"The Magic Glasses Philippines": a cluster randomised controlled trial of a health education package for the prevention of intestinal worm infections in schoolchildren

Abstract

Background: Soil-transmitted helminths (STH) cause substantial disease and disability globally. Health education has proven complementary to school-based drug administration programs for STH control. We determined the generalizability of the impact of "The Magic Glasses" health education package for STH prevention in schoolchildren in Laguna province, the Philippines, having previously shown its positive impact in China.

Methods: We conducted a cluster-randomised controlled trial, in schoolchildren, aged 9-10 years, across 40 schools over one year. Schools were randomly assigned either to the "Magic Glasses Philippines" health education intervention package (consisting of a cartoon video, classroom discussions, drawing and essay competition) complementing the standard health education activities of the Philippines Departments of Health and Education, or to a control group, which involved only the standard health education activities. The primary trial outcomes were the proportion of STH infected schoolchildren and their knowledge, attitude and behaviour of STH assessed in both groups at baseline and through two follow-up surveys undertaken immediately prior to the semi-annual national mass administration of albendazole. The outcomes between the study arms were compared using generalized estimating equation models, accounting for clustering at the school level. The trial is registered with Australian New Zealand Clinical Trials Registry number: ACTRN12616000508471.

Findings: At follow-up assessments, the mean knowledge and behaviour scores in the intervention group were, respectively, 5·3 (95% confidence interval [CI]:4·2-6·5; p=<0.001) and 1·1 (95% CI: 0·4-1·7; p=0.002) percentage points higher than the control group. There was no overall effect on helminth infections (any STH; adjusted odds ratio [aOR]:1·0; 95% CI: 0·8-1·3; p=0·856), Ascaris lumbricoides; aOR:1·0; 95% CI: 0·7-1·6; p=0·894, or Trichuris trichiura; aOR:1·7; 95% CI: 0·9-1·6; p=0·315) but sub-group analysis showed a 60% reduction in the odds of any STH infection resulting from the "Magic Glasses" intervention in schools with a baseline prevalence ≤15% (aOR: 0·4; 95% CI: 0·2-0·7; p=0·001).

Interpretation: The health-education package demonstrated a modest but statistically significant impact on the students' overall STH knowledge and changes in their behaviour but was only effective in preventing STH infections in intervention schools where the baseline prevalence was ≤15%.

Funding: National Health and Medical Research Council, Australia, and the UBS-Optimus Foundation, Switzerland.

Keywords: Magic Glasses Philippines; Soil-transmitted helminths; integrated control; randomised controlled trial; school-based health education intervention.

Figure 1

Trial profile. Flow diagram showing the trial study design and timeline of activities including baseline, follow-up surveys and intervention delivery, and Knowledge, Attitude and Practice (KAP), and parasitologic surveys among schoolchildren in Laguna Province, the Philippines. The figure was adapted from Mationg MLS, Williams GM, Tallo VL, Olveda RM, Aung E, Alday P, Reñosa MD, Daga CM, Landicho J, Demonteverde MP, Santos ED, Bravo TA, Angly Bieri FA, Li Y, Clements ACA, Steinmann P, Halton K, Stewart DE, McManus DP, Gray DJ. Determining the Impact of a School-Based Health Education Package for Prevention of Intestinal Worm Infections in the Philippines: Protocol for a Cluster Randomized Intervention Trial JMIR Res Protoc 2020;9(6):e18419. doi: 10.2196/18419 https://www.researchprotocols.org/2020/6/e18419/; copyright ©Mary Lorraine S Mationg, Gail M Williams, Veronica L Tallo, Remigio M Olveda, Eindra Aung, Portia Alday, Mark Donald Reñosa, Chona Mae Daga, Jhoys Landicho, Maria Paz Demonteverde, Eunice Dianne Santos, Thea Andrea Bravo, Franziska A Angly Bieri, Yuesheng Li, Archie C A Clements, Peter Steinmann, Kate Halton, Donald E Stewart, Donald P McManus, Darren J Gray. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.06.2020. This was published and can be reproduced under the terms of Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/).

Figure 2

Trial recruitment, follow-up, and retention of study participants.A spatial sampling frame was used for randomization: schools were randomly selected from the list of schools within three kilometres radius of each other. Twenty schools were randomly assigned to the intervention group and another twenty schools were randomly assigned to the control group. A total of 3,366 students were enrolled in the study, of whom 2,138 with matching stool results and KAP (knowledge, attitudes, and practices) data at baseline were included as a fixed cohort for follow-up over the course of the trial. During the whole study period, 118 students were lost to follow-up, while the number of students who were transferred to other schools from the control and intervention groups were 60 and 56, respectively. Two students in the intervention group were reported deceased during the first follow-up survey.