School health programmes have been identified as a cost-effective strategy
to reduce morbidity due to soil-transmitted helminths in the school-age pop
ulation, but the low rate of school enrolment in developing countries is a
major factor limiting their success.
OBJECTIVE The present study was conducted to identify reasons for non-enrol
ment and to evaluate differences in the occurrence of helminth infection be
tween enrolled and non-enrolled children in Zanzibar, United Republic of Ta
nzania. METHOD
A questionnaire was submitted to 520 households to obtain information about
enrolment and other socio-economic indicators. In addition, one school-age
chili was randomly selected in each household and investigated for soil-tr
ansmitted helminth infection.
RESULTS Overall, 71% of school-age children were enrolled. Enrolment increa
sed with age. Only 41% of children under 9 years of age were enrolled compa
red to 91% in children older than 12 years. Enrolment 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 sc
hool-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 sc
hool-based helminth control programme in reducing the intensity of infectio
n was confirmed. The significant gains achieved by enrolled school-age chil
dren in this study must be viewed as an attainable goal for the important n
umbers of non-enrolled school-age children in endemic areas. Decision-maker
s must ensure that outreach activities are included in helminth control pro
grammes targeted to school-age children.