistosomiasis, low cost active urine screening and drug therapy with praziquantel ad part of a cost recovery programme. Parents of infected children were contacted and encouraged to see that the child received treatment. No information is provided of the methods and content for the health education.

Evaluation Method Inadvertently, a large part of Mindjil, one of four assessment villages, had been essentially excluded from the program, creating a unique natural control. Follow-up data on prevalence and intensity of Schistosoma hemotobium was collected two years after the programme from 108 children exposed to the programme and 170 children from the school that had not been reached. Reference in the discussion is made to a KAP study but details are not provided in the text.

Impact Achieved The prevalence of infection with Schistosoma hematobium in school-aged children was 7% in the areas where the control program was implemented, and 71% in the excluded areas (P < 0.0002). High intensity infection was 1% and 26% in the two areas, respectively (P < 0.0002). Children in the school where the control interventions were implemented had a significantly lower prevalence of infection with Schistosoma hematobium (P < 0.005). Subjects in intervention areas demonstrated greater knowledge about the transmission of schistosomiasis than those in the control area (but details of the method used to obtain details of knowledge are not provided. A baseline is reported to have been carried out but the data from this is not drawn upon or methodology described.

Kotb, M., Al-Teheawy, M., El-Setouhy, M. and Hussein, H. (1998) Evaluation of a school-based health education model in schistosomiasis: a randomized community trial. Eastern Mediterranean Health Journal 4, 265-275 . Ref ID : 8384

Target Group/Country Egyptian primary school children

Intervention Methodology The health education consisted of three modules presented over three days covering the risks from contaminated water, the life cycle of schistosomiasis and the nature and importance of preventive health behaviours including the importance of screening. The methods used include health talks, stories, case histories, role plays and drama. A  day training course was held for teachers involved (one per school).

Evaluation Method A randomized community trial of three pairs of comparable schools in rural areas was implemented. One school in each pair received screening, treatment and health education whereas the other received treatment and screening only. A baseline study was carried out on 422 and 378 children from 3 intervention and 3 control schools respectively. The first post-intervention survey was carried out one month after the health education programme on 212 children in the intervention schools. A second post-intervention survey was carried one year after the intervention with 394 and 360 children in the intervention and control schools.

Impact Achieved The study revealed a significant improvement in knowledge and attitudes as well as a reduction of schistosomal infection 1 year post intervention in the intervention schools of pairs I and II (p<0.05%). However, the improvements in knowledge in the intervention school of pair III were not accompanied by significant changes in attitude or schistosomal infection

Yuan,L., Manderson,L., Tempongko,M.S., Wei,W. and Aiguo,P. (2011)  The impact of educational videotapes on water contact behaviour of primary school students in the Dongting Lakes region, China.  Trop. Med. Int. Health  5, 538-544.Ref ID: 8781

Target Group/Country Primary school children in Dongting Lakes Region, China

Intervention Methodology A 15 minute video and a comic book in colour based on baseline research and designed to increase children's knowledge of schistosomiasis as an environmental disease and to encourage them to reduce their contact with unsafe water sources. The video used cartoon format to tell the story of a group of children who did not know where the 'demons' i.e. schistosomes) hid in their environment. A angel -representing a health worker - who the children which places are safe and which are unsafe. A song ran through the programme reinforcing the message. In intervention schools the video was shown to all grade 4 pupils twice in one day with 10 minutes of class discussion following the first screening (carried out by a member of the local anti-schistosmiasis station. The comic strip was distributed to all children who saw the video.

Evaluation Method A baseline survey consisting of a short self-completed questionnaire was given to 2263 school children in 1995. A post intervention survey was carried in 1996  out using the same questionnaire with 1739 children with 875 from the intervention  group and 864 from the control group. In addition observation data was collected of water contact behaviour at safe and unsafe locations for 10 days prior to the intervention  and for a second 10 day period one month after the intervention. Details of the observational method are not provided.

Impact Achieved After the intervention knowledge about schistosomiasis was much higher in the intervention group compared the control (p<0.001). There was no overall difference between frequency of water contact behaviour of the two groups after the even - in both groups this had decreased and this was attributed to heavy rains in 1996. However, among the children in the intervention schools there was a decrease in the use of unsafe water and a marked increase (26%) in the use of safe water sites (differences between the use of safe and unsafe water between intervention and control groups were significant p<0.001). It is disappointing that more information was not provided on the observational method.


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