Examining the Acceptability of Helminth Education Packages “Magic Glasses Lower Mekong” and “Magic Glasses Opisthorchiasis” and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial
Authors: O'Connor Suji Y , Mationg Mary Lorraine , Kelly Matthew J , Williams Gail M , Clements Archie CA , Sripa Banchob , Sayasone Somphou , Khieu Virak , Wangdi Kinley , Stewart Donald E , Tangkawattana Sirikachorn , Suwannatrai Apiporn T , Savathdy Vanthanom , Khieu Visal , Odermatt Peter , Gordon Catherine A , Wannachart Sangduan , McManus Donald P , Gray Darren J 
Published: September 2024

Background
Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The “Magic Glasses” is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People’s Democratic Republic (PDR), and Thailand.

Objective
The objective of this study is to evaluate the acceptability of the “Magic Glasses Lower Mekong” and “Magic Glasses Opisthorchiasis” education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students’ KAP surrounding STH and OV, respectively.

Methods
Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren’s initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up.

Results
The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages.

Conclusions
This trial will examine the acceptability of the “Magic Glasses Opisthorchiasis” and “Magic Glasses Lower Mekong” interventions and provide evidence on the effectiveness of the “Magic Glasses” on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the “Magic Glasses” education packages in Cambodia, Lao PDR, and Thailand.

Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315&isReview=true

International Registered Report Identifier (IRRID)
DERR1-10.2196/55290