Move over Chutes & Ladders: Schisto & Ladders has educational value plus worms

The game "Schisto & Ladders" is introduced to students in an elementary school in a part of Nigeria where the neglected tropical disease schistosomiasis, spread by parasitic worms, affects many residents. This version of the classic "Chutes & Ladders" games aims to teach children how to avoid getting infected — and details of the treatment for those who catch it. Daniel Amao hide caption toggle caption Daniel Amao Chutes & Ladders has been a beloved board game in the U.S. since the 1940s — adapted from an ancient Indian game that aimed to teach moral lessons. Kids in Nigeria are now playing a version called "Schisto & Ladders." It too aims to teach — about how to prevent a disease called schistosomiasis. It's a parasitic infection caused by a worm that infects humans via skin contact with infested waters. An unlucky player might land on a square that says "playing in a river" That puts you at risk for this tropical disease — and sends your game token down a worm instead of a chute. Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game — it's part of an arsenal of creative approaches to warding off the illness. Known locally at "Atosi Aja" or Bloody Urine, the disease not only causes blood in the urine but has other short-term symptoms such as fever and rash. If untreated, it can cause major organ and neurological 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 because of the lack of funding to fight it, schistosomiasis is a serious challenge for impoverished communities. There are over 200 million cases across sub-Saharan Africa. School age children are at the greatest risk of infection because they like to play in the water and their immune systems aren't fully developed. Nigerian researcher and educator Cynthia Umunnakwe is one of the developers of the game Schisto & Ladders. It's part of an arsenal of creative approaches to warding off the illness. Daniel Amao hide caption toggle caption Daniel Amao Though effective medication exists, the issue is persistent in areas with a lack of easy access to testing, treatment and clean water so people don't rely on local bodies of water for drinking and bathing. Awareness of its transmission is also an issue. Touching infested water, even just a splash, can risk infection, as microscopic larvae swimming along the surface are able to wriggle through skin. Uh oh, a worm! The game, created in 2014 by a team led by Professor of Parasitology Uwem Ekpo of Akwa Ibom State University, follows the classic pattern: Roll a dice to advance up a winding path to the top of the colorful board. A player could land on a square that sends them up a ladder or sliding down a Schisto worm (which takes the place of the traditional chute). An example of a positive square is "eat before taking medicine" – the right thing to do for someone who's infected and sends the player up a ladder to move ahead in the game. They trademarked their 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 go up the ladder when they encounter a good behavior [in the game] that would prevent schistosomiasis," Cynthia Umunnakwe says. These include "Take praziquantel at school" and "Cutting vegetation around a river" – removing invasive plants that offer ideal conditions for proliferation of the intermediate snail hosts, which carry the parasite. The game also highlights key steps of transmission. The "Fetching water from a stream" square showed a child stooped at the river's edge. A schistosome worm stretched from this square down the board to the complication of the illness, depicted in another square reading "Swollen belly"; while "Defecating near a river," brings the player's piece far down the