OGUN STATE — Nigerian researcher and educator Cynthia Umunnakwe taught schoolchildren in Apojola village, Ogun State, to play the educational board game Schisto & Ladders in July 2025. The activity was part of a Ministry of Health program providing urine testing and treatment for schistosomiasis.

Schisto & Ladders is a version of the board game Chutes & Ladders created in 2014 by a team led by Professor of Parasitology Uwem Ekpo of Akwa Ibom State University. Umunnakwe, who holds a Ph.D. in parasitology, is one of its developers. In the game, landing on a square labeled "playing in a river" moves a player's token down a worm, while a square labeled "eat before taking medicine" moves the token up a ladder.

"Children go up the ladder when they encounter a good behavior [in the game] that would prevent schistosomiasis," Umunnakwe said. Good behaviors in the game include "Take praziquantel at school" and "Cutting vegetation around a river." Other squares connect negative actions to consequences; "Fetching water from a stream" links via a worm to "Swollen belly," and "Defecating near a river" leads to "Spreading infection."

During the July 2025 visit, Ministry of Health staff offered the oral drug praziquantel to children at a neighboring schoolhouse. Children received free snacks for participating in the treatment. Eating before taking praziquantel can help ease stomach pain that often occurs if the drug is taken on an empty stomach. The medication can both prevent and treat schistosomiasis.

Olubukola Adelakun, a veterinary public health researcher and post-doctoral scholar at the Federal University of Agriculture in Abeokuta, collected live snails from the river for identification during the activity. Untreated schistosomiasis can cause major organ and neurological damage, infertility, and bladder cancer, with school-age children at the greatest risk of infection.

Umunnakwe published research on the impact of Schisto & Ladders in the journal International Health. The research included a six-month study involving 275 students across six schools in rural Ogun State. Before playing the game, no child in the study group had heard of praziquantel. By the end of the trial, more than two-thirds of the students knew what the drug was and understood it was safe. Additionally, 65% of students signed up to receive treatment with parental permission.

Why It Matters

Schistosomiasis is a parasitic infection caused by a worm that infects humans through skin contact with infested waters. The infection causes symptoms such as blood in the urine, fever, and rash. There are more than 200 million cases of schistosomiasis across sub-Saharan Africa. In Nigeria, the disease is associated with higher rates of bladder cancer in young people. Screening data from a clinic in part of Ogun State revealed that one-third of residents tested had an active schistosomiasis infection.