Impact of a video-based health education intervention on soil-transmitted helminth infections in Chinese schoolchildren.

Worldwide, more than 2 billion people are infected with soil-transmitted helminths (STH), commonly known as intestinal worms. The STH are a group of parasitic nematodes which include roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura) and hookworms (Necator americanus and Ancylostoma duodenale). Diseases caused by the STH belong to the group of Neglected Tropical Diseases, comprising 17 infections currently targeted for prevention and research by the World Health Organization, the United Nations Development Program and the World Bank. STH are intimately connected with rural poverty, inadequate sanitation and waste disposal, lack of clean water and poor hygiene, as well as limited access to health care and preventive measures such as health education. Even though STH rarely cause death, they impact significantly on public health and cause severe disability in the world’s poorest countries. The worldwide burden of STH has been estimated to be as high as 39 million disability-adjusted life years (DALYs), with almost half of the global disease burden due to these worm infections afflicting children aged 5-14 years. Nevertheless, STH remain largely neglected by the medical and international community. In China, STH still impact substantially on public health with an estimated 129 million infected people and children aged 5-14 years having the highest rates of infection. Major endemic foci are observed in the central, western and southern provinces.

To date, mass drug administration (MDA), aimed at treating morbidity, has been the cornerstone of STH control and is promoted by the World Health Organization. However, longterm health benefits of mass drug administration are limited due to rapid reinfection and there is growing concern about the development of parasite resistance to albendazole and other anti-STH drugs as a result of continued treatment pressure. Therefore, interventions that prevent STH reinfection, such as improvements in hygiene achieved through health education, are required to augment chemotherapy as part of an integrated approach, whereby chemotherapy reduces morbidity and prevalence, and preventive interventions (e.g. health education) prevent reinfection, thus reducing incidence. This will limit the number of treatment cycles required for effective control and subsequently reduce the treatment pressure, as well as creating a more sustainable long-term approach to control.

The major objective of the thesis was to determine whether a video-based education package, targeting STH prevention at school widens the students' knowledge and changes their behaviour, resulting in fewer STH infections. Further, we systematically reviewed school-based video interventions targeting infectious diseases and formulated informed guidelines for the evaluation of future video-based studies within the school setting.