**Schistosomiasis Training in Health Education Using the Inquiry-Based Learning Method as a Co-Construction Tool with the Communities for Implementing the One Health Paradigm**

**Gabriel Mouahid and Hélène Moné** IHPE, Univ Perpignan Via Domitia, CNRS, IFREMER, Univ Montpellier, Perpignan, France

Schistosomiasis is a chronic parasitic disease that affects humans with low social and economic status. It is widely present in Africa, Central America, Asia, the Middle East, and South Europe, causing health damage mainly to schoolchildren. It is due to a flatworm named Schistosome belonging to the genus Schistosoma and infecting domestic and wild animals. The life cycle includes two hosts: a homeothermic vertebrate where male and female worms reproduce sexually in the venous vessels, and a freshwater snail where an asexual multiplication occurs. Transmission between the two hosts is due to free-swimming larvae. Schistosomiasis control requires an integrated approach, including health education, which is part of the One Health paradigm. The training was conducted in South Benin with teachers in the sites where schoolchildren were largely infected. The training was based on the inquiry-based learning method. Trainees were faced with an educational situation for which they had to identify the main problem and express it with a question and implement an experimental protocol to answer the question. The trainees were confronted with different urine samples that showed different colors ranging from yellow to blood-red. All samples were collected from the schools where they teach. They were surprised by the high prevalence. Most of them identified the red color of the urine as the main scientific problem to study. They carried out the study and identified the parasite inside the eggs in the urine; they hatched the larvae of the parasite using freshwater and made observations under a microscope. The trainees were uncomfortable during the first day with the inquirybased method and with the organization of the classroom, where they were no longer in front of the teacher but in front of themselves in several groups. The training program has been constructed in such a way that teachers can use it with their schoolchildren with minimal changes. The different parts of the parasite lifecycle have been studied, and the ecosystem factors that enhance the transmission of schistosomes and their role in the control of the disease have been discussed.

#### Conclusions

The training program was constructed in such a way that teachers can use it with their schoolchildren (8 to 12 years old) with minimal changes. The different parts of the parasitic life cycle were investigated and the ecosystem factors that enhance the transmission of schistosomes and their role in the control of the disease were discussed.

### Introduction

Schistosomiasis is a chronic parasitic disease which affects humans with low social and economic status. It is widely present in Africa, Central America, Asia, the Middle East and the south of Europe, mainly causing health damage in schoolchildren. It is caused by a flatworm belonging to the genus Schistosoma infecting domestic and wild animals. The life cycle includes two hosts: a homeothermic vertebrate, where male and female worms reproduce sexually in the venous vessels, and a freshwater snail in which an asexual multiplication occurs. Transmission between the two hosts is due to free-swimming larvae. Schistosomiasis control requires an integrated approach, including health education, which is part of the One Health paradigm.

### Materials for Training

Training was conducted in South Benin with schoolteachers and their supervisors at sites where schoolchildren were becoming infected. The biological material was collected at the school after an information phase with the schoolchildren. The urine samples were immediately transferred to the training classroom.

Authors

Gabriel Mouahid and Hélène Moné

IHPE, Univ Perpignan Via Domitia, CNRS, IFREMER, Univ Montpellier, Perpignan, France

#### Training Steps

The trainees were put into groups of four or five. They communicated, shared their ideas and discussed within their group. Whenever necessary, synthesis times were used for intergroup sharing. Each group was given urine samples showing different colors (from yellow to red) and asked to: A. identify the main problem and express it with the question; B. state a testable hypothesis based on their knowledge; and C. build an inquiry method (experimentation) to test the hypothesis. Some groups proposed examining the urine using a microscope; D. The trainees identified abnormal particles within the urine; a precise examination showed that these particles were similar to eggs. A high magnification showed that the eggs contained moving larvae. This was one of the most important points of the training: the trainees realized for the first time that children were infected by a parasite that lays eggs inside the bladder that pass out with the urine. Then, a new question arose: what happens to these larvae once the urine has been passed? The trainees were invited, as above, to state a new hypothesis and implement a new inquiry method (see Figure below). This procedure was used for each scientific question throughout the training period until all the steps of the parasite life cycle had been constructed.

Schistosomiasis Training in Health Education Using the Inquiry-Based Learning Method as a Co-Construction Tool with Communities for Implementing the One Health Paradigm

## **The Power of Community Participation for Improving the Health of Older Persons during COVID-19: The Case of Rwanda**

**Eli Mugabowishema**

Nsindagiza, Kigali, Rwanda

In Rwanda, people aged 60+ are the least infected, but most die of COVID-19. NSINDAGIZA conducted a COVID-19 rapid needs assessment (RNA) for older persons to build evidence, designed the response and advocacy strategy, and documented and used evidence to engage the government and other stakeholders. Trained volunteers randomly chose 248 people (177F and 71M) in Nyarugenge and Ruhango, interviewed individuals and focus groups, and data were treated by the expert of Helpage Int.


Designing the response and advocacy approach: Worked with older persons to analyze and interpret the findings, make decisions on the response priorities, and agree on an approach to engage the government. Delivery of the response and engagement: Distribution of PPEs, non-food items (NFIs), assistive devices, engagement in policy dialogue with government, and outcomes of these engagements. Through the RNA, we reached the most marginalized facing the impact of the lockdown. We engaged the older persons' structure to plan and provide PPEs, NFIs, and assistive devices, and through the lobby with the government and other key decision-makers, a successful result was achieved for the older persons.

Eli Mugabowishema

Nsindagiza, Kigali, Rwanda

#### **NSINDAGIZA** Organization **c;** 7**ageInternational**

#### Introduction

The first case of COVID-19 was reported in Rwanda on March 14, 2020. Older persons aged 70 years and above were the least infected but most likely to die of COVID-19.

#### Results


### Community Response to COVID-19

NSINDAGIZA conducted a COVID-19 rapid needs assessment (RNA) for older persons, to build evidence, designed the response and advocacy strategy, and documented and used evidence to engage government and other stakeholders.

#### RNA Methodology

Trained volunteers chose 246 people (177F and 71M) randomly in Nyarugenge and Ruhango, and interviewed individuals and focus groups. Data were examined by the expert from HelpAge International.

#### Designing the response and advocacy approach

Working with older persons to analyse and interpret the findings, making decisions on the response priorities, agreeing on approach to engage the government.

#### Delivery of the response and engagement

The distribution of PPE, non-food items (NFIs), assistive devices, engagement in policy dialogue with government and the outcomes of these engagements.

#### Conclusion

Through the RNA, we reached the most marginalised facing the impact of the lockdown. We engaged the older person's structure to plan and provide PPE, NFIs and assistive devices, and through lobbying the government and other key decision-makers this was achieved for older people.
