Evaluation and monitoring of schistosomiasis control

This paper attempts to review the process of evaluation in schistosomiasis control with special emphasis on the maintenance phase, in which control and evaluation activities need to be integrated into existing health care delivery services. The conceptual framework of evaluation suggested consists of five levels each asking for its specific indicators: input - process - output - outcomes (effects and coverage) - impact. A review of the literature reveals that many control projects suffer from substantial inconsistencies between initially stated objectives (e.g. transmission and morbidity control) and the indicators used for the impact assessment. Monitoring is considered as a special form of continuous evaluation focusing on the process and the outcomes, thus enabling the timely identification of deficiencies and in turn the strengthening and readjustment of control strategies. Feedback is regarded as an integral part of both evaluation and monitoring and becomes a key element for the maintenance of control. In view of the conceptual changes in schistosomiasis control from the control of transmission to the control of disease, the paper summarizes various direct and indirect morbidity indicators for both urinary and intestinal schistosomiasis that might be applied in evaluation and monitoring approaches. Similarly, indicators for the assessment of transmission or integrated control approaches are outlined. Despite the substantial number of potential indicators there is still a great need for their comprehensive standardization and large-scale field validation before they can be efficiently applied for intra-programme and inter-programme evaluation and comparison. Finally, the proposed indicators for transmission and morbidity control are examined for their application in routine health services and/or by specialized control teams.(ABSTRACT TRUNCATED AT 250 WORDS)