The impact of a school health programme on the prevalence and morbidity ofurinary schistosomiasis in Mwera Division, Pangani District, Tanzania

The prevalence of urinary schistosomiasis among schoolchildren in Pangani D istrict (Tanzania) was assessed rapidly by a questionnaire approach. Based on the results, a strategy of selective treatment with praziquantel was ado pted. Eleven primary schools in Mwera Division, Pangani District, with abou t 2500 schoolchildren were included in a control programme for urinary schi stosomiasis. Macru- and microscopic haematuria diagnosed visually and with urine reagent strips was used as an indirect indicator of Schistosoma haema tobium infection. Intensity of infection among children was monitored in cl ass 5 (median age 14 years, range 11-17) by urine filtration techniques. Tr eatment was administered as 40 mg/kg praziquantel in a single dose at the b eginning of the school year. The programme was implemented by schoolteacher s and coordinated by the District Health Management Team in collaboration w ith the District Education Office. Teachers were responsible for carrying o ut all programme activities. Community participation was through collaborat ion with Teachers-Parents Associations and Village Health Committees. Cover age at yearly (1995-99) examination varied from 67.7% to 80.3%. Prevalence of haematuria decreased from 51.2% (range 22.2-89.5%) at baseline to 23.4% (range 58-56.7%) in 1999, a reduction of 54.3%. Macrohaematuria was 21.2% a t baseline and 7.2% in 1999, a reduction of 66.0%. Prevalence of infection in class 5 was reduced by 71.4% and geometric mean intensity of positives r educed from 71 eggs/10 mL (95% confidence interval [CI] 52.5-97.7) to 28 eg gs/10 mL (95% CI 25.7-55.0), a reduction of 60.6%. Teachers were highly com mitted, and secured community participation and a smooth implementation of the programme. The community accepted the introduction of a cost-recovery s ystem, whereby parents pay for the treatment of children with episodes of v isible haematuria during the school year. Communities also participated in the improvement of sanitary installations at the schools.