The game “Schisto and Ladders” has been introduced to students at a primary school in a part of Nigeria where schistosomiasis, a neglected tropical disease spread by parasitic insects, affects many residents. This version of the classic “Chutes and Ladders” game aims to teach kids how to avoid getting infected and what to do if they do catch it.
Chutes and Ladders has been a beloved board game in America since the 1940s, adapted from an ancient Indian game that teaches a moral lesson.
Children in Nigeria are now playing a version called “Snakes and Ladders”. It also aims to teach how to prevent a disease called schistosomiasis. it’s a parasite
It is an infection caused by a worm that infects humans through skin contact with infected water.
An unlucky player may land on an intersection that says “Playing in the River”, putting them at risk of this tropical disease – and sending their game tokens into a wormhole instead of down a slope.
Nigerian researcher and teacher Cynthia Umunnakwe is one of the game’s developers – it’s part of an arsenal of creative approaches to disease survival. Locally known as “Atosi Aja” or bloody urine, this disease not only causes blood in the urine but also causes other short-term symptoms, such as fever and rash. If left untreated, it can cause major organ and nerve damage, infertility, and even bladder cancer. In Nigeria, it is associated with high rates of bladder cancer in young people.
Known as a neglected tropical disease due to a lack of funding to fight it, schistosomiasis poses a serious challenge to poor communities. There are well over 200 million cases in sub-Saharan Africa. School-age children are most at risk of infection because they enjoy playing in water and their immune systems are still developing.
Nigerian researcher and teacher Cynthia Umunnakwe is one of the developers of the Shisto and Ladders game. It’s part of an arsenal of creative approaches to avoiding disease.
Although effective medication exists, the problem remains persistent in areas lacking testing, treatment and easy access to clean water, so people do not rely on local water bodies for drinking and bathing. Awareness about its transmission is also an issue. Touching infected water, even splashing, can pose a risk of infection, as microscopic larvae floating on the surface are able to burrow through the skin.
Uh oh, a worm!
game. Created in 2014 by a team led by Uwem Ekpo, professor of parasitology at Akwa Ibom State University, it follows the classic pattern: roll a die to advance along a winding path across the top of a coloured board. A player can land on a square that sends them up a ladder or slide down a schist worm (which replaces the traditional chute). An example of a positive category is “eat before taking medicine” – this action is the perfect thing to do for someone who is infected, sending the player up a ladder to advance in the game.
He trademarked his name.
Another class with negative results says “Blood in Urine”, but the neighbouring square offers the player a path to salvation: “Visit the Health Center” with a picture of a smiling health worker.
‘When children encounter good behaviour, they climb the stairs [in the game].’ This approach will prevent schistosomiasis,” says Cynthia Umunnakwe. These include “taking praziquantel to school” and “cutting vegetation around rivers” – removing invasive plants that create ideal conditions for the spread of intermediate snail hosts, which carry the parasite.
The game also highlights the key stages of transmission.
The square “Fetching water from the stream” depicts a child crouching on the bank of a river. To complicate the disease, a schistosome worm spreads down the board from this square, depicted in another square reading “inflamed stomach”. While “defecating near the river”, the player’s piece moves far down the board and lands on a square that reads “Infection is spreading”. These represent two chances to disrupt the parasite’s life cycle: avoiding infection of humans in the larval stage through water contact and discouraging the spread of the parasite into river water through human waste, where eggs in the waste can re-infect the snails.
playing the game
On a school visit to Apozola village in July 2025, Cynthia Umunnakwe taught young children to play “Snakes and Ladders” as part of a health ministry programme that also provided urine testing and treatment for affected people.
And it’s not just a game. In this part of Ogun State, one third of residents examined at a urine testing clinic were found to have active schistosomiasis infection. The disease is common in these rural fishing villages where residents depend on freshwater for daily living. The Oyan River is used for essential daily tasks such as washing clothes, fishing and cleaning and preparing the main crop, cassava root. The shallow riverbank is also a playground for schoolchildren, who wander around for fun – and their parents also ask them to check the fishnets.
“Hello everyone, I am Dr Cynthia from Nigeria.” She says with a smile – she holds a PhD in parasitology – and waves. She supervises the pushing of tables and benches into groups in the classroom and then the game begins.
Umunnakwe also brought live snails, familiar to the youth playing in the river, so they could identify the host of the parasite that infects humans and causes disease. These were collected by his colleague, Dr Olubukola Adelakun. She is a veterinary public health researcher and postdoctoral scholar at the Federal University of Agriculture in Abeokuta, where she researches the habitat of these snails.
A day earlier, she had been immersed in river water up to her waist, wearing waterproof clothes to avoid infection. He had their shells cleaned for easy identification, as there are many similar freshwater snails in the area, although none of them had the typical shell shape of snails that carry the parasite.
The day’s activities also included medical assistance. At a neighbouring school, Health Ministry staff offered all children the oral drug praziquantel, which can both prevent and treat the disease.
They received a free breakfast for participating, because eating before treatment can help reduce the stomach pain that often occurs when taking medication on an empty stomach.
The team doctor administered treatment doses according to height, using a standardised measuring tape against the wall to help determine the dosage.
In previous years, Cynthia Umunnakwe had conducted research demonstrating the impact of sport, published in international health.
In a six-month study involving 275 students in six schools in rural Ogun State – schools where praziquantel had previously been rejected due to false rumours that it could cause unconsciousness and even death – not a single child in the study group had heard of the medicine before playing the game.
The game was played in each school during the trial period, and the team surveyed children before and after the trial and held focus group discussions with students, parents, and carers.
By the end of the trial, more than two-thirds of the students knew what the drug was and understood it was safe, and 65% enrolled, with parental permission, to receive the treatment.
“So we are hoping that by playing this game, school children will actually apply the knowledge they gain to change their behaviour,” Umunnakwe said.
And not only the game, children also enjoy it.
“Hey, woo-hoo, mo’ wa lok!” said one boy who won the game by reaching the last “schisto-free child” square. “Hey look, I’m on top!”
