SCHISTOSOMA-MANSONI, INTESTINAL PARASITES AND PERCEIVED MORBIDITY INDICATORS IN SCHOOLCHILDREN IN A RURAL ENDEMIC AREA OF WESTERN COTE-DIVOIRE

There is a great need for rapid and low-cost identification of communi ties at high risk of intestinal schistosomiasis. We report the develop ment of a questionnaire approach that may do so. In the first phase, 2 09 schoolchildren from 3 neighbouring villages in a rural area endemic for intestinal schistosomiasis in western Cote d'Ivoire were screened for Schistosoma mansoni and other helminths on 4 consecutive days usi ng Kato-Katz thick smears. Daily infection prevalences of S. mansoni w ere high (60%-71%) and the cumulative infection prevalence was 92.3 %. Infections with hookworms and Ascaris lumbricoides were also frequent , with cumulative prevalences of 60.8% and 38.3%, respectively. On day 3, the presence of Entamoeba histolytica/E. dispar and Giardia lambli a was assessed by a faecal concentration procedure. In the second phas e, focus group discussions (FGD) were conducted: in each village one F GD with heavily infected children and one FGD with lightly or S. manso ni-uninfected schoolchildren to assess their perception of morbidity. The aim was to establish local terms indicating S. mansoni infections. 'Diarrhoea', 'blood in the stools','stomach disorders' and 4 terms in the local Yacouba/Dioula languages were frequently used by infected c hildren. A simple questionnaire was then developed and the headteacher s interviewed all schoolchildren individually. 'Blood in stools', gnon and toto were reported significantly more frequently among moderately and heavily S. mansoni-infected children than by those not or only li ghtly infected. The term gloujeu indicated borderline significance. Th e best diagnostic performance was found for 'blood in stool' (sensitiv ity: 47%; specificity: 76%; positive predictive value: 66%; negative p redictive value: 60%). All schistosomiasis infections were treated wit h a single oral dose of praziquantel (40 mg/kg body weight) and the sa me questionnaire was re-administered 6 weeks post-treatment. Statistic ally significantly less children reported having had 'blood in stool' and 'gloujeu' after treatment (McNemar's (chi(2)-test, P < 0.01). We c onclude that 'blood in stool','gnon', 'toto' and 'gloujeu' are the mos t reliable reported symptoms for rapid and low-cost identification of communities that are at high risk of S. mansoni infections in Cote d'I voire.