School-based participatory health education for malaria control in Ghana: engaging children as health messengers
Malaria Journal
RSecseharcoh ol-based participatory health education for malaria control in Ghana: engaging children as health messengers
Irene Ayi
Daisuke Nonaka
Josiah K Adjovu
Shigeki Hanafusa 0
Masamine Jimba
Kwabena M Bosompem
Tetsuya Mizoue
Tsutomu Takeuchi
Daniel A Boakye
Jun Kobayashi 0
0 Bureau of International Medical Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku , Tokyo , Japan
Background: School children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults. Methods: This study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fisher's Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention. Results: After the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (p < 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (p = 0.003). These positive changes were observed only in the intervention group. Conclusions: This study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.
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Background
Ghana is located in sub-Saharan Africa, where an
estimated 90% of the world's malaria-attributable deaths
occur. In Ghana, malaria accounts for more than 44% of
reported outpatient visits and an estimated 22% of deaths
in children under the age of five. Reported malaria cases
represent only a small proportion of the actual number of
episodes, as the majority of people with symptomatic
infections are treated at home and are, therefore, not
often reported [1,2]. In Ghana, the national malaria
control programme focuses chiefly on pregnant women and
children under five years of age, as malaria leads to more
serious consequences in this group. The main activities of
the malaria control programme in Ghana are
facilitybased and implemented at the health centre level, i.e.,
providing intermittent preventive treatment (IPT) and
distributing insecticide-treated bed nets (ITNs) to
pregnant women during antenatal care, and distributing ITNs
to women with young children during immunization [3].
Children of school-going age have also been targeted
for malaria control in some endemic countries including
Ghana [4-6]. As more and more children attend school,
governments are increasingly recognizing the importance
of child health for educational achievement [7]. A
number of studies that focus primarily on evaluating the
effectiveness of providing treatment for children have been
conducted in the school setting, [5,8,9]. Recently, the
impact of IPT among school children has drawn
increased attention [10-12]. However, while IPT is
relevant only in high-transmission areas, skills-based health
education for malaria control is recommended to be
effective in all transmission settings [13].
Recently, school-based health education interventions
have been conducted for malaria control. They use an
innovative approach that engages school children to
reach community adults with health messages and
hygienic practices through action-oriented and
participatory learning action (PLA). For example, Okabayashi et al
[14] reported that school children disseminated
information on malaria to the community through a variety of
approaches including issuing newsletters, placing
billboards, and holding village events in Thailand. As a
result, both children and community adults showed
improved knowledge, attitudes, and practices pertaining
to malaria. Onyango-Ouma et al [15] evaluated the
potential of school children as health change agents in a
rural community in Kenya and observed improved
knowledge pertaini (...truncated)