Serious game could be a game changer in public health education.

Caused by the dengue virus, which is transmitted to humans via the bite of an infective Aedes species (Ae. aegypti or Ae. albopictus) of the mosquito, dengue fever causes symptoms such as high fever, headache, pain behind the eyes, muscle or joint pain, nausea, vomiting, as well as rash. “Seek medical attention as soon as possible if you suspect that you might have dengue,” said Dr Alon Tan, Associate Consultant, SingHealth Polyclinics (SHP). “This will allow the doctor to confirm the diagnosis via a laboratory blood test and determine whether you are suitable for home recovery. In severe cases, hospitalisation and further treatment may be required.” First-time dengue infections can be severe, particularly among the elderly and people with pre-existing medical conditions. When these groups of people are re-infected, there is a higher probability of severe dengue. Dengue haemorrhagic fever can cause patients to suffer internal bleeding, shock and even death.

There are four different serotypes of dengue virus (DENV1 to 4). Those who have recovered from infection have lifelong immunity against that particular serotype, but remain vulnerable to infection by any of the other three serotypes.

Dengue is endemic in Singapore. Each year, a significant number of residents are infected with dengue and, for a small proportion of these patients, dengue may be fatal, said Dr Tan. According to the National Environment Agency (NEA), more than 32,000 dengue cases were reported in 2022 despite extensive vector control measures to curb mosquito breeding.

A dengue vaccine has been approved by the Health Sciences Authority (HSA) for the prevention of dengue in individuals aged 12 to 45 years with laboratory-confirmed evidence of previous dengue infection. The recommended age range is based on the epidemiological situation in Singapore and after consideration of the risk-benefit analysis by the local authority.

However, the vaccine is unsuitable for those who have not been previously infected, as it is associated with an increased risk of severe dengue in those who contract this naturally after vaccination. Other factors that may preclude individuals from being administered the dengue vaccine include allergies to any ingredient in the vaccine, or weakened immunity, such as patients who are receiving chemotherapy for cancer. Individuals who have had recent blood or plasma transfusions, treatments with immunoglobulin (a type of antibody), are pregnant, planning to conceive, breastfeeding, are feeling unwell and having a fever, are advised to discuss with their family doctor first and it may be necessary to reschedule their vaccination to a later date when these factors are no longer applicable.

NEA campaigns over the years have helped to educate and raise community awareness of dengue vector control. To complement these efforts, a serious game built for learning and education has been co-created by a team in SHP, headed by Dr Tan and mobile application developers from AI Innovation Labs.

Available for download from the Apple App Store and Google Play, Sam’s Mozzie Adventure allows players, in the role of a schoolboy named Sam, to travel through four different scenarios. The game triggers players to click on potential dengue breeding sites (vases, potted plants, clogged gutters) and take action to rectify the problem. A player earns points for correct answers or actions; for wrong moves, a player would lose points or be required to repeat the task.

See this video for the gameplay:

The effectiveness of this engaging game in educating people about dengue prevention was evaluated in a study with over 370 volunteers at Sengkang Polyclinic. Participants were randomly allocated to two groups; those in the intervention group played the game, while those in the control group visited a website to learn more about dengue prevention. Participants in both groups had scores for Knowledge, Attitude and Practice (KAP) higher than the baseline, but the mean difference in score was greater when assessing participants in the intervention group.

Based on this promising outcome, the SHP team is working on securing funding to enhance the game. For instance, over 84 per cent of participants in both groups expressed interest in dengue vaccination, so future iterations of the game may include an in-game feature to identify suitable vaccination candidates and work with primary care clinics to provide the vaccination. The team is currently seeking collaborations with NEA to promote the game to the general public and in schools.

“Gaining knowledge about dengue is the first step to winning the battle against dengue,” said Dr Tan. Beyond dengue prevention, he sees the potential of serious games in helping the general population to manage chronic diseases such as diabetes, high blood pressure and high cholesterol through bite-sized steps.

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