School-based participatory health education for malaria control in Ghana: engaging children as health messengers

Malaria Journal, Dec 2010

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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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. - 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)


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Daisuke Nonaka, Daniel A Boakye, Irene Ayi, Josiah K Adjovu, Jun Kobayashi, Kwabena M Bosompem, Masamine Jimba, Shigeki Hanafusa, Tetsuya Mizoue, Tsutomu Takeuchi. School-based participatory health education for malaria control in Ghana: engaging children as health messengers, Malaria Journal, 2010,