Community-based questionnaires and health statistics as tools for the cost-efficient identification of communities at risk of urinary schistosomiasis

Self-administered questionnaires, distributed by existing administrative channels to village party chairmen, head-teachers and schoolchildren, showed good diagnostic performance for the qualitative assessment of urinary schistosomiasis endemicity. At a cost 34 times below that of the WHO-recommended parasitological screening strategy, the schoolchildren's questionnaire allowed the screening of 75 out of 77 schools of a rural Tanzanian district in six weeks, and the exclusion of schools not at high risk for urinary schistosomiasis with over 90% confidence. The headteacher and party questionnaires made it possible to assess the perceived importance of a spectrum of diseases and symptoms, among which was schistosomiasis. The priority rank of schistosomiasis control was strongly correlated with the prevalence rate of the disease in the community. The questionnaires also looked for the prioritization of health among other community issues and thus contributed important information for planning at district level. Standardized monthly disease reports, sent by all primary health services, were also analysed. They allowed a zonal schistosomiasis endemicity classification.