THE USE OF QUESTIONNAIRES FOR THE IDENTIFICATION OF HIGH-RISK AREAS FOR URINARY SCHISTOSOMIASIS - THE ETHIOPIAN EXPERIENCE

The applicability and usefulness of questionnaires directed at school children and teachers and routed through the usual administrative/educ ational system for the identification of communities at risk for urina ry schistosomiasis in Ethiopia was assessed in the Awash Valley in 199 2 as part of a multi-country study. Pre-tested questionnaires were dis tributed to 28 elementary schools. A total of 2918 children and 56 tea chers completed the questionnaires. Teachers and the biomedical ream t ested 2662 and 2602 children by reagent strips in 24 schools. The prev alences of children with questionnaire positive (yes) answers for indi cators of urinary schistosomiasis, ''blood in urine'', ''schistosomias is'' or ''pain when urinating'', were 4.1%, 3.6% and 11.2%, respective ly. he median rank given try teachers for ''blood in urine'' and ''sch istosomiasis'' from among a list of symptoms/diseases that were affect ing children in the area was 7 (not cited by the respondent). The prev alence of haematuria at the 1+ limit by teacher and biomedical team re agent testing was 21.9% and 17.5%, respectively. Prevalence of urinary schistosomiasis among the children tested by urine filtration was 2.7 %. The relation between children's and teachers's questionnaire answer s for the markers of urinary schistosomiasis, on the one hand, and bet ween children's questionnaire answers and teacher stick testing result s, on the other, gave no significant correlation. Conventional parasit ological testing required US$ 226 per screened school as opposed to US $ 47 and US$ 153 for questionnaires and teacher testing, respectively. The approach worked well operationally and was cheaper. Nevertheless, it did not serve its diagnostic purpose in the Awash Valley. This is explained, among others, by the low prevalence of urinary schistosomia sis in the study area which probably resulted in low perception of the disease by the immigrant population fr om the highlands who,constitut ed the majority of the study population. However, as the feasibility a nd the cost-effectiveness of questionnaires far large-scale screening provide many possibilities in the frame of a PHC approach to disease c ontrol, a similar investigation should be carried out in a different u rinary schistosomiasis endemic area before sound conclusion is given a s to the diagnostic capability of the approach.