Quasi-experimental study of Malaria and HIV-Prevention Programming among School Pupils in Nigeria

DETAILED SUMMARY

Importance

• Malaria and HIV/AIDS remain major public health threats in Nigeria, particularly among children and adolescents.
• While football-based health education (Grassroot Soccer’s model, delivered locally by the Youth Empowerment and Development Initiative, or YEDI) had previously been used to build HIV-related knowledge and life skills among youth in other countries, no data existed on whether this approach could also build malaria-related knowledge, and its impact had not previously been independently evaluated in Nigeria.

Objective

• To assess whether a football-based health education program is effective in changing malaria- and HIV-related knowledge, attitudes, self-reported behavior, and communication among primary and junior secondary school pupils in Lagos State, Nigeria.

Study details

• Study design: Quasi-experimental study; included a control group
• Data collection tools: Pre- and post-intervention structured questionnaires (n = 640: 320 intervention, 320 control); 16 focus group discussions with pupils and Coaches; 6 key informant interviews with school teachers/Game Masters serving as Coaches
• Participants: Mixed gender primary and junior secondary school pupils aged 11-15 years, teachers/Game Masters, Coaches
• Implementation setting: 16 public primary and junior secondary schools across three Local Government Areas (Agege, Apapa, and Mushin) in Lagos State, Nigeria (urban)
• Study period: May 2014 to July 2014 (pre-assessment in May; post-assessment in July)

Intervention

• YEDI Grassroots Soccer: A football-based health education program, adapted from Grassroot Soccer’s SKILLZ curriculum by the Youth Empowerment and Development Initiative (YEDI), delivered by trained school Game Masters serving as near-peer Coaches to teach pupils about malaria and HIV/AIDS prevention alongside basic life skills through soccer-based activities.

Results

• A total of 640 pupils (320 intervention; 320 control) completed structured pre- and post-intervention questionnaires, alongside 16 focus group discussions and 6 key informant interviews with school teachers/Coaches.
• Malaria-related knowledge improved in both groups following the intervention, with knowledge of the parasite causing malaria increasing more in intervention schools (from 26.6% to 50.6%) than in control schools (from 29.2% to 43.8%).
• Knowledge of HIV/AIDS definitions, modes of transmission, and abstinence as a prevention method improved significantly more among pupils in intervention schools compared with control schools.
• Willingness to associate with and care for people living with HIV increased in the intervention group, with fewer pupils reporting they would avoid an HIV-positive friend after program participation.
• Despite these gains, results were inconsistent: knowledge gaps remained high in both groups, and some outcomes (e.g., peer-pressure resistance related to HIV prevention) showed no significant improvement in the intervention group.
• About 90% of participants had never been tested for HIV, though over 60% expressed willingness to be tested.
• Quote: “…our paramount objective is to educate the kids.” (Coach)

Conclusions and implications

• The YEDI Grassroots Soccer initiative shows promise in building malaria- and HIV-related knowledge among school pupils in Lagos, Nigeria, though inconsistent gains relative to the control group suggest the curriculum could be strengthened.
• Recommended improvements include shortening the curriculum content, tailoring it to junior and senior age groups, and building stronger follow-up mechanisms to sustain knowledge gains.