Health education to school children in Okpatu, Nigeria: impact on onchocerciasisÐrelated knowledge EN Shu 1 *, PO Okonkwo 1 and EO Onwujekwe 1 1 Health Policy Research Unit, Department of Pharmacology and Therapeutics, College of Medicine, Enugu Campus, University of Nigeria, PMB 01129 Enugu, Nigeria We assessed the in¯uence of health education on the knowledge about onchocerciasis in school children in Okpatu, Nigeria. The children, aged between 11 and 17y, received health education in both English and Igbo (local language) for three months on the transmission, clinical manifestations, treatment and prevention of onchocerciasis. Illustrated pictorial materials were used to support and enhance their understanding of the subject matter. Their level of knowledge was evaluated nine months later using a pre-tested personal interview administered questionnaire. A signi®cantly higher proportion of these children knew about onchocerciasis (w 2  260.4,df  1, P < 0.0001), and its causative agent (w 2  175.0,df  4, P < 0.0001), clinical manifestations (w 2  254.0,df  5, P < 0.0001), diagnosis (w 2  123.9,df  2, P < 0.0001), treatment (w 2  197.8,df  3, P < 0.0001) and prevention (w 2  220.8, df  3, P < 0.0001) in the post- than in the pre-educational intervention. It is therefore concluded that school-based health education showed an increase in knowledge about onchocerciasis and school children could provide a useful `multiplier' resource for health education in the community. Keywords: health education; school children; knowledge; onchocerciasis Introduction Onchocerciasis (river blindness) is a ®larial disease of man caused by Onchocerca volvulus, and transmitted by the bites of Simulium (black¯y). The adult female worm lives onaverage10±11yinahumanhost,producingmillionsof embryos (micro®lariae). These micro®lariae invade the tissues of the body, particularly the skin and eyes. Tissue reaction to the death of micro®lariae results in eye lesions of the anterior and posterior segments, which if left untreated progresses to serious visual impairment and ultimately to blindness. 1 Skin lesions and various grades of dermatitis are often accompanied by intense itching. There is evidence that the disease is an important risk factor for epilepsy and hyposexual dwar®sm in some areas, 2 and has detrimental effects on marriage age and breast feeding. 3 Onchocerciasis therefore constitutes a serious public health problem in much of tropical Africa and parts of Central and South America and Yemen. 2 In Africa, it is endemic from Senegal in the West to Uganda and Ethiopia in the East and as far South as Zambia. Since there are plans to exclude onchocerciasis as a public health problem beyond the end of the next decade, two main control programmes are actively involved in Africa: (1) the Onchocerciasis Control Programme in West Africa (OCP) which is based on controlling the vector and interrupting the transmission cycle of the disease (for 14y, which is longer than the life span of the adult worm); and (2) the African Programme for Onchocerciasis Control (APOC) which is based on treatment with ivermectin and aims to establish, within a period of 12y, effective and self- sustainable community-based ivermectin treatment throughout the endemic areas covered by the programme and to eliminate the disease by vector control in selected foci. Ivermectin, a potent new anthelmintic that has proven to be effective and well tolerated, has shown considerable promise in the treatment of onchocerciasis. 4,5 The drug is fully effective in single oral doses 6 and has less severe side- effects. 7,8 In Nigeria, the government and non-governmen- tal organizations (NGOs) ®nance the mass distribution of ivermectin through `vertical' delivery teams. Although ivermectin has revolutionized the treatment of onchocerciasis, 9 the rural populace is still ill-informed of the cause and transmission, treatment, effects and pre- ventive measures of the disease. Considering this, WHO 1 therefore selected the radio as a medium of health communication in Africa simply because it can rapidly create awareness, reach a wider audience, overcome literacy problems and be more cost effective. Nevertheless, developing these radio programmes in participation with community members may enhance comprehension and encourage the community to take appropriate health-related actions. However, the potential of local media and television drama is restricted by the possibly limited exposure of audiences to them and other elements of drama (plot, character, actions) distract the audiences. It means that those for whom health programmes are most relevant (the rural, low-income families), are least likely to be reached. Even though some of these health education messages are normally targeted at issues of relevance for adolescents, those that may appropriately be directed at all age groups and both sexes such as malaria and onchocerciasis deliberately exclude some segments of the population, the school children. This therefore emphasizes the need for locality speci®city in designing health programmes, since there is considerable heterogeneity in the age and sex distribution, and therefore health priorities. The suspicion in Nigeria is that school children in some communities have rather poor perception of their health status and that of their communities. The situation in other countries is different, reports in Ghana and Tanzania show that school children are knowledgeable in predicting *Correspondence: Dr EN Shu. Accepted 13 January 1999 Public Health (1999) 113, 215±218 ß R.I.P.H.H. 1999 http://www.stockton-press.co.uk/ph