Public health experts are turning to an unlikely tool in the fight against a debilitating parasitic disease: a board game. Researchers have developed Schisto & Ladders, an educational adaptation of the classic children’s game Chutes and Ladders, designed to teach communities how to prevent schistosomiasis — a condition caused by parasitic worms that infect millions globally.
Schistosomiasis, also known as bilharzia, is a disease caused by blood flukes — parasitic flatworms of the genus Schistosoma. The parasites live in specific types of freshwater snails. When infected people urinate or defecate in freshwater sources, they contaminate the water with parasite eggs. These eggs hatch and infect snails, where they multiply. The parasites then leave the snails and enter the water, where they can survive for about 48 hours.
Infection occurs when larval forms of the parasite penetrate the skin of people who are wading, swimming, bathing, or washing in contaminated water. Once inside the body, the larvae develop into adult worms that live in blood vessels. The female worms release eggs, some of which are passed out of the body to continue the cycle, while others become trapped in body tissues, causing immune reactions and progressive damage to organs.
The disease disproportionately affects children in tropical and subtropical regions, particularly in poor communities without access to safe drinking water and adequate sanitation. School-aged children often have the highest infection rates because of their frequent contact with infested water during play, swimming, or household chores. Chronic infection can lead to anemia, stunted growth, impaired cognitive development, and long-term damage to the liver, intestines, lungs, and bladder. The World Health Organization estimates that over 200 million people worldwide are infected, with more than 700 million living in at-risk areas.
Schisto & Ladders adapts the familiar “race to the finish” mechanic of its namesake. Players move tokens along a numbered grid based on dice rolls. Landing on a ladder square represents a positive prevention behavior — such as using a latrine, wearing protective boots when working in water, or taking preventive medication during mass drug administration campaigns — allowing the player to advance quickly. Landing on a “chute” (or snake) square represents a risky behavior, such as urinating or defecating in open water, swimming in known infested areas, or ignoring symptoms like blood in urine. These choices send the player backward on the board.
The game was developed through collaboration between public health researchers and game designers, with input from community members in endemic regions to ensure cultural relevance. Visual cues and simple text make it accessible to players with varying literacy levels.
Traditional health education often relies on lectures, posters, or pamphlets — methods that can struggle to engage children or overcome literacy barriers. Game-based learning leverages active participation, repetition, and social interaction to reinforce key messages. Studies on similar “serious games” for diseases like malaria and dengue have shown improvements in knowledge retention and, in some cases, reported behavior change.
For schistosomiasis, prevention hinges on interrupting the transmission cycle: stopping contamination of water sources, reducing human contact with infested water, controlling snail populations, and ensuring regular treatment with the drug praziquantel. A game that makes these abstract concepts tangible — showing immediately how a “good choice” moves you forward and a “bad choice” sets you back — can help children internalize behaviors that protect themselves and their communities.
While Schisto & Ladders is currently a research and intervention tool rather than a commercial product, its development signals a growing recognition that effective health communication must meet people where they are — culturally, linguistically, and developmentally. For families in endemic areas, tools like this can empower children to become agents of change within their households, reminding parents to use latrines or seek treatment. For the global health community, it offers a low-cost, scalable model that could be adapted for other neglected tropical diseases. The ultimate measure of success will not be high scores, but reduced infection rates and healthier childhoods.
Image: Photo: Vladislovas Sketerskis · Pexels
Based on reporting from npr.org.
Cookies & Privacy: This website uses cookies to ensure you get the best experience on our website. Read more.
