Evaluation of a urogenital schistosomiasis behavioural intervention among students from rural schools in Unguja and Pemba islands, Zanzibar

Abstract

Highlights Children self-reported changes in urogenital schistosomiasis risk taking behaviours. Children self-reported an increase in swallowing anthelmintic drugs during MDA. Rebranding the concept of “worm” to “blood fluke” created a critical perceived health threat. The Health Belief Model was a viable foundation for the behavioural intervention.

Behaviour change interventions for the control and elimination of schistosomiasis: A systematic review of evidence from low- and middle-income countries

“…Sixteen publications scored ≥7, indicating an adequate body of evidence. Three methodological concerns were noted, including: not using behavioural indicators to assess outcomes (n = 5) [ 52 , 55 , 57 , 61 , 77 ], relying exclusively on ‘self-reported’ measures to assess BC (n = 14) [ 45 , 47 , 48 , 50 , 51 , 56 , 58 , 60 , 70 , 71 , 74 , 76 , 80 , 82 ], and lacking control groups in evaluation designs(n = 10) [ 52 , 55 – 58 , 67 , 70 , 74 , 79 , 80 ].…”

“…Three fourths of the projects (24 of 31) did not report using a theoretical framework, either psychological or educational. The remaining seven used six different approaches: conditional cash transfers [ 81 ], community-led total sanitation (CLTS) [ 64 ], human-centred design [ 71 , 72 ], enhanced development governance [ 66 ], participatory hygiene and sanitation transformation (PHAST) [ 67 , 70 ], and community dialogue approach [ 74 ].…”

“…Seven SEIs were reviewed, three targeted single behaviours [ 64 , 66 , 70 ]. Two attempted to control all three risk practices [ 71 , 74 ]. Most consistent positive outcomes were observed for those SEIs with a single focus on open defaecation [ 64 , 66 ].…”

“…No outcome measures were reported pertaining open urination. Beneficiary schoolchildren who initially rejected treatment were reportedly more likely to take praziquantel post-intervention [ 71 ]. Overall, however, MDA coverage for districts without BC activities was similar to those with [ 72 ].…”

“…Notwithstanding those considerations, the BC literature considers that the delivery of enticing, precise, and well-framed messages is key to prompt individuals to initiate action [ 28 , 90 ]. Certain pedagogical techniques appeared useful in our review: (i) (audio)visual materials, given their capacity to summarise complex information [ 47 , 48 , 51 , 71 , 74 ] and generate emotional reactions (e.g., frightening images) [ 71 ]; (ii) participatory sessions, which help beneficiaries to assess problems and outline solutions themselves, thus enhancing their confidence to take action [ 67 , 70 , 71 , 74 ]; (iii) context-based tailored messages, which ensure recommendations are applicable to local realities and relatable to beneficiaries’ concerns [ 48 , 51 , 71 , 74 ]; and (iv) enjoyable delivery platforms, like songs or games, which not only enhance their learning experience but can also attach positive emotions to safe practices (e.g., enjoyment) [ 47 , 48 , 71 ]. Mobilising trusted local figures, like school and religious teachers, has been established to add credibility to health messages [ 42 , 51 , 56 ].…”