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      Development of an educational cartoon to prevent worm infections in Chinese schoolchildren

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          Abstract

          Background

          With more than two billion people infected worldwide, soil-transmitted helminths (STH) are the most widespread infections. To date, STH control efforts rely predominantly on recurrent mass drug administration (MDA), which does not prevent reinfection. Additional public health measures including novel health educational tools are required for more sustained integrated control of STH. We describe the development of an educational cartoon video ( The Magic Glasses) targeting STH infections in Chinese schoolchildren and its pilot testing in China.

          We applied an extensive community-based mixed methods approach involving input from the target group of 9–10 year old schoolchildren and key informants, such as teachers, doctors and parents, in order to identify potential STH infection risks in the study area and to formulate key messages for the cartoon. The development of the educational cartoon included three major steps: formative research, production, and pilot testing and revision.

          Results

          We found that most adults and approximately 50% of the schoolchildren were aware of roundworm ( Ascaris) infection, but knowledge of transmission, prevention and treatment of STH was poor. Observations in the study area showed that unhygienic food practices, such as eating raw and unwashed fruit or playing in vegetable gardens previously fertilised with human faeces, posed major STH infection risks.

          Conclusions

          It was crucial to assess the intellectual, emotional, social and cultural background of the target population prior to video production in order to integrate the key messages of the cartoon into everyday situations. Overall, our strategy for the development of the cartoon and its incorporation into a health education package proved successful, and we provide a summary of recommendations for the development of future educational videos based on our experiences in China.

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          Most cited references14

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          Health-education package to prevent worm infections in Chinese schoolchildren.

          Soil-transmitted helminths are among the most prevalent sources of human infections globally. We determined the effect of an educational package at rural schools in Linxiang City District, Hunan province, China, where these worms are prevalent. The intervention aimed to increase knowledge about soil-transmitted helminths, induce behavioral change, and reduce the rate of infection. We conducted a single-blind, unmatched, cluster-randomized intervention trial involving 1718 children, 9 to 10 years of age, in 38 schools over the course of 1 school year. Schools were randomly assigned to the health-education package, which included a cartoon video, or to a control package, which involved only the display of a health-education poster. Infection rates, knowledge about soil-transmitted helminths (as assessed with the use of a questionnaire), and hand-washing behavior were assessed before and after the intervention. Albendazole was administered in all the participants at baseline and in all the children who were found to be positive for infection with soil-transmitted helminths at the follow-up assessment at the end of the school year. At the follow-up assessment, the mean score for the knowledge of helminths, calculated as a percentage of a total of 43 points on a questionnaire, was 90% higher in the intervention group than in the control group (63.3 vs. 33.4, P<0.001), the percentage of children who washed their hands after using the toilet was nearly twice as high in the intervention group (98.9%, vs. 54.2% in the control group; P<0.001), and the incidence of infection with soil-transmitted helminths was 50% lower in the intervention group than in the control group (4.1% vs. 8.4%, P<0.001). No adverse events were observed immediately (within 15 minutes) after albendazole treatment. The health-education package increased students' knowledge about soil-transmitted helminths and led to a change in behavior and a reduced incidence of infection within 1 school year. (Funded by UBS Optimus Foundation, Zurich, Switzerland; Australian New Zealand Clinical Trials Registry number, ACTRN12610000048088.).
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            Exploring attitudes: the case for Q methodology.

            R M Cross (2005)
            Attitudes are often referred to, researched and considered in the discipline of health education and health promotion. This paper highlights Q methodology as an appropriate and relevant means of exploring and studying attitudes within this field. It begins by discussing the difficulties in defining attitude and the problems inherent in attitude measurement. A brief history of Q methodology is given, followed by an explanation of what Q methodology is and the processes involved. This paper argues the case for the use of Q methodology when studying attitudes and justifies why Q methodology should particularly be selected in the study of attitudes within the health field. There are many reasons for this assertion which are explored throughout the paper. The principle one is that Q methodology is a more robust technique, than alternative methods, for the measurement of attitudes and subjective opinion. This paper concludes by proposing that Q methodology is taken up by researchers within health education and health promotion who are concerned with exploring attitudes and subjective opinion.
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              Hookworm and poverty.

              Human hookworm infection is the leading cause of anemia and undernutrition and the second most important parasitic infection of humans. Hookworm occurs almost exclusively in the setting of rural poverty in the developing countries of the tropics. The rural dependency reflects the precise soil and temperature requirements of the environmental life history stages of the parasite, whereas the relationship between hookworm and poverty is based on multiple factors, including inadequate sanitation, the absence of concrete floors in home dwellings, and lack of access to essential medicines. Also, hookworm not only occurs in the setting of poverty but also promotes poverty because of its health and educational effects in children, its adverse effect on pregnancy outcome, and its effect on worker productivity. Since the middle of the 20th century, poverty reduction and urbanization have successfully reduced the prevalence of hookworm in the world's industrialized nations and some middle-income countries. However, the control of hookworm in low-income countries still relies heavily on the frequent and periodic use of anthelminthic drugs either through deworming programs targeting school-aged children or through integrated control programs that simultaneously target the seven neglected tropical diseases, including hookworm. However, the high rates of hookworm reinfection and the possible emergence of drug resistance will ultimately require the development of new control tools--including the Human Hookworm Vaccine, one of several so-called antipoverty vaccines that could undergo development and testing over the next decade.
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                Author and article information

                Contributors
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central
                2049-9957
                2013
                2 December 2013
                : 2
                : 29
                Affiliations
                [1 ]QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
                [2 ]The School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
                [3 ]Hunan Institute of Parasitic Diseases, WHO Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, People’s Republic of China
                [4 ]Andrew Bedford Creative Services, Brisbane, Australia
                [5 ]Swiss Tropical and Public Health Institute, Basel, Switzerland
                [6 ]Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
                Article
                2049-9957-2-29
                10.1186/2049-9957-2-29
                4177148
                24289667
                8d2076ef-1892-40aa-b9e2-830c0d1c0f02
                Copyright © 2013 Bieri et al.; licensee BioMed Central Ltd.

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 August 2013
                : 13 November 2013
                Categories
                Research Article

                soil-transmitted helminths,neglected tropical diseases,health promotion,video-based health education package,development of educational cartoon,integrated control,formative research,pilot testing,sustainable control of soil-transmitted helminths

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