Preparing for national school-based deworming in Kenya: the validation and large-scale distribution of school questionnaires with urinary schistosomiasis

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Abstract

Objective

School questionnaires of self-reported schistosomiasis provide a rapid and simple approach for identifying schools at high risk of Schistosoma haematobium and requiring mass treatment. This study investigates the reliability of school questionnaires to identify such schools and infected children within the context of a national school-based deworming programme in Kenya.

Methods

Between November 2008 and March 2009, 6182 children from 61 schools in Coast Province, Kenya were asked by an interviewer whether they had blood in urine or urinary schistosomiasis (kichocho), and their results were compared with results from microscopic examination of urine samples. Subsequently, in 2009, a school-based questionnaire survey for self-reported schistosomiasis was distributed by the Ministry of Education to all schools in Coast Province, and its results were compared against results from the parasitological survey. The questionnaire survey results were linked to a schools database and mapped.

Results

Prevalence of self-reported blood in urine was lower among girls than boys among all ages. The use of a 30% threshold of reported blood in urine was both highly sensitive (91.7%) and specific (100%) in identifying high (>50%) prevalence schools in Coast Province. Questionnaires were however less reliable in diagnosing S. haematobium infection in individuals, particularly among young girls. Comparable levels of reliability were observed when the questionnaire was distributed through the existing education systems and administered by class teachers.

Conclusions

The results confirm that blood in urine questionnaires can be reliably used to target mass treatment with praziquantel at national scales. The mapped results of the Ministry of Education survey serve to describe the spatial variation of urinary schistosomiasis and identify schools requiring mass treatment.

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Most cited references 25

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Geographic distribution of schistosomiasis and soil-transmitted helminths in Western Kenya: implications for anthelminthic mass treatment.

Thomas Handzel, Diana M. S. Karanja, David G. Addiss … (2003)

A survey of 1,246 children 10-12 years old in 32 primary schools in Kenya near Lake Victoria was conducted to determine prevalence and distribution of schistosome and geohelminth infections. Stool and urine samples were collected and examined for eggs of Schistosoma mansoni, S. haematobium, and intestinal helminths. A questionnaire was used to obtain demographic information and to quantify exposure to surface waters. Houses, schools, and water sources were mapped using a geographic information system. The mean school prevalence of S. mansoni infection was 16.3% (range = 0-80%). Proximity to the lake (r = 0.89, P < 0.001) and contact with lake water were associated with infection, as were specific water-related activities including swimming, fishing, and collecting water. Sixty-three percent of students were infected with one or more other geohelminths and these infections were more homogenously distributed. The separate distributions of schistosome and geohelminth infections have important implications for combined mass-treatment programs.

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Questionnaires for rapid screening of schistosomiasis in sub-Saharan Africa.

Christian Lengeler, Marcel Tanner, Jürg Utzinger (2001)

New initiatives are aiming to reduce the global burden of schistosomiasis, mainly through the large-scale application of chemotherapy. To target chemotherapy effectively, rapid assessment procedures are needed for identifying high-risk communities that are foci for the disease. In this review, we examine the development and validation of simple school questionnaires for screening communities for Schistosoma haematobium and S. mansoni rapidly and inexpensively. The focus is on sub-Saharan Africa, where 85% of the current schistosomiasis burden is concentrated. For more than a decade, the questionnaire approach has been validated in 10 countries, with 133 880 children interviewed in 1282 schools, and with 54 996 children examined for S. haematobium. The questionnaires were well accepted, highly reliable, and of low cost. The success of the questionnaires is explained by the fact that S. haematobium infections were easily perceived through the presence of blood in urine. Evidence from 48 258 children interviewed in 545 schools indicated that reported blood in stools and bloody diarrhoea are valuable indicators for community diagnosis of S. mansoni. However, the diagnostic performance of the questionnaires for S. mansoni was weaker than for S. haematobium, and although these results are encouraging, the questionnaires need additional validation. Recently, questionnaires were extended from community to individual diagnosis and showed considerable promise. Questionnaires are now available for promptly defining the magnitude of schistosomiasis in a large area, which will allow limited resources for morbidity control to be allocated optimally.

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An assessment of active versus passive methods for obtaining parental consent.

David J. Hawes, P Ellickson (1989)

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Author and article information

Journal

Journal ID (nlm-ta): Trop Med Int Health

Journal ID (iso-abbrev): Trop. Med. Int. Health

Journal ID (publisher-id): tmi

Title: Tropical Medicine & International Health

Publisher: Blackwell Publishing Ltd (Oxford, UK )

ISSN (Print): 1360-2276

ISSN (Electronic): 1365-3156

Publication date (Print): October 2011

Publication date (Electronic): 18 July 2011

Volume: 16

Issue: 10

Pages: 1326-1333

Affiliations

[1 ]Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute Nairobi, Kenya

[2 ]Division of Vector Borne Diseases, Ministry of Health Nairobi, Kenya

[3 ]Deworm the World Nairobi, Kenya

[4 ]KEMRI-Wellcome Trust Collaborative Programme Nairobi, Kenya

[5 ]Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine London, UK

Author notes

Corresponding Author Jimmy Kihara, Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, P.O. Box 54840 – 00200, Nairobi, Kenya. E-mail: jkihara@ 123456kemri.org

Article

DOI: 10.1111/j.1365-3156.2011.02829.x

PMC ID: 3558801

PubMed ID: 21767334

SO-VID: 3acb6126-ebd8-46b9-a318-88c74c1eb62f

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Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation.

Preparing for national school-based deworming in Kenya: the validation and large-scale distribution of school questionnaires with urinary schistosomiasis

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Abstract

Objective

Methods

Results

Conclusions

Related collections

Chinese Journal of Schistosomiasis Control

Most cited references 25

Geographic distribution of schistosomiasis and soil-transmitted helminths in Western Kenya: implications for anthelminthic mass treatment.

Questionnaires for rapid screening of schistosomiasis in sub-Saharan Africa.

An assessment of active versus passive methods for obtaining parental consent.

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