The game “Schisto & Ladders” is introduced to students at a primary school in a part of Nigeria where schistosomiasis, a neglected tropical disease, transmitted by parasitic worms, affects many residents. This version of the classic game “Chutes & Ladders” aims to teach children how to avoid getting infected and details of treatment for those
The game “Schisto & Ladders” is introduced to students at a primary school in a part of Nigeria where schistosomiasis, a neglected tropical disease, transmitted by parasitic worms, affects many residents. This version of the classic game “Chutes & Ladders” aims to teach children how to avoid getting infected and details of treatment for those who contract it.
Daniel Amo
hide title
toggle title
Daniel Amo
Chutes & Ladders has been a beloved board game in the US since the 1940s, adapted from a Ancient Indian game that aimed to teach moral lessons.
Nigerian children now play a version called “Schisto & Ladders.” It also aims to teach how to prevent a disease called schistosomiasis. It’s a parasite
Infection caused by a worm that infects humans through skin contact with infested water.
An unlucky player might land on a square that says “playing in a river.” That puts you at risk of contracting this tropical disease and sends your playing token into a worm instead of a slide.
Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game: it is part of an arsenal of creative approaches to protect yourself from the disease. Known locally as “Atosi Aja” or Urine with bloodThe disease not only causes blood in the urine but also presents other short-term symptoms such as fever and rash. If left untreated, it can cause significant neurological and organ damage, infertility, and even bladder cancer. In Nigeria, it is associated with Higher rates of bladder cancer in young people.
Known as a neglected tropical disease due to a lack of funding to combat it, schistosomiasis is a serious challenge for impoverished communities. There is More than 200 million cases in sub-Saharan Africa. School-age children are at higher risk of infection because they like to play in water and their immune systems are not fully developed.
Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game Schisto & Ladders. It is part of an arsenal of creative approaches to protect yourself from the disease.
Daniel Amo
hide title
toggle title
Daniel Amo
Although effective medications exist, the problem persists in areas with a lack of easy access to testing, treatment and clean water, so people do not depend on local water bodies for drinking and bathing. Awareness of its transmission is also a problem. Touching infested water, even just a splash, can lead to infection, as microscopic larvae swimming along the surface can slide through the skin.
Oh, a worm!
the game, Created in 2014 by a team led by Parasitology Professor Uwem Ekpo of Akwa Ibom State University, it follows the classic pattern: roll a die to advance along a winding path to the top of the colorful board. A player could land on a square that sends them climbing a ladder or sliding down a Schisto worm (which replaces the traditional slide). An example of a positive square is “eat before taking medicine”: the correct thing to do for someone who is infected and sends the player climbing a ladder to advance in the game.
They registered his name.
Another square with negative consequences says “Blood in urine”, but the neighboring square offers the player a path to redemption: “visit the health center” with a drawing of a smiling health worker.
“Children climb the ladder when they find good behavior [in the game] that would prevent schistosomiasis,” says Cynthia Umunnakwe. These include “taking praziquantel at school” and “cutting down vegetation around a river,” that is, removing invasive plants that provide ideal conditions for the proliferation of intermediate host snails, which carry the parasite.
The game also highlights key steps of streaming.
The painting “Looking for water from a stream” showed a boy crouching on the bank of the river. A schistosome worm extended from this square across the board to the complication of the disease, represented by another square reading “Swollen Belly”; while “Defecate near a river”, causes the player’s piece to go very low on the board and land on a square that says “Spread infection”. These represent two opportunities to disrupt the parasite’s life cycle: preventing infection of humans in the larval stage through contact with water, and discouraging spread of the parasite to river water through human waste, where eggs from the waste can reinfect snails.
playing the game
On a visit to a school in Apojola village in July 2025, Cynthia Umunnakwe taught young children how to play “Schisto & Ladders”, part of a Ministry of Health program that also provided urine testing and treatment to those affected.
And it’s not just a game. In this part of Ogun State, one-third of residents tested at a urinalysis clinic were found to have active schistosomiasis infection. The disease is common in these rural fishing towns where residents depend on fresh water for their daily lives. The Oyan River is used for the essential daily tasks of washing clothes, fishing, and cleaning and preparing cassava root, the main crop. The shallow bank of the river is also a playground for schoolchildren, who splash around for fun and are also told by their parents to check the fish traps.
“Hello everyone, I am Dr. Cynthia from Nigeria.” he says with a smile (he has a PhD in parasitology) and waves. She supervises how the tables and benches are grouped in the classroom and then the game begins.
Umunnakwe also brought live snails, familiar to the young people playing in the river, so that they could recognize the host of the parasite that infects humans and causes this disease. They were picked up by his colleague, Dr. Olubukola Adelakun. veterinary public health researcher and postdoctoral fellow at the Federal University of Agriculture in Abeokuta researching the habitat of these snails. The day before she had submerged herself in waist-deep river water, wearing waterproof boots to protect herself from infection. She had cleaned their shells for easy identification, as there are many similar freshwater snails in the area, although none of them had the shell shape characteristic of parasite-carrying snails.
The day’s activities also included medical help. At a neighboring school, Ministry of Health staff offered all children the oral medication praziquantel, which can prevent and treat the disease. They received free snacks for participating, as eating before treatment can help relieve stomach pain that often occurs if the medication is taken on an empty stomach.
The team doctor administered treatment doses based on height, with a standardized tape measure against the wall to help determine the dose.
In previous years, Cynthia Umunnakwe had conducted research demonstrating the impact of play, published in International Health. In a six-month study involving 275 students from six schools in rural Ogun State: schools where praziquantel had previously been rejected due to false rumors that it caused fainting and even death — not a single child in the study group had heard of the drug before playing. The game was played at each school during the trial, and the team surveyed children before and after the trial, holding focus group discussions with students, parents and caregivers. By the end of the trial, more than two-thirds of the students knew what the medication was and understood that it was safe, and 65% signed up, with their parents’ permission, for treatment.
“So we hope that by playing this game schoolchildren will actually translate the knowledge they gain into behavioral changes,” Umunnakwe said.
And not only that, the children have fun.
“Hey, wò ó, mo wà lókè!” said a boy who won the game by reaching the last “Shale-Free Boy” square: “Hey, look, I’m on top!”
William McCarthy is a medical student at McGovern Medical School and a researcher and writer committed to solving global children’s health problems. His research includes environmental health and Global innovation in health diagnosis. He is currently studying schistosomiasis with the Prakash Laboratory at Stanford Bioengineering, where he works on community-based approaches to infectious disease control. He is executive director and co-founder of the student-run nonprofit group. Health In Your Hands Diagnosis.
{For more tech updates, stay tuned to our blog.|Keep following us for the latest insights.|Check back often for more exciting news!}
