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SCHISTO DERE LAKSI: A community-wide schistosomal rash education initiative for early detection in endemic Philippine province using a film and comic book

Lead Dermatologist: Dr. Mirla Celina TAIRA
Project team members: Sandra Sabate DALA, Dr. Rodel DELGADO, Dr. Marlyn UMIL, Rowie ROMUAR, Divina Gracia SALAS
Affiliation: Dionisio Cornel Medical Center, Inc., Antipolo City, the Philippines

 

SCHISTO DERE LAKSI

 

An entertaining and ‘mass appeal’ approach, utilizing a film and comic book to educate the community of Eastern Samar in the Philippines on the early recognition of Schistosomiasis

Executive summary

Schistosomiasis control has been unsuccessful in Eastern Samar, the Philippines where this Neglected Tropical Disease continues to be endemic. Ongoing government programs are treatment­aimed, lacking towards prevention and total eradication.

This project will teach the whole community: healthcare professionals, teachers, parents, and school children, of the early recognition of Schistosomiasis, leading to early management. The aim of the project is avoidance of chronic morbidity and late­stage sequelae of Schistosomiasis, prevalent in three rural towns of the province. A film and a comic book, because of their mass appeal, shall be used in workshops to educate the community.

The challenge

In the second poorest province of the Philippines, three adjacent northern towns of Eastern Samar have the highest recorded cases of Schistosomiasis.

Current government programs are ongoing to identify and treat active and suspected cases, however re­infection is still high due to: continuous use of infested natural bodies of freshwater for drinking, bathing, and washing; lack of toilet facilities; and poor sanitation, which are all due to severe poverty.

The majority of patients seek medical help only when they experience chronic and late-stage symptoms, usually during teen and adult years. Knowing that these symptoms manifest 10­15 years after cercarial penetration on the skin, it is imperative to educate children when primary infection may have happened. Initial manifestation of Schistosomiasis is cutaneous (may present as pruritic erythematous dermatitis, urticarial or maculopapular eruption) beginning within minutes to a few hours after cercarial entry, and may persist for 1­2 weeks. However, in this province, communities and even health workers are unaware of the presence of this rash. Thus, it is necessary to teach the whole community, with special focus on children, about recognition of this rash; not to dismiss it, but to report to the health center for early treatment and monitoring. The final aim is reduction of morbidity and prevalence of this disease.

Prevention programs have failed due to the residents’ dependence on infested freshwater for daily use. Thus, the need is to focus on education for early detection; hoping to prevent progression to chronicity and late­stage sequelae of this disease.

Project overview

This project consists of five stages:

STAGE 1: PREPARATION

Two weeks after the grant is received, the project team shall meet to discuss the preparation, implementation, and evaluation of the project in the three municipalities: Oras, Dolores and Can­avid, as project sites.
Preparation and production of a film and a comic book in the local dialect showing the lifecycle of the Schistosome fluke, pathogenesis, skin manifestations, signs and symptoms, chronic and late-stage sequelae, and treatment, shall be initiated and is expected to take three months. The contents will be studied and supplied by the Dermatologist; but the situational film will be designed and produced by a film crew; and the comic book entitled “Schisto Dere Laksi (Schisto Not a Joke) will be designed by a graphic artist. Both will be directed toward the mass audience. These will help participants understand and remember important concepts about the disease, especially recognition of cutaneous manifestations. The Film shall be shown to various groups in the communities during the Workshops, and the Comic Book distributed to each participant.
Preparation of evaluation questionnaires shall be prepared by the Training Specialist.
Four months after the grant is awarded, the Dermatologist with members of the Project Team shall conduct two Pilot Workshops – one for healthcare professionals, parents, and teachers; and another for schoolchildren. Feedback from these Pilot Workshops shall be used to improve the design and implementation of the actual Workshops.

STAGE 2: WORKSHOP 1

A month after the Pilot Workshops, Workshop 1 shall be conducted for various target groups in the project communities – Healthcare Professionals, Teachers, Parents, and Students in Public Schools. The Workshop shall consist of a lecture by the Dermatologist on Schistosomiasis emphasizing the characteristic Cutaneous Rash, its appearance, and importance of recognition. The Film will be shown, and the Comic Book distributed to each participant. After each workshop, an evaluation using a written questionnaire shall be completed to gain feedback from the participants. The Dermatologist will be in constant coordination with healthcare professionals and provincial project coordinators to monitor progress in the implementation of the project.

STAGE 3: WORKSHOP 2

Two months after Workshop 1, a follow­up Workshop shall be conducted in the target groups. The Film will be re­shown, and the Comic Book distributed when needed. The rationale is, repetition deepens learning and reinforces application. Questions and concerns encountered in experiences shall be addressed.

STAGE 4: EVALUATION OF THE PROJECT

Three months after Workshop 2, conferences in participation with the Project Team, Provincial Coordinators and Healthcare Professionals shall be held to conduct an evaluation of the project. Data gathered in the meetings shall be used in monitoring the practice of the healthcare professionals in prevention, early detection, and management of Schistosomiasis.

STAGE 5: MONITORING

The Project Team shall continue coordinating with the Provincial Health Office to monitor implementation and long­term results of this project by checking the annual provincial report. The Dermatologist commits to address ongoing concerns related to the project.

Success criteria and evaluation

The project shall be evaluated based on the following success factors and expected outcomes:

  • Increase in referral of cases made by teachers, parents, and students using baseline data before, during and after the Project, based on medical records in the Rural Health Center
  • Increase in consultation/visits by patients at the Rural Health Center
  • High level of accuracy in detecting early skin manifestations by healthcare professionals based on the result of self­assessment
  • High percent attendance of the participants in workshops and meetings
  • Decreasing incidence of Schistosomiasis in the communities for five years

Benefits to the community shall be felt when early detection by members of the community is practiced through increase in referrals and consults to the Rural Health Centers. Consequently, precise diagnosis and proper management are afforded to the patient which arrests progress of the disease. Thus, this prevents suffering and saves the patient unnecessary medical expenses resulting in a healthy community.

The aforementioned benefits to the community can be tracked through health statistics data in the Health Center, identified by less cases of Schistosomiasis as patients are referred and treated early.

The design of this project is sustainable and can be duplicated in other provinces in the Philippines since resource persons, such as Dermatologists, members of the Project Team, and trained Healthcare Professionals, are available to share their expertise in other areas when needed. The materials such as the Film, Comic Books, and Evaluation Instruments may be readily reproduced.