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

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 Diane Santos; Thea Andrea Bravo; Franziska Angly Bieri; Andrew Bedford; Yuesheng Li; Archie C A Clements; Peter Steinmann; Kate Halton; Donald E Stewart; Donald P McManus; Darren J Gray

doi:10.1016/j.lanwpc.2021.100312

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

Lancet Reg Health West Pac. 2021 Nov 3:18:100312. doi: 10.1016/j.lanwpc.2021.100312. eCollection 2022 Jan.

Authors

Mary Lorraine S Mationg^{1

2}, Gail M Williams³, Veronica L Tallo², Remigio M Olveda², Eindra Aung^{1

4}, Portia Alday², Mark Donald Reñosa², Chona Mae Daga², Jhoys Landicho², Maria Paz Demonteverde², Eunice Diane Santos², Thea Andrea Bravo², Franziska Angly Bieri¹, Andrew Bedford¹, Yuesheng Li^{5

6}, Archie C A Clements⁷, Peter Steinmann^{8

9}, Kate Halton¹⁰, Donald E Stewart^{1

11}, Donald P McManus⁵, Darren J Gray¹

Affiliations

¹ Research School of Population Heath, The Australian National University, Canberra, Australia.
² Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines.
³ School of Public Health, University of Queensland, Brisbane, Australia.
⁴ St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
⁵ Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
⁶ Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, China.
⁷ Faculty of Health Sciences, Curtin University, Perth, Australia.
⁸ Swiss Tropical and Public Health Institute, Basel, Switzerland.
⁹ University of Basel, Basel, Switzerland.
¹⁰ School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
¹¹ School of Medicine, Griffith University, Brisbane, Australia.

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.