Acting Against Worms Evaluation Report

Publication Date
June 1, 2011

Schistosomiasis Control Initiative (SCI)

This 90-page report, published by Theatrescience, shares findings of an evaluation of Acting Against Worms (AAW), a drama-based initiative designed to improve understanding and public engagement with health messages related to preventing and controlling schistosomiasis and intestinal worms amongst rural communities in Uganda. AAW, a collaboration between the Schistosomiasis Control Initiative (SCI), the Ugandan Ministry of Health, and Theatrescience, was carried out in Busia district in Eastern Uganda, which is endemic for schistosomiasis and intestinal worms. According to the report, little difference was found between baseline and final evaluation in terms of knowledge and awareness, but more young people identified school as a source for information about schistosomiasis. The study suggests that greater attention must be paid to resource and behavioural challenges preventing turning knowledge into action.

The study was carried out in 18 schools and their neighbouring communities in Busia district. In the control arm, schoolchildren aged 10-15 years received the standard health education through the national programme, which is through teachers, leaflets, and comics where available. Knowledge, attitudes, and practices (KAP) towards the prevention and treatment of schistosomiasis were measured in schoolchildren using structured KAP questionnaire interviews and in the communities using focus group discussions (FGDs). The participants were information-rich people who were identified from each village by the local leaders.

According to the report, the baseline awareness of schistosomiasis was high (93.1% versus 94.2%), and there was no increase in pupils' awareness in the arm that had received the drama intervention compared to those who had not. When asked how they had heard about schistosomiasis, pupils responded with multiple answers, with the majority having heard from teachers and family members. At baseline, there was a higher proportion of those in the intervention arm who heard from teachers. Following the drama intervention, there was a significantly higher number of pupils in the intervention arm that had heard about schistosomiasis through a school announcement than in the control arm.

Post-intervention, there was no significant difference between the intervention and control pupils' responses to whether they had ever suffered from schistosomiasis. However, those reporting that they had suffered had decreased in both groups between baseline and follow-up. Knowledge on how you get infected with schistosomiasis was higher in the pupils who received the drama intervention at follow-up; however, the same was true at baseline. There was less of an understanding about how schistosomiasis is actually transmitted at baseline (64.4% intervention versus 37.6% control), with many students in both arms giving incorrect answers such as drinking contaminated water, eating dirty or raw food, and sharing utensils. There was no statistical increase in this understanding in the intervention pupils at follow-up. That said, further analysis showed that there was an overall increase in knowledge of transmission in both arms at follow-up.

The majority of the responses from the FGD participants in both the intervention and control groups, were similar. However, the FGDs pointed to some considerations for future work. The FGDs in both intervention and control arms identified that some people don't go for treatment because they fear the side-effects, such as diarrhoea and dizziness, as the drugs are strong; also, some fear the size and the smell of the pills, or worry the drugs will make them impotent. Others may think it is too far to travel to get the treatment during mass treatment campaigns. Areas that the participants required more knowledge on were how schistosomiasis infects, how it is spread, and how long it takes to cure after treatment.

Overall, the KAP survey revealed that there was little difference between the intervention and control arms at follow-up where an increased change would be expected in the intervention arm. However, a significant increase was seen in the proportion of students who heard about schistosomiasis through their teachers, and an impact on knowledge of how one becomes infected with schistosomiasis were both seen in the intervention group at follow-up. Additionally, although there was no difference between the two arms at follow-up, there was a significant increase in the correct answers given at follow-up than at baseline for how schistosomiasis is transmitted from person to person. These differences are interpreted as being a result of the drama intervention.

The researchers found that preconceptions relating to the pupils' level of understanding of schistosomiasis and its prevention were actually quite different than the reality. Early on in the project, it became apparent that the general knowledge of prevention and treatment was very high. However, there were a number of social, economic, and behavioural issues, which prevented this knowledge from being translated into practice. The focus of the project then shifted from educating about the disease to disseminating messages about how to actively change behaviour.

According to the report, the evaluation results show some supporting evidence that the Acting Against Worms project had an impact on the knowledge, attitudes, and practices in the schoolchildren to whom the drama was rolled out. Those directly involved in the drama project acknowledged that the initiative benefited not only themselves but their wider community by engaging the pupils and teachers in researching the biomedical and local understandings of schistosomiasis infections for developing their plays and involving a community audience. The youth are important "agents of change", and, by involving them in such educational projects, it not only empowers them but also increases their life skills for the future. In addition, drama is perceived as an effective communication and education tool in rural communities and thus should be used by schools and communities to spread messages about schistosomiasis prevention and treatment in endemic communities.


Theatrescience website on December 18 2011.