West African Centre for International Parasite Control (WACIPAC) in collaboration with. Noguchi Memorial Institute for Medical Research.

Transcription

1 by West African Centre for International Parasite Control (WACIPAC) in collaboration with Noguchi Memorial Institute for Medical Research and Japan International Cooperation Agency 1

2 1. GENERAL OVERVIEW Worms & Ladders is a game designed for school children to learn about good and bad health practices in relation to parasitic diseases infection and control. The game places emphasis on some important parasitic diseases in the West African sub-region, which are malaria and worm infections (soil transmitted helminthiasis (STH) and schistosomiasis). It has been developed to assist children to learn important causal relationships such as swimming in contaminated river and blood in urine. Intestinal helminth infections rank first among the causes of all communicable and non-communicable diseases in school-age children in developing countries. They contribute to the impairment of cognitive ability and growth in children. The Global Parasite Control Initiative (GPCI) approach therefore aims at parasitic diseases control by using STH and schistosomiasis control as entry points in schools. GPCI employs periodic mass deworming with safe, effective and inexpensive drugs together with school health education to ultimately change their behavior, which will eventually result in interruption of transmission. Teachers and facilitators are encouraged to supplement the knowledge acquired from the game with more detailed information and practical skills on personal hygiene to enable the children to understand better the causal relationships. Relevant information for this education is provided at the end of this instruction manual. 2. WHAT YOU NEED TO GET BEFORE PLAYING 1) Playing pieces to represent players: Stones or objects of various shapes such as bottle-tops can be used to represent each player. It might also be a good idea to let the children make their own pieces for the game. 2) A dice: If a dice is not available, a short pencil which is hexagon in a shape can be numbered 1-6 on each side at the tail end for this purpose. Alternatively, pieces of paper numbered 1-6 can be placed in a box and each player then draws one blind. 2

3 3. RULES 1) Number of players: 2 to 4 (plus 1 facilitator) 2) Each player places his/her playing piece at the START square. 3) Each player rolls the dice (or pencil) in turn. The player who plays the highest number makes the first move according to the number which shows up on the dice. N.B. A player does NOT have to roll 6 to start the game. 4) Other players then continue to roll the dice and move their playing pieces. Play continues to the right direction of the first player. N.B. Even if a player rolls 6 during the game, he/she does NOT roll the dice again as a bonus. 5) Players must wait for the current player to move his/her piece and answer the necessary questions or provide explanations to the pictures as appropriate before they pick the dice from the board to roll. This is very important in this learning game. 6) When a player lands at the bottom of a ladder, he/she will move up to the top of it. 7) When a player lands at the head of a worm, he/she will slide down to its tail. 8) When a player lands at the tail of a worm, he/she will miss the next turn. N.B. If the player has come down through the worm, h e/she does not have to miss the next turn. 9) The player who reaches the GOAL first is the winner. N.B. It is necessary to roll the exact dice to reach the GOAL. 4. IMPORTANT TIPS FOR FACILITATORS 4.1 When a player is promoted, always ask the player what the illustration in the square depicts, why he/she is being promoted, and then follow up with explanations to the children why he/she is promoted. When the correct answer is provided, everybody should then clap hands for the player. e.g. A player stops at the square 2, which is Sleeping under the mosquito net. You may ask the following question: Ah, you have stopped at number 2, what does it show? Yes, you are sleeping under the mosquito net. Why do you think that sleeping in the mosquito net is good? Yes, it s because you don t get bitten by mosquitoes which transmit malaria if you sleep in the net, isn t it? Very good, so you climb up the ladder, then you see, you have slept well without getting malaria. Let s clap for him! 4.2 Note that a good health practice is placed in the game so that the player who gets promoted skips the square with the alternate bad practice. e.g. A player who slept 3

