title: Questionnaire-based approach to assess schoolchildren's physical fitness and its potential role in exploring the putative impact of helminth and Plasmodium spp. infections in Côte d'Ivoire.
abstract: BACKGROUND
  Disability weights (DWs) are important for estimating burden of disease in terms of disability-adjusted life years. The previous practice of eliciting DWs by expert opinion has been challenged. More recent approaches employed quality of life (QoL) questionnaires to establish patient-based DWs, but results are ambiguous.
  
  
  METHODS
  In early 2010, we administered a questionnaire pertaining to physical fitness to 200 schoolchildren in Côte d'Ivoire. Helminth and Plasmodium spp. infections were determined and schoolchildren's physical fitness objectively measured in a maximal multistage 20 m shuttle run test. Associations between objectively measured and self-reported physical fitness and between self-reported physical fitness and infection status were determined. Spearman rank correlation coefficient, uni- and multivariable linear regression models adjusting for children's age and sex, ambient air temperature and humidity, Fisher's test, χ(2) and t-test statistics were used for statistical analysis.
  
  
  RESULTS
  The prevalence of Schistosoma haematobium, Plasmodium spp., Schistosoma mansoni, hookworm and Ascaris lumbricoides in 167 children with complete parasitological results was 84.4%, 74.9%, 54.5%, 14.4% and 1.2%, respectively. High infection intensities and multiple species parasite infections were common. In the 137 children with complete data also from the shuttle run test, we found statistically significant correlations between objectively measured and self-reported physical fitness. However, no statistically significant correlation between the children's parasitic infection status and self-reported physical fitness was identified. An attrition analysis revealed considerably lower self-reported physical fitness scores of parasitized children who were excluded from shuttle run testing due to medical concerns in comparison to parasitized children who were able to successfully complete the shuttle run test.
  
  
  CONCLUSIONS
  Our QoL questionnaire proofed valid to assess children's physical fitness in the current study area. Reasons why no differences in self-reported physical fitness in children with different parasitic infections were found are manifold, but do not preclude the use of QoL questionnaires in the elicitation of DWs. Indeed, the questionnaire was particularly useful in assessing physical fitness of those children, who were - supposedly due to parasitic infections - unable to complete the shuttle run test. Hence, we encourage others to use QoL questionnaires to determine not only physical fitness, but also more subtle morbidities.
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland. thomas.fuerst@unibas.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: Fürst
authors.forename: Ivan
authors.initials: I
authors.lastname: Müller
authors.forename: Jean T
authors.initials: JT
authors.lastname: Coulibaly
authors.forename: Adrien K
authors.initials: AK
authors.lastname: Yao
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.forename: Eliézer K
authors.initials: EK
authors.lastname: N'Goran
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D007560:Cote d'Ivoire; D005260:Female; D006373:Helminthiasis / Q000503:physiopathology*; D006376:Helminths / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D008288:Malaria / Q000503:physiopathology*; D008297:Male; D010809:Physical Fitness; D010961:Plasmodium / Q000302:isolation & purification; D011795:Surveys and Questionnaires