2005 UPDATE: evaluation of the "Juma na Kichocho" health education booklet
The distribution of urinary schistosomiasis in schoolchildren on Zanzibar Island (Unguja) was surveyed during May 2001 to determine a potential correlation with the distribution of intermediate snail hosts. The survey primarily used parasitological methods which were supplemented with questionnaires. This survey hoped to provide a better insight into the epidemiology of transmission. These findings were then related to better measures of integrated control of the disease.
The survey was prepared, performed and analysed by a team comprising J. Russell Stothard (Natural History Museum, London, email russ@nhm.ac.uk), Mr Ali Fouam Mgeni (Ministry of Health, Zanzibar), Dr.Mahdi Ramsan (Ivo de Carneri Foundation, Zanzibar) and Dr.Lorenzo Savioli (WHO, Geneva)
(1) The questionnaire was prepared in Kiswahili, the local language on Unguja.
(2) Following an initial question 'in the last year have you', the 12 prepared questions were asked relating to:
| the child's general health |
Qu 1 had a headache? Qu 2 had an abdominal pain? |
| water contact patterns |
Qu 3 do you have access to well or tap water? Qu 4 did you play in the sea? Qu 5a have you played in freshwater ponds
or streams around you home? Qu 6 - did you help tend rice in paddies? Qu 7 - did you wash, or help to wash, your clothes in freshwater ponds? |
| travel within Unguja | Qu 8a have you visited the countryside
around Stone Town (Chuini, Kidichi, Kinyasini)? Qu 8b if yes, have you played, washed or bathed in pond water there? |
| knowledge & capacity for self-diagnosis of urinary schistosomiasis |
Qu 9 what colour is your urine (red or not red)? Qu 10 (to teacher) can the teacher confirm the colour of this urine? Qu 11 do you know what exactly is Kichocho? Qu 12a have you ever been treated for kichocho? |
(3) The options of response to majority of questions was either: "Yes", "No" or "Don't know"; those questions that posed how often? were answered numerically by the child, these answers were subsequently transformed to 3 categories:
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400 children from 10 schools were selected in the survey. In a total of 206 boys and 194 girls examined, of an average age of 12 years, 51 dipstick positive urines were detected, gross-haematuria was not common. Terminal spined schistosome eggs could be seen in 47 urines with 12 containing 50+ eggs per 10ml. In the 4 dipstick-positive urines that were egg-negative, 3 were attributable to menses, the remainder probably presenting a light infection. A total prevalence of 12% across the 10 schools was found but in 5 schools schistosome infections were absent and only a single infection detected in another. The distribution of urinary schistosomiasis on Unguja appeared confined within the distribution of the intermediate host snail B. globosus. Schools found in areas where only B. nasutus occurred were almost free from the disease.
At each school the response to each question was represented as a pie diagram (Figure 1) and the average response across all schools shown at the top of the graphic.
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Yes response |
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No response |
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stars |
B. globosus (black fill denotes natural infections with S. haematobium) |
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squares |
B. nasutus |
The questionnaire data were subsequently analysed with Classification and Regression Trees (CART). CART is a non-parametric multivariate statistical algorithm that can be used to select which combination of risk factors best described a particular classification or event. In this case, CART analysis was implemented with the hope of identification of potential risk factors, and their inter-relationships, that might best predict S. haematobium infections on Unguja.
CART analyses of questionnaire data detected a major split within the data based upon longitude of school (Figure 2). Nearly all infections were found west of 39o19'E (39.319 in decimal degree co-ordinates). The four minor miss-classifications were found in Ndijani and Mtende schools. A similar split based upon latitude, schools located north of 6o10'S and school name, was also capable of finding similar classification.
After the removal of major geographic risk factors i.e. longitude, latitude, and school name, a further CART analysis was performed (Figure 3). The resulting 10-terminal node CART tree revealed a complex summary and interactions between variables. Children who did not wash their clothes in pond water were likely to be free from infection; of the 277 children found in internal node 2, only 13 (5%) cases were dipstick-positive. From these 277 children, in terminal node 1 only 3 (1.7%) children were found to be dipstick-positive from a total of 179 whom did not help in rice-paddies. Only half of the 10 dipstick-positive children who helped in rice-paddies appeared to be aware of what kichocho was. The 123 children who did wash clothes in freshwater ponds, see internal node 5 and below, appeared to have different partitioning factors. Foremost it appeared that of the 38 dipstick-positive children, 24 (63%) of these had previously been treated for schistosomiasis while 14 had not. Assessing divisions between these 14 infected children from the 65 children who did wash clothes in ponds and had not had previous treatment was complex. Playing in the sea and pain in the abdomen separated off 8 cases but with a misclassification of 9 (52%) individuals. Playing in freshwater ponds and streams classified a further 4 remaining cases but with a misclassification of 12 (75%) individuals.
Class Questionnaire Form:Afya ya watoto wa shule. Fomu ya Walimu wa madarasa ya kudodosa wanafunzi.
Ziara za Maskulini
Wachunguzi: Ali Fouam Mgeni, Dr.Russell Stothard, Dr.Mahdi Ramsan, Dr.Lorenzo Savioli
| Taasisi: | Wizara ya Afya, Zanzibar |
| Makumbusho ya Historia ya Asili ,London | |
| Maabara ya Afya ya Jamii Pemba ,Pemba | |
| Shirika la Afya la Duniani , Geneva |
Sisