title: Rapid, low-cost, two-step method to screen for urinary schistosomiasis at the district level: the Kilosa experience.
abstract: The operational and diagnostic performance of a two-step method for the cost-effective screening of urinary schistosomiasis was investigated in the Kilosa District of east-central Tanzania. In the first step a simple questionnaire was administered to 15,073 primary schoolchildren by their class teachers over a 4-week period. The answers to the questionnaires had a high negative predictive value for schistosomiasis, and this permitted the safe exclusion of schools where the risk of the disease was low. In the second step, the head-teachers of the 49 high-risk schools and of 26 low-risk schools were instructed on the use of reagent sticks to detect haematuria. Each head-teacher then performed this test on 80 children selected at random in their schools (5750 children were screened within 6 weeks). Crosschecks of the results in 18 schools confirmed the reliability of the head-teachers' testing and their findings were therefore used to prepare an epidemiological map of the district and to arrange for treatment of positive children. This two-step approach relied entirely on the existing school system and permitted screening of a rural district of area 15,000 km2 (population, 350,000) over a 4-month period at a cost of only US$3000.
authors.affiliation: Swiss Tropical Institute Field Laboratory (STIFL), Ifakara, United Republic of Tanzania.
authors.forename: C
authors.initials: C
authors.lastname: Lengeler
authors.forename: P
authors.initials: P
authors.lastname: Kilima
authors.forename: H
authors.initials: H
authors.lastname: Mshinda
authors.forename: D
authors.initials: D
authors.lastname: Morona
authors.forename: C
authors.initials: C
authors.lastname: Hatz
authors.forename: M
authors.initials: M
authors.lastname: Tanner
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods* / Q000592:standards; D011933:Reagent Kits, Diagnostic; D012553:Schistosomiasis haematobia / Q000453:epidemiology / Q000517:prevention & control / Q000652:urine*; D012572:School Health Services / Q000191:economics / Q000458:organization & administration; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires / Q000191:economics / Q000592:standards; D013636:Tanzania / Q000453:epidemiology; D014556:Urine / Q000469:parasitology
chemical_list: D011933:Reagent Kits, Diagnostic