Games in Ghana: How a Little Fun Goes a Long Way in Disease Prevention Education
By Meredith Wright
In a small village in western Ghana, bright red balloons are passed hand to hand down two rows of students racing to win a prize. At the end, the balloons are popped to reveal facts about malaria. While the winners laugh and enjoy the game, which uses red balloons as a symbol of the red blood cells’ role in the malaria life cycle, recent student research shows that the real prize is an increased knowledge of preventing a deadly disease.
This past summer Mark Pavlyukovskyy ’13 of the Molecular Biology department traveled to Ghana on the Adel Mahmoud Global Health Scholarship in hopes of revolutionizing the way kids learn about malaria. Inspired by Jane McGonigal’s book Reality is Broken, which explores how games can impart social change, Pavlyukovskyy designed games which centered around teaching the basics of the malaria life cycle, how it is spread, and how it can be prevented. In results that are currently being reviewed by the Journal of Health Education Teaching, Pavlyukovskyy shows that for young students the games were in fact more effective than traditional teaching styles at imparting knowledge about malaria.
“I knew that the people who had gotten the scholarship had really cool projects and were trying to prototype some method for making change locally that would also make an impact in a broader way,” said Pavlyukovskyy. “I wanted to go to Africa and see if I could come up with a new way to introduce some small change that could be applied there.”
Pavlyukovskyy explained that he was interested in helping children, as many health problems in Africa disproportionally impact them. This is likely due to a lack of prevention education, poor hygiene, and the sheer number of children creating perfect conditions for the spread of disease. Children are also less likely to have built up immunity over time the way many adults have. Taken together, these factors lead to the World Health Organization’s estimate that one child in Africa dies every minute from malaria.
Adel Mahmoud, the Woodrow Wilson School and Molecular Biology professor for whom the scholarship is named, elaborated on the factors which make malaria so dangerous.
“It is not simply a mosquito biting an individual, it’s the behavior of the individual, the way the individual interacts with the environment…whether they have cognizance of the infection, whether they have cognizance of how people acquire it, whether they have cognizance how people can protect themselves against it,” said Mahmoud. “Consequently, if you really think of what will make a difference on a long term basis, it is a multi-factorial approach, something social and cultural. And that’s where Mark’s project fits.”
Before heading to Ghana, Mahmoud guided Pavlyukovskyy in the creation of a simple experimental design. Pavlyukovskyy then contacted the Ghana Health Education Initiative, which is based out of Humjibre, Ghana. The organization, whose mission is, “to enable communities in the BAB District of Ghana to improve their children’s health, learning success and opportunities by building local capacity and providing necessary resources and support,” helped facilitate the trip and provided translators. A friend of Pavlyukovskyy’s, Austin Elcano ‘15, also traveled to Ghana to help carry out the project.
The nuts and bolts involved testing traditional lecture-based curricula on malaria against an experimental curricula based on games. Pavlyukovskyy worked in a primary school and a secondary school (the American equivalents of elementary and middle schools, respectively), with a control and experimental classroom in each. A baseline measurement was given before and after the education period, assessing their knowledge of disease prevention and recording their own behavior—were the students washing their hands? Using mosquito nets? Dumping out still water?
Pavlyukovskyy made and taught the games, which consisted of activities ranging from bingo to the balloon race. These games were simpler than first planned, as Pavlyukovskyy found conditions in Ghana different than expected.
“Our curriculum initially was going to be very involved, having the kids getting in teams and going around knocking on doors engaging with their community,” said Pavlyukovskyy. “When we got there we realized that wasn’t going to be possible. It was a very small village, and the parents need help on the farms from the kids—they had maybe an hour after school.” The number of translators in each classroom also limited the intricacies of the games.
Additionally, towards the end of Pavlyukovskyy’s summer in Ghana, he came down with a virus which was never diagnosed by Ghanian healthcare providers or those in the U.S. International SOS advised Pavlyukovskyy to evacuate before the end of his research, leaving Elcano to take the reins.
“I actually spent a night in a Ghanaian hospital and I got a lot of antimalarial procedures done,” recalled Pavlyukovskyy. “It was really overcrowded, it’s crazy, you don’t want to go there.”
Elcano performed the final baseline test, which showed a significant increase in malaria knowledge and proper prevention behaviors in primary school students who were taught through games. This increase was not as strong for primary school students with conventional teaching methods. In secondary school students, both games and lecture-based teaching were equally effective.
“For both schools it seems that replacing or at least supplementing the curriculum would be more effective in knowledge transmission, because they are at least as effective as the standard curriculum,” said Pavyukovskyy.
The work, while fascinating, still needs refining before it can cause widespread change to education practices.
“One of the challenges is the short duration of Mark’s project,” said Mahmoud. “I think the most logical thing is to see whether we can persuade the organization Mark worked with or some of the Ghanaian authorities to repeat the study and use it in a couple of different areas and to collect more information about impact and sustainability of the impact.”
Pavlyukovskyy hopes he is able to return to this research in the future, specifically by repeating them in other settings.
“I am interested in potentially working with Jeremy Farrar, who heads the Oxford University Clinical Research Unit,” said Pavlyukovskyy. The OUCRU focuses its efforts primarily in Vietnam. “He has shown interest in this idea, and I will have to explore the details further of implementing the curriculum in Vietnam on infectious disease that are present in Southeast Asia.”
Until then, Pavlyukovskyy will be directing his energies towards his senior thesis and getting into graduate school, knowing that back in Ghana there are at least some children who remember his games and are a bit safer for it.