Move over Chutes & Ladders: Schisto & Ladders has educational value plus worms

Chutes & Ladders has been a beloved board sport within the U.S. because the Forties — tailored from an historic Indian sport that aimed to show ethical classes.

Youngsters in Nigeria are actually enjoying a model referred to as “Schisto & Ladders.” It too goals to show — about how one can forestall a illness referred to as schistosomiasis. It is a parasitic

an infection attributable to a worm that infects people by way of pores and skin contact with infested waters.

An unfortunate participant may land on a sq. that claims “enjoying in a river” That places you in danger for this tropical illness — and sends your sport token down a worm as a substitute of a chute.

Nigerian researcher and educator Cynthia Umunnakwe is likely one of the builders of the sport — it is a part of an arsenal of artistic approaches to averting the sickness. Recognized regionally at “Atosi Aja” or Bloody Urine, the illness not solely causes blood within the urine however has different short-term signs reminiscent of fever and rash. If untreated, it will probably trigger main organ and neurological injury, infertility and even bladder most cancers. In Nigeria, it’s related to increased charges of bladder most cancers in younger individuals.

Often known as a Uncared for Tropical Illness due to the dearth of funding to combat it, schistosomiasis is a critical problem for impoverished communities. There are over 200 million circumstances throughout sub-Saharan Africa. Faculty age youngsters are on the best danger of an infection as a result of they prefer to play within the water and their immune programs aren’t totally developed.

Although efficient medicine exists, the difficulty is persistent in areas with a scarcity of easy accessibility to testing, therapy and clear water so individuals do not depend on native our bodies of water for consuming and bathing. Consciousness of its transmission can be a problem. Touching infested water, even only a splash, can danger an infection, as microscopic larvae swimming alongside the floor are capable of wriggle by means of pores and skin.

Uh oh, a worm!

The sport, created in 2014 by a group led by Professor of Parasitology Uwem Ekpo of Akwa Ibom State College, follows the basic sample: Roll a cube to advance up a winding path to the highest of the colourful board. A participant might land on a sq. that sends them up a ladder or sliding down a Schisto worm (which takes the place of the standard chute). An instance of a optimistic sq. is “eat earlier than taking drugs” – the correct factor to do for somebody who’s contaminated and sends the participant up a ladder to maneuver forward within the sport.

They trademarked their identify.

One other sq. with unfavourable penalties says  “Blood in Urine” however the neighboring sq. provides the participant a path to redemption: “go to the well being heart” with a drawing of a smiling well being employee.

“Youngsters go up the ladder after they encounter an excellent conduct [in the game] that will forestall schistosomiasis,” Cynthia Umunnakwe says. These embrace “Take praziquantel at college” and “Slicing vegetation round a river” – eradicating invasive vegetation that provide supreme circumstances for proliferation of the intermediate snail hosts, which carry the parasite.

The sport additionally highlights key steps of transmission.

The “Fetching water from a stream” sq. confirmed a toddler stooped on the river’s edge. A schistosome worm stretched from this sq. down the board to the complication of the sickness, depicted in one other sq. studying “Swollen stomach”; whereas “Defecating close to a river,” brings the participant’s piece far down the board, touchdown on a sq. studying “Spreading an infection.” These characterize two probabilities to interrupt the parasite’s life cycle: Avoiding an infection of people on the larval stage by way of water contact and discouraging propagation of the parasite into river water by way of human waste, the place eggs in waste can then reinfect snails.

Taking part in the sport

On a go to to a schoolhouse in Apojola village in July 2025, Cynthia Umunnakwe taught younger youngsters to play “Schisto & Ladders” — a part of a Ministry of Well being program that additionally offered urine testing and therapy for these affected.

And it is not only a sport. On this a part of Ogun State, a 3rd of residents screened at a urine testing clinic had been discovered to have lively schistosomiasis an infection. The illness is frequent in these rural fishing villages the place residents depend on freshwater for every day residing. Tthe Oyan River is used for the important every day duties of washing garments, fishing and cleansing and making ready cassava root, the principle crop. The shallow river’s edge can be a playground for schoolchildren, who splash round for enjoyable — and in addition are instructed by their dad and mom to test fish traps.

“Hello everybody, I’m Dr. Cynthia from Nigeria.” she says with a smile – she holds a Ph.D in parasitology – and provides a wave. She supervises the pushing of tables and benches into clusters within the classroom, after which the sport begins.

Umunnakwe additionally introduced in dwell snails — acquainted to the children who play within the river — so they may acknowledge the host for the parasite that infects people, resulting in this sickness. They had been collected by her colleague, Dr. Olubukola Adelakun. a veterinary public well being researcher and post-doctoral scholar at Federal College of Agriculture in Abeokuta who researches the habitat of those snails. She had waded waist-deep within the river water the day earlier than, clad in waterproof waders to guard from an infection. She had scrubbed their shells clear for simple identification, as there are lots of comparable freshwater snails within the space, although none of them had the attribute shell shapes of the parasite-carrying snails.

The day’s actions included medical assist as effectively. In a neighboring schoolhouse, Ministry of Well being employees supplied all youngsters the oral drug praziquantel, which may each forestall and deal with the illness. They obtained free snacks for collaborating, since consuming earlier than therapy can assist ease abdomen ache that always happens if the drug is taken on an empty abdomen.

The group’s physician administered therapy doses in accordance with peak, with a standardized measuring tape towards the wall to assist decide the dose.

In earlier years, Cynthia Umunnakwe had performed analysis demonstrating the sport’s affect, printed in Worldwide Well being. In a six-month examine involving 275 college students throughout six colleges in rural Ogun State — colleges the place praziquantel had beforehand been rejected due to false rumors that it triggered fainting and even demise — not a single little one within the examine group had heard of the drug earlier than enjoying the sport. The sport was performed in every faculty at some point of the trial, and the group surveyed youngsters earlier than and after the trial, performed focus group discussions with college students, dad and mom, and caregivers. By the tip of the trial, greater than two-thirds of the scholars knew what the drug was and understood it was secure, and 65% put their names down, with parental permission, to obtain therapy.

“So we hope that by enjoying this sport that the schoolchildren will truly translate the information acquired into altering their behaviors,” Umunnakwe mentioned,

And never solely that, the youngsters have enjoyable.

“Hey, wò ó, mo wà lókè!” mentioned a boy who gained the sport by reaching the ultimate “Schisto-free little one” sq.: “Hey look, I am on high!”

William McCarthy is a medical scholar at McGovern Medical Faculty and a researcher and author dedicated to international little one well being problem-solving. His analysis consists of environmental well being and international well being diagnostics innovation. Presently, he research schistosomiasis with the Prakash Lab at Stanford Bioengineering, the place he works on community-led approaches to infectious illness management. He is CEO and co-founder of the student-led nonprofit group Well being In Your Fingers Diagnostics.