School-based Participatory Health Education for Malaria Control in Ghana: Engaging Children as Health Messengers

This 12-page case study, published in the Malaria Journal, shares findings from a study to determine the impact of school-based malaria education interventions on school children and community adults in the Dangme-East district of the Greater Accra Region in Ghana. Trained schoolteachers designed participatory health education activities and led schoolchildren to disseminate messages related to malaria control to their communities. 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 schoolchildren, but also on community adults, through the improvement of knowledge and practices.

The articles explains that school-based health education interventions are conducted for malaria control using innovative approaches that engage school children to reach community adults with health messages and hygienic practices through participatory methods. In collaboration with local education and health authorities, three primary schools (Afiadenyigba, Dorgobom, and Tojeh) and their surrounding communities were selected, the first as the intervention site and the other two as control sites. The intervention included training teachers, who in turn led students through activities such as dramatisation, drawing, and singing songs to communicate malaria prevention at school and in the community. Teachers and students also conducted a one day anti-malaria campaign which included a march through the village and a durbar (village meeting/festival), comprising songs, drama, and poetry.

According to the post-intervention interviews, 23.1% (24 out of 104) of the children in the intervention school responded that they had, at least once, presented a picture related to the intervention to family members and/or other community members. For adults in the intervention community, 37.1% (92 of 248) confirmed that a child showed a picture to them at least once; 80.7% (201 of 249) responded they had heard the malaria songs, sung by the school children; and 59.0% (147/249) responded that they attended the durbar at the intervention school.

According to the article, previous studies conducted in sub-Saharan African countries including Ghana showed that people believed that not only mosquito bites, but also eating mango, drinking dirty water, and being exposed to hot sun were causes of malaria. While 95.2% of the community adults correctly answered at baseline that mosquito bites can cause malaria, only a small proportion of the respondents disagreed with the incorrect statements that "heat from the sun", "eating mango", and "drinking dirty water" cause malaria. After the intervention, this knowledge was significantly improved in the intervention area. The improvement is important because a lack of understanding of the linkage between malaria and mosquito bites is associated with poor adherence to vector control interventions.

After the intervention, the malaria prevalence was significantly decreased in school children in the intervention school, although no decrease was observed in children in the control schools. The study found that parasite prevalence significantly reduced from 30.9% to 10.3% (p = 0.003) at post-intervention in the intervention school, while it increased from 9.5% to 15.9% in the control schools.

Observational surveys showed that more mosquito proof nets were intact in the intervention households (69.4%) than in control households (41.3%), and water storages were more likely to be covered in the intervention households (77.9%) than in control households (67.3%). Although the extra opportunity to treat their nets was provided to community people during the one-day campaign, providing an opportunity alone is unlikely to increase the net treatment rate. According to the local health authority, community people rarely participate in free net treatment services which health workers offer regularly in the study villages. Previous studies reported that barriers of insecticide-treatment were not only influenced by cost and access to treatment place, but also fear about insecticide, and poor linkage between malaria and ITNs. Thus, the article suggests that community awareness raised by the children about malaria likely had a substantial impact on increasing net treatment practices.

According to the article, schoolteachers successfully adopted education activities using the participatory learning approach, such as role-playing, poetry recitals, slogan chanting, song composition, and dramatisation. These activities could be socially and culturally acceptable, because teachers themselves designed these activities. The results showed that most of the community adults were exposed to these activities. Moreover, participants in the intervention area were more likely to talk about malaria than those in the control area. Thus, the application of this strategy in other malaria endemic areas is recommended. School-based malaria education intervention engaging school children as health messengers had a substantial impact not only on school children, but also on community adults in improving knowledge on cause and prevention and bed net impregnation practices. The improved knowledge and practices could be associated with the decrease in the malaria prevalence observed in the school children.