Development of Schistosomal School-Based Health Education Model for Yemeni Schoolchildren

1. Development of Schistosomal School-Based Health Education Model for Yemeni Schoolchildren Hassan K. Bassiouny MD, Dr.PH., Tropical Health Dept. High Institute of Public Health, Alexandria University, Egypt. Latifa A. Al-Shibani Bsc., Dr.PH Faculty of Medicine and Health Sciences, Sana'a University, Yemen. 2006

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

3. Schoolchildren form a major target for health education on schistosomiasis, because they play an important role in water contamination and infection transmission, besides, they are the most susceptible to infection. • In Yemen , there is no health education activities directed to schoolchildren especially those concerning the endemic diseases.

4. Aim of the Study • The present study aims at developing a simple and effective schistosomal school-based health education model for Yemeni schoolchildren.

5. Subjects & Methods • A cross sectional study was conducted on 20% of the families (527 inhabitants, 251 males & 276 females) of two Schistosoma mansoni endemic villages in Taiz Governorate. Besides 152 students (90 males & 62 females) of primary ( 52 males & 30 females) and preparatory ( 38 males & 32 females) schoolchildren of different age and sex group. • A pre-coded interview questionnaire was designed and pre-tested to collect personal and socio-economic data from both villagers and students.

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

7. This model composed of three modules: • Module I: focused on the orientation of the disease, mode of the infection, water risky and contamination behavior. • Module II: directed to the identification of the life cycle, symptoms and complications. • Module III: stressed on the importance of health behavior and seeking medical care when necessary.

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

9. Early evaluation of the impact of the model was done one month after the implementation of the program to assess early changes in KAP. • The second post-intervention was done one year later using the same questionnaire. It included only 143 schoolchildren because 9 students (4 males & 5 females) were left school.

10. Stool samples were collected from every villager and student during the base line survey and after one year post-intervention. Three Kato thick smears were examined from every individual for detection of S.mansoni eggs and to estimate the intensity of infection (geometric mean egg count GMEC= No. of eggs/ gram stool). • The infected cases were received praziquantel treatment with a dose of 40 mg/kg body weight.

11. Results X12=3.71, p> 0.05

15. Prevalence of S.mansoni infection among schoolchildrenpre and post- intervention with health education program X22=15.4, p<0.01

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

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

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

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

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

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

22. 7. It is worthy to mention that no significant change in mean KAP scores in relation to S.mansoni infection one year of the program. This could be due to various interacting factors: in Yemen there is no formal or systemic health education activities directed to schoolchildren especially those concerning with prevention of endemic diseases. • Absence of community participation and non involvement of the NGOs may be another factor affecting non significant change in KAP.

23. In conclusion, intestinal schistsomiasis continues to be a major public health problem in rural areas in Yemen. Villagers can not expected to change their behaviors unless there are some change in local environmental conditions, provision of safe water supply and snail control measures supported by provision of appropriate information and health education. • Inserting a relatively low cost behavioral intervention program into routine screening and treatment of schoolchildren may result in reduction of schistosomal infection among them.

24. Thank You