Malaria diagnosis and treatment administered by teachers in primary schools in Tanzania

A school health programme in Mwera Division, Pangani District included trea tment of malaria attacks occurring in children during school time. A combin ation of symptoms (headache, muscle/joint pains, feeling feverish) and oral temperature greater than or equal to 37.5 degreesC was used for the diagno sis of malaria. Chloroquine (25 mg/kg given over 3 days) was used for treat ment. Malariometric surveys on children aged 7-15 years (mean 10 years) wer e conducted once a year (1995-1997). Plasmodium falciparum accounted for 10 0% of infections and the parasite prevalence varied between 32.7 and 35.3% from 1995 to 1997. The number of malaria cases (cases/1000 registered schoo l children) diagnosed and treated by school teachers was 159 (67) in 1995, 324 (124) in 1996, 348 (128) in 1997 and 339 (108) in 1998. Children in gra des 1-4 (age 7-13) accounted for 64.6% of cases. Symptoms and oral temperat ure were recorded for 1258 children. Of those, 992 (78.9%) complained of fe ver and at least one other symptom when presenting to teachers, 98 (7.8%) h ad fever as their only complaint and 168 (13.5%) presented without a percep tion of fever, but with other symptoms. Of these children, 36 (21.4%) had a temperature greater than or equal to 37.5 degreesC. The sensitivity of 'fe eling feverish' was 96.5% with a specificity of 54.5%. The positive predict ive value of feeling feverish was 89.9% and the negative predictive value 7 8.6%. Blood slides were prepared from 55.3 and 37.2% of children diagnosed by teachers during 1995 and 1996, respectively, and 71.4% were found positi ve. Among children who fulfilled the algorithm criteria 75.0% had a positiv e blood slide. With little training and regular supervision it was feasible for school teachers to make a presumptive diagnosis of malaria. We conclud e that teachers can play a major role in school health programmes and are w illing to be involved in health matters as long as they are supported by he alth and educational authorities.