The impact of control measures on urinary schistosomiasis in primary school children in northern Cameroon: a unique opportunity for controlled observations.

As part of a program to integrate schistosomiasis control into the primary health care system in northern Cameroon, an unexpected opportunity to undertake a controlled evaluation of the impact of interventions was recognized. Inadvertently, a large part of Mindjil, one of four assessment villages, had been essentially excluded from the program, creating a unique natural control. The prevalence of infection with Schistosoma hematobium in school-aged children was 7% in the areas where the control program was implemented, and 71% in the excluded areas (P < 0.0002). High intensity infection was 1% and 26% in the two areas, respectively (P < 0.0002). Children in the school where the control interventions were implemented had a significantly lower prevalence of infection with Schistosoma hematobium (P < 0.005). Subjects in intervention areas demonstrated greater knowledge about the transmission of schistosomiasis than those in the control area. This study documented and quantified program impact in a controlled manner not usually possible in field studies and also illustrated how unrecognized intracultural diversity (within culture differences) in target populations may effect disease control programs in communities.