Utzinger J, N'Goran E K, Esse Aya C M, Acka Adjoua C, Lohourignon K L, Tanner M, Lengeler C
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basle.
Trop Med Int Health. 1998 Sep;3(9):711-20. doi: 10.1046/j.1365-3156.1998.00292.x.
There is a great need for rapid and low-cost identification of communities at high risk of intestinal schistosomiasis. We report the development of a questionnaire approach that may do so. In the first phase, 209 schoolchildren from 3 neighbouring villages in a rural area endemic for intestinal schistosomiasis in western Côte d'Ivoire were screened for Schistosoma mansoni and other helminths on 4 consecutive days using Kato-Katz thick smears. Daily infection prevalences of S. mansoni were high (60%-71%) and the cumulative infection prevalence was 92.3%. Infections with hookworms and Ascaris lumbricoides were also frequent, with cumulative prevalences of 60.8% and 38.3%, respectively. On day 3, the presence of Entamoeba histolytica/E. dispar and Giardia lamblia was assessed by a faecal concentration procedure. In the second phase, focus group discussions (FGD) were conducted: in each village one FGD with heavily infected children and one FGD with lightly or S. mansoni-uninfected schoolchildren to assess their perception of morbidity. The aim was to establish local terms indicating S. mansoni infections. 'Diarrhoea', 'blood in the stools', 'stomach disorders' and 4 terms in the local Yacouba/Dioula languages were frequently used by infected children. A simple questionnaire was then developed and the headteachers interviewed all schoolchildren individually. 'Blood in stools', gnon and toto were reported significantly more frequently among moderately and heavily S. mansoni-infected children than by those not or only lightly infected. The term gloujeu indicated borderline significance. The best diagnostic performance was found for 'blood in stool' (sensitivity: 47%; specificity: 76%; positive predictive value: 66%; negative predictive value: 60%). All schistosomiasis infections were treated with a single oral dose of praziquantel (40 mg/kg body weight) and the same questionnaire was re-administered 6 weeks post-treatment. Statistically significantly less children reported having had 'blood in stool' and 'gloujeu' after treatment (McNemar's (chi2-test, P < 0.01). We conclude that 'blood in stool', 'gnon', 'toto' and 'gloujeu' are the most reliable reported symptoms for rapid and low-cost identification of communities that are at high risk of S. mansoni infections in Côte d'Ivoire.
迫切需要快速且低成本地识别出肠道血吸虫病高风险社区。我们报告了一种可能实现这一目标的问卷调查方法。在第一阶段，对来自科特迪瓦西部一个肠道血吸虫病流行农村地区相邻3个村庄的209名学童，连续4天使用加藤厚涂片法筛查曼氏血吸虫和其他蠕虫。曼氏血吸虫的每日感染率很高（60%-71%），累积感染率为92.3%。钩虫和蛔虫感染也很常见，累积感染率分别为60.8%和38.3%。在第3天，通过粪便浓缩法评估溶组织内阿米巴/迪氏内阿米巴和蓝氏贾第鞭毛虫的感染情况。在第二阶段，开展了焦点小组讨论（FGD）：在每个村庄，与重度感染儿童进行一次FGD，与轻度感染或未感染曼氏血吸虫的学童进行一次FGD，以评估他们对发病率的认知。目的是确定表示曼氏血吸虫感染的当地用语。“腹泻”、“便血”、“胃部不适”以及当地亚库巴/迪乌拉语中的4个用语，感染儿童经常提及。随后制定了一份简单问卷，校长对所有学童进行了单独访谈。与未感染或仅轻度感染的儿童相比，中度和重度曼氏血吸虫感染儿童报告“便血”、gnon和toto的频率显著更高。术语gloujeu显示出临界显著性。发现“便血”的诊断性能最佳（敏感性：47%；特异性：76%；阳性预测值：66%；阴性预测值：60%）。所有血吸虫病感染儿童均口服单剂量吡喹酮（40mg/kg体重）进行治疗，并在治疗6周后再次使用相同问卷进行调查。治疗后报告有“便血”和“gloujeu”的儿童在统计学上显著减少（麦克尼马尔检验（卡方检验，P<0.01）。我们得出结论，“便血”、“gnon”、“toto”和“gloujeu”是用于快速且低成本识别科特迪瓦高风险曼氏血吸虫感染社区的最可靠报告症状。
