Assessment of the diagnostic system of Schistosoma infection at rural health unit level, Egypt.
The study sample was 6 rural health units and 405 attendants. Assessment of inputs was done through review of documents, charts, interviews, questionnaires and direct observation. Assessment of accuracy of the techniques was done by cross matching the results of urine and stools examination using different techniques (filtration and sedimentation for urine, and Kato-Katz and direct smear for stools). Results of technicians were compared with that of investigators using the same technique. Two days examinations of urine and stools samples were done by investigators using nucleopore and Kato-Katz, respectively. Environment assessment showed that, political and economic environments were the most influencing components that affect the system of diagnosis. Organization assessment showed that organization structure adapted to a large extent its objectives. However, decentralization and technological development were required. Filtration was more sensitive than sedimentation (82% and 51.3%, respectively). Specificity and PV+ were 100% for both tests. While, PV- and efficiency were 97.6% and 97.8% for filtration, and 93.7% and 94.1% for sedimentation, respectively. Sensitivity of Kato-Katz was higher than direct smear (88.5% and 11.5%, respectively). Kappa coefficient ranged between 0.63 and 1 as regards results of technicians compared to that of investigators. Mean daily workload of urinary examinations per technician ranged between 5.8 and 34.8. That of stools examinations was 5.3 and 32.4. Satisfaction rates ranged between 51.3% and 100% for different rural health units. Strengths and opportunities should be intensified. Weaknesses and threats should be treated.
Sayed
H A
HA
Department of Community Health, Theodor Bilharz Research Institute, Imbaba, Giza, Egypt.
el Dusoki
H H
HH
el Ayyat
A A
AA
Kamel
L M
LM
Tawfik
S A
SA
el Nahal
H S
HS
Sabry
H Y
HY
Amer
N M
NM
D004534:Egypt; D006801:Humans; D017064:Process Assessment, Health Care; D012423:Rural Health; D012552:Schistosomiasis / Q000175:diagnosis*