The impact of a school health programme on the prevalence and morbidity of urinary schistosomiasis in Mwera Division, Pangani District, Tanzania

Abstract

The prevalence of urinary schistosomiasis among schoolchildren in Pangani District (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was adopted. Eleven primary schools in Mwera Division, Pangani District, with about 2500 schoolchildren were included in a control programme for urinary schistosomiasis. Macro- and microscopic haematuria diagnosed visually and with urine reagent strips was used as an indirect indicator of Schistosoma haematobium infection. Intensity of infection among children was monitored in class 5 (median age 14 years, range 11-17) by urine filtration techniques. Treatment was administered as 40 mg/kg praziquantel in a single dose at the beginning of the school year. The programme was implemented by schoolteachers and coordinated by the District Health Management Team in collaboration with the District Education Office. Teachers were responsible for carrying out all programme activities. Community participation was through collaboration with Teachers-Parents Associations and Village Health Committees. Coverage at yearly (1995-99) examination varied from 67.7% to 80.3%. Prevalence of haematuria decreased from 51.2% (range 22.2-89.5%) at baseline to 23.4% (range 5.8-56.7%) in 1999, a reduction of 54.3%. Macrohaematuria was 21.2% at baseline and 7.2% in 1999, a reduction of 66.0%. Prevalence of infection in class 5 was reduced by 71.4% and geometric mean intensity of positives reduced from 71 eggs/10 mL (95% confidence interval [CI] 52.5-97.7) to 28 eggs/10 mL (95% CI 25.7-55.0), a reduction of 60.6%. Teachers were highly committed, and secured community participation and a smooth implementation of the programme. The community accepted the introduction of a cost-recovery system, whereby parents pay for the treatment of children with episodes of visible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools.

Impact on a national helminth control programme on infection and morbidity in Ugandan schoolchildren

“…The experience of the Uganda national control programmes confirms that the potential of helminth control, previously demonstrated through pilot programmes, 8,12,13 can be realized at realistic geographical scale in sub-Saharan Africa. However, a key challenge for national control programmes outside sub-Saharan Africa has been to sustain initial morbidity gains over time.…”

“…As this method uses the existing school infrastructure and provides easy accessibility to children, it is a cost-effective public health strategy, 8 and many pilot programmes have demonstrated its feasibility, affordability and effectiveness. [9][10][11][12][13] It is unclear, however, whether the observed health benefits of such a control method can be replicated under nationwide programmatic conditions. Earlier large-scale helminth control efforts typically evaluated infection indicators, often prevalence, rather than morbidity indicators, 14,15 but rarely continued due to financial problems and decreased effectiveness.…”

Impact of school health programme on urinary schistosomiasis control in schoolchildren in Kilosa, Tanzania

“…Similar results have been reported in Zimbabwe (Chimbari & Ndela, 2001) and Tanga, Tanzania (Magnussen et al, 2001). The results confirm further that implementing school-based control programmes can significantly control urinary schistosomiasis in the community.…”

Understanding Low Uptake of Mass Treatment for Intestinal Schistosomiasis Among School Children: A Qualitative Study in Jinja District, Uganda

“…While it has been argued that it is cost-effective to deliver interventions through schools (Bundy & Guyatt, 1996;Brooker et al, 2001;Magnussen et al, 2001), it is S. Muhumuza et al 516 important to acknowledge some of the likely limitations. The introduction of the Universal Primary Education (UPE) in Uganda in 1997 increased access to primary education for a large population of children, particularly in rural areas (UBOS, 2012).…”