title: Schistosoma mansoni, intestinal parasites and perceived morbidity indicators in schoolchildren in a rural endemic area of western Côte d'Ivoire.
abstract: There is a great need for rapid and low-cost identification of communities at high risk of intestinal schistosomiasis. We report the development of a questionnaire approach that may do so. In the first phase, 209 schoolchildren from 3 neighbouring villages in a rural area endemic for intestinal schistosomiasis in western Côte d'Ivoire were screened for Schistosoma mansoni and other helminths on 4 consecutive days using Kato-Katz thick smears. Daily infection prevalences of S. mansoni were high (60%-71%) and the cumulative infection prevalence was 92.3%. Infections with hookworms and Ascaris lumbricoides were also frequent, with cumulative prevalences of 60.8% and 38.3%, respectively. On day 3, the presence of Entamoeba histolytica/E. dispar and Giardia lamblia was assessed by a faecal concentration procedure. In the second phase, focus group discussions (FGD) were conducted: in each village one FGD with heavily infected children and one FGD with lightly or S. mansoni-uninfected schoolchildren to assess their perception of morbidity. The aim was to establish local terms indicating S. mansoni infections. 'Diarrhoea', 'blood in the stools', 'stomach disorders' and 4 terms in the local Yacouba/Dioula languages were frequently used by infected children. A simple questionnaire was then developed and the headteachers interviewed all schoolchildren individually. 'Blood in stools', gnon and toto were reported significantly more frequently among moderately and heavily S. mansoni-infected children than by those not or only lightly infected. The term gloujeu indicated borderline significance. The best diagnostic performance was found for 'blood in stool' (sensitivity: 47%; specificity: 76%; positive predictive value: 66%; negative predictive value: 60%). All schistosomiasis infections were treated with a single oral dose of praziquantel (40 mg/kg body weight) and the same questionnaire was re-administered 6 weeks post-treatment. Statistically significantly less children reported having had 'blood in stool' and 'gloujeu' after treatment (McNemar's (chi2-test, P < 0.01). We conclude that 'blood in stool', 'gnon', 'toto' and 'gloujeu' are the most reliable reported symptoms for rapid and low-cost identification of communities that are at high risk of S. mansoni infections in Côte d'Ivoire.
authors.affiliation: Department of Public Health and Epidemiology, Swiss Tropical Institute, Basle.
authors.forename: J
authors.initials: J
authors.lastname: Utzinger
authors.forename: E K
authors.initials: EK
authors.lastname: N'Goran
authors.forename: C M
authors.initials: CM
authors.lastname: Esse Aya
authors.forename: C
authors.initials: C
authors.lastname: Acka Adjoua
authors.forename: K L
authors.initials: KL
authors.lastname: Lohourignon
authors.forename: M
authors.initials: M
authors.lastname: Tanner
authors.forename: C
authors.initials: C
authors.lastname: Lengeler
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D007560:Cote d'Ivoire / Q000453:epidemiology; D019353:Endemic Diseases / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D017144:Focus Groups; D006305:Health Status Indicators; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009017:Morbidity; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012555:Schistosomiasis mansoni / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires / Q000592:standards*