title: Diagnosis of schistosomiasis japonica in Chinese schoolchildren by administration of a questionnaire.
abstract: This paper describes a rapid, simple, cost-effective questionnaire for screening school-aged children at risk for Asian schistosomiasis in China. Five hundred and thirty-two children, aged 8-14 years, were selected from 3 schools in an area moderately endemic for Schistosoma japonicum in Hunan province. The questionnaire, comprising 15 multiple-choice questions, was administered by teachers in order to collect both ethnographic and epidemiological data relevant to current S. japonicum infections. This was followed by Kato-Katz thick smear stool examinations, miracidium hatching tests, and soluble egg antigen-enzyme linked immunosorbent assays in order to validate the efficacy of the questionnaire approach. The results from a combination of all 3 procedures indicated that the overall schistosomiasis prevalence in the 3 schools was 29.9% (138/472). Six risk factors (episodes of diarrhoea, frequency of water contact, school grade attained, weakness, past history of S. japonicum infection(s), and whether a subject had been previously treated for schistosomiasis) in the questionnaire were determined by logistic regression to be highly statistically significant predictors of individual current infection. The sensitivity (93.7%), specificity (91.9%) and low cost (c. US$ 0.6/true positive case) associated with the 6 variables model make the questionnaire approach a very useful diagnostic tool for screening marshland and lake communities at high risk for schistosomiasis in China before selective treatment with praziquantel or diagnostic follow-up. An even simpler 3 variables 'yes/no' model was derived from the questionnaire and found to be nearly as good at predicting individual infection (sensitivity 86.2% and specificity exceeding 97.6%) and extremely simple to use. If validated in other ecological settings in China the questionnaire, modified or as presented here, could be adopted by the national schistosomiasis control programme.
authors.affiliation: School of Public Health, Hunan Medical University, Changsha, People's Republic of China.
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.forename: A G
authors.initials: AG
authors.lastname: Ross
authors.forename: G F
authors.initials: GF
authors.lastname: Hartel
authors.forename: A C
authors.initials: AC
authors.lastname: Sleigh
authors.forename: G M
authors.initials: GM
authors.lastname: Williams
authors.forename: D P
authors.initials: DP
authors.lastname: McManus
authors.forename: X S
authors.initials: XS
authors.lastname: Luo
authors.forename: Y
authors.initials: Y
authors.lastname: He
authors.forename: Y S
authors.initials: YS
authors.lastname: Li
mesh_terms: D000293:Adolescent; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010274:Parasitology / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D012554:Schistosomiasis japonica / Q000175:diagnosis*; D012574:Schools; D011795:Surveys and Questionnaires