Developing and evaluating health education learning package (HELP) to control soil-transmitted helminth infections among Orang Asli children in Malaysia

Abstract

Background: This study was carried out to develop a health education learning package (HELP) about soil-transmitted helminth (STH) infections, and to evaluate what impact such a package could have in terms of reducing the incidence and intensity of STH infections among Orang Asli schoolchildren in Pahang, Malaysia.

Methods: To identify the key risk factors of STH in Orang Asli communities, we applied an extensive mixed methods approach which involved an intensive literature review, as well as community-based discussions with children, their parents, teachers and health personnel, whilst also placing the children under direct observation. To evaluate the package, 317 children from two schools in Lipis, Pahang were screened for STH infections, treated by a 3-day course of albendazole and then followed up over the next 6 months. The knowledge of teachers, parents and children towards STH infections were assessed at baseline and after 3 months.

Results: The developed package consists of a half day workshop for teachers, a teacher's guide book to STH infections, posters, a comic book, a music video, a puppet show, drawing activities and an aid kit. The package was well-received with effective contributions being made by teachers, children and their parents. The incidence rates of hookworm infection at different assessment points were significantly lower among children in the intervention school compared to those in the control school. Similarly, the intensity of trichuriasis, ascariasis and hookworm infections were found to be significantly lower among children in the HELP group compared to those in the control group (P < 0.05). Moreover, the package significantly improved the knowledge, attitude and practices (KAP) of Orang Asli people and the knowledge of teachers towards STH infections.

Conclusion: A school-based health education learning package (HELP) was developed which displayed a significant impact in terms of reducing the intensity of all three main STH infections, as well as in reducing the prevalence of hookworm infections. Moreover, the knowledge levels of both teachers and the Orang Asli population regarding STH was significantly improved, a fact which greatly helped in attracting community participation and thus raising the general level of awareness regarding these forms of infections.

Figure 1

A geographic map showing Pahang state and the locations of the selected schools and villages in Lipis district.

Figure 2

Flow chart of the study’s activities and follow up.

Figure 3

Prevalence and incidence of STH infections among the intervention and control groups. A: Trichuriasis. B: Ascariasis. C: Hookworm infection. *Significant difference (P < 0.05).

Figure 4

Intensity of STH infections among the intervention and control groups. A: Trichuriasis. B: Ascariasis. C: Hookworm infection. Significant difference (*P < 0.05; † P < 0.01; ‡ P < 0.001).

Figure 5

New houses provided to Orang Asli people in some areas. A: A new house and an old house in the study area. B: Toilets in the new houses are used as store rooms. C: A toilet after the introduction of HELP.

Figure 6

Examples of drawing assessments for children at baseline and after 3 months. A: Control school. B: Intervention school; 1: Baseline. 2: After 3 months.