Open Access Highly Accessed Open Badges Research

School-based participatory health education for malaria control in Ghana: engaging children as health messengers

Irene Ayi1, Daisuke Nonaka23, Josiah K Adjovu4, Shigeki Hanafusa5, Masamine Jimba2, Kwabena M Bosompem1, Tetsuya Mizoue3, Tsutomu Takeuchi6, Daniel A Boakye1 and Jun Kobayashi5*

Author Affiliations

1 West African Centre for International Parasite Control, Parasitology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana

2 Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan

3 Department of Epidemiology and International Health, International Clinical Research Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, Japan

4 Zoology Department, University of Ghana, Legon, Accra, Ghana

5 Bureau of International Medical Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, Japan

6 Department of Tropical Medicine and Parasitology, School of Medicine, Keio University, 35 Shinano-machi, Shinjuku, Tokyo, Japan

For all author emails, please log on.

Malaria Journal 2010, 9:98  doi:10.1186/1475-2875-9-98

Published: 18 April 2010



School children have been increasingly recognized as health messengers for malaria control. However, little evidence is available. The objective of this study was to determine the impact of school-based malaria education intervention on school children and community adults.


This study was conducted in the Dangme-East district of the Greater Accra Region, Ghana, between 2007 and 2008. Trained schoolteachers designed participatory health education activities and led school children to disseminate messages related to malaria control to their communities. Three schools and their respective communities were chosen for the study and assigned to an intervention group (one school) and a control group (two schools). Questionnaire-based interviews and parasitological surveys were conducted before and after the intervention, with the intervention group (105 children, 250 community adults) and the control group (81 children, 133 community adults). Chi-square and Fisher's Exact tests were used to analyse differences in knowledge, practices, and parasite prevalence between pre- and post-intervention.


After the intervention, the misperception that malaria has multiple causes was significantly improved, both among children and community adults. Moreover, the community adults who treated a bed net with insecticide in the past six months, increased from 21.5% to 50.0% (p < 0.001). Parasite prevalence in school children decreased from 30.9% to 10.3% (p = 0.003). These positive changes were observed only in the intervention group.


This study suggests that the participatory health education intervention contributed to the decreased malaria prevalence among children. It had a positive impact not only on school children, but also on community adults, through the improvement of knowledge and practices. This strategy can be applied as a complementary approach to existing malaria control strategies in West African countries where school health management systems have been strengthened.