School enrollment in Zanzibar linked to children's age and helminth infections.
School health programmes have been identified as a cost-effective strategy to reduce morbidity due to soil-transmitted helminths in the school-age population, but the low rate of school enrollment in developing countries is a major factor limiting their success.


OBJECTIVE
The present study was conducted to identify reasons for non-enrollment and to evaluate differences in the occurrence of helminth infection between enrolled and non-enrolled children in Zanzibar, United Republic of Tanzania.


METHODS
A questionnaire was submitted to 520 households to obtain information about enrollment and other socio-economic indicators. In addition, one school-age child was randomly selected in each household and investigated for soil-transmitted helminth infection.


RESULTS
Overall, 71% of school-age children were enrolled. Enrollment increased with age. Only 41% of children under 9 years of age were enrolled compared to 91% in children older than 12 years. Enrollment is delayed because of an insufficient number of schools. Among non-enrolled school-age children, the proportion of heavy intensity infections was twice that of enrolled school-age children.


CONCLUSIONS
Most of the non-enrolled school-age children live together with enrolled siblings in the same household, thereby representing an important opportunity for effective outreach activities. The effectiveness of the school-based helminth control programme in reducing the intensity of infection was confirmed. The significant gains achieved by enrolled school-age children in this study must be viewed as an attainable goal for the important numbers of non-enrolled school-age children in endemic areas. Decision-makers must ensure that outreach activities are included in helminth control programmes targeted to school-age children.
Montresor
A
A
Communicable Diseases Prevention and Eradication, WHO, Geneva; Pemba Public Health Laboratory, Zanzibar, United Republic of Tanzania; Ministry of Health, Zanzibar, United Republic of Tanzania. montresora@who.int
Ramsan
M
M
Chwaya
H M
HM
Ameir
H
H
Foum
A
A
Albonico
M
M
Gyorkos
T W
TW
Savioli
L
L
D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006373:Helminthiasis / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012572:School Health Services; D012574:Schools; D012727:Sex Characteristics; D013636:Tanzania