4 under the mosquito net (square 2) will not stop at the square 8 which is bitten by mosquito. 4.3 When a player is demoted, always ask the player what the square shows, why he/she had to be demoted, and then follow up with an explanation or the reason. e.g. A player stopped at the square 33 which is swimming in the contaminated river. Ask the player questions like followings: Ah, you have stopped at this, tell us what is happening here? Yes, swimming in the river. Can you see this? (Point to the snail in the river). What is this? This is a snail, isn t it? These little snails contain large numbers of baby schistosomes called cercariae, which they release into the river water to enter your skin. Is this a good practice or bad practice? Why is swimming or contact with the river bad? Yes, you can get schistosomiasis or Bilharzia by swimming in the river, isn t it? So you should come down to this (square 23), what is this? Yes, red urine, isn t it? Bilharzia can cause blood in urine, you know? And loss of blood in urine leads to less blood in your body, which is called anaemia. So now you have learnt that swimming in the river can cause Bilharzia which make your urine red after a while. 4.4 Note that the length of the ladder for washing hands with water should be compared with that of washing with soap. Washing with water is good, but washing with soap is even better, so the ladder for washing with soap is longer. However, this is not always the case for the other ladders. 4.5 Try as much as possible to let the children repeat what you have said. For example, let them say Urinating in the river is a bad practice, because it can transmit schistosomiasis and we can get a big belly (intestinal schistosomiasis) after your explanation (square numbers 42 and 27). 4.6 After the game, it would be a good idea to summarize the lessons learnt and allow time for questions. 4

5 5. DESCRIPTION FOR EACH SQUARE 2: Sleeping in the mosquito net 5: Child with fever and chills in bed, which implies a malaria attack 7: Vomiting and abdominal pain, which implies stomach problems 8: Bitten by a mosquito 9: Flies carry disease germs from faeces to uncovered food 10: Waking up well rested after sleeping in the net 12: Washing hands with soap and water 13: Washing hands with water only 15: Defecating in a latrine 18: Eating with dirty hands and long nails 19: Defecating in the bush 21: Eating banana with a clean hand 23: Presence of blood in urine 26: Eating with clean hands 27: Big abdomen (liver), which implies intestinal schistosomiasis 28: Healthy child going to school 29: Fetching water without entering the river, and boiling the water for drinking purposes 30: Deworming of children at school 33: Swimming in schistosome infested water 34: Anaemic child with pale tongue and conjunctiva 5

6 35: Disposing garbage into a rubbish bin 37: Wearing shoes 39: Drinking safe water 42: Urinating or defecating near river 43: Worms coming out from the anus 44: Not wearing shoes 45: Healthy child with a lot of energy 6. IMPORTANT BACKGROOUND INFORMATION 6.1 Malaria (Square 2, 5, 8 and 10) Malaria is the most dangerous and prevalent parasitic disease in Africa. More than one million people die of malaria every year, mostly in Africa. It is transmitted by female Anopheles mosquito, which bites human form dusk to dawn. The major symptoms of malaria are fever and shivering. Headache and vomiting are also common. Malaria can kill children if treatment is delayed, so it is very important for children to understand that they should ask their parents to send them to the health centre immediately if they suspect malaria. Malaria can be treated with medicine, but it must be taken strictly according to the doctor s instruction. It is very important to complete the full course of treatment. People suffering from malaria should not stop taking medicine halfway even if they feel better after taking a few tablets. It is also important to prevent mosquito bites by reducing mosquitoes in the environment. Breeding sites for mosquitoes such as water puddle near the house should regularly be filled with sand. Empty bottles and bins should not be left standing outside, for they can collect rainwater and serve as breeding sites. Children should be encouraged to stay indoors after dark, and ideally their homes should have mosquito screens for the doors and windows. It is also important to sleep under insecticide-treated mosquito nets. It should be reminded that the net must be treated with the drug (insecticide) every 6 months. 6.2 Schistosomiasis (Square 23, 27, 33 and 42) 6

7 Schistosomiasis, commonly known as bilharzia is caused by a wormy parasite called schistosome. There are two types of the disease, urinary and intestinal schistosomiasis. The urinary disease is caused by Schistosoma haematobium infection, and the intestinal disease is caused mainly by Schistosoma mansoni infection. Both types are prevalent in Ghana. Schistosome eggs are excreted either in an infected person s urine or stool. If an infected person urinates or defecates near a fresh water body such as river or pond, schistosome eggs enter the water. The eggs then hatch into hairy forms that swim in search of a particular type of snail to infect it. These hairy forms then develop in the snail and hatch again into tiny baby worms called cercaria. The snail then releases thousands of cercaria into the water. Cercaria are so small (0.2 mm) that they cannot be seen with naked eyes. They enter the human body by piercing through the skin when people come to swim, fetch water or wash clothes in infested water bodies or rivers. The cercaria grow in the human body into adult worms. After one month, the adult worms start laying eggs which are excreted in either the urine or faeces according to the type of the schistosome. In urinary schistosomiasis, the eggs, which cause the disease in human bodies, damage the bladder and therefore the urine appears red because it contains blood. In the long run, it can cause cancer of the bladder. Intestinal schistosomiasis damages the liver and the gut. It enlarges the liver (hepatomegaly), and the abdomen becomes very big. It can also manifest as blood in the stool. In order to prevent schistosomiasis, it is therefore very important to abstain from coming into contact with the water by swimming or even stepping in the infested river. It is also very important NOT to urinate or defecate near the water body to avoid contaminating the water with schistosome eggs. Schistosomiasis can be treated with a medicine called Praziquantel. The WHO is advocating mass treatment of school-age children with this medicine in schistosomiasis endemic countries. 6.3 Intestinal worms (soil transmitted helminthiasis: STH, square 30, 34, 37, 43, 44 and 45) There are two types of STH that are dealt with in the game, Ascaris (round worm) and Hookworm. 7

8 a) Ascaris is a big intestinal worm (as big as 30 cm in length) that can cause transient pneumonia and abdominal pain. People who are infected with Ascaris excrete hundreds of thousands of its eggs in the stool every day. The eggs are so small that they cannot be seen with the naked eye. People get infected by eating vegetables contaminated with Ascaris eggs or eating with dirty contaminated hands especially after defecation. Ascaris can be easily treated with drugs. As recommended for schistosomiasis control, the WHO is also advocating for mass deworming of school-age children to control STH. Square 30 and 43 show that a child is expelling Ascaris after being dewormed at school. It is important to note that some drugs do not expel the worms; instead the worms are killed and crushed in the abdomen. b) Hookworm is a small intestinal worm (about 1 cm in length), which can cause anaemia in human. Hookworms live in the human gut and suck blood from the gut wall, and that explains why the patient loose blood to become anaemic. They lay eggs, which are passed through the stool. The stool from infected persons contaminates the soil when they defecate in the open and not use appropriate facility. The hookworm eggs will hatch in the soil to become baby worms called larvae, which are too small to be seen with the naked eye. The larvae move and attach themselves to small bushes or weed to await contact with humans. If a person walks without shoes, the larva of the hookworm infects him/her by penetrating the skin. Therefore it is important to wear shoes to prevent hookworm infection. The other type of hookworm larva can infect human if foods contaminated with the larvae are eaten. Therefore hand washing before eating and washing of vegetables and dropped food is very important. Hookworm can also be treated with the same medicine that is used for Ascaris treatment. 7 PERSONAL HYGIENE The game deals with several good and bad practices in terms of personal hygiene. Washing hands before meal especially with soap should be always encouraged. Indiscriminate defecation is a very bad practice, for it can contaminate the environment and spread STH infections. Eating with dirty hands should be discouraged, for it can cause various infections including STH and bacterial diarrhoea. Boiling water is a good practice in many ways. It can prevent many diseases such as diarrhoea and guinea worm. Garbage disposal is another important issue, which must be discussed in the school. 8