Impact of school health programme on urinary schistosomiasis control in schoolchildren in Kilosa, Tanzania.

Urinary schistosomiasis is more prevalent in schoolaged children than in adults (Hussein et al., 1996). Thus interventions aimed at school-aged children focusing on delivery through schools are strongly encouraged (WHO, 1993). School-based programmes provide an infrastructure for delivering treatment against geohelminths and schistosomiasis (PCD, 1999). Such programmes have been shown to improve health and well-being of schoolchildren in Tanzania (Guyatt et al., 2001), and the acceptability of such programmes among teachers and parents is acceptably high (PCD 2001). Kilosa School Health Programme (KSHP) which started in 1997 aimed to strengthen district capacity to plan, implement and evaluate a school health programme in Kilosa district of Tanzania, focusing on control of schistosomiasis and geohelminths. The establishment of this programme was a priority in this area because intestinal helminths and schistosomiasis were the leading health problems in school-aged children in the district (Lengeler et al., 1991). During the programme schoolchildren were given praziquantel drugs after screening for the infection. Since, biomedical evaluation of school-based health interventions in schistosomiasis control is vital for advocating health policy change this study was carried out to assess the impact of the programme on reducing urinary schistosomiasis among schoolchildren in Kilosa district. Thirty eighty schools with a total of 8726 children participated in this programme. Of these, 971 children participated in baseline survey in 1997 and 733 children in postintervention survey in 2000. Five primary schools were selected randomly from the 38 primary schools under the programme. Two repeated cross-sectional biomedical surveys were conducted at each school to assess egg excretion of Schistosoma haematobium as primary outcome before and after the intervention. Infections of S. haematobium were diagnosed by microscopic examination of urine using the filtration technique (WHO, 1991). Delivery of mass treatment for urinary schistosomiasis using praziquantel drugs was done by school teachers and health workers in 38 schools. Routine health education was also given to schoolchildren on how schistosomiasis is transmitted and how it can be prevented. All data were double entered using Fox Pro software and consistency checking performed. Reduction in prevalence was assessed by z-test using STATA 8.0 software (Olson, 1987). The impact of the programme was estimated by calculating the mean eggs count of all children before and after the intervention, the difference between the means was expressed as percentage of mean egg count before intervention as recommended (WHO, 1998). All children who were found with schistosome eggs microscopically were treated with a standard dose of 40mg of praziquantel/kg body weight after initial examination and annually during the study period. The descriptive statistics of the study population is summarised in Table 1. During the preintervention survey S. haematobium eggs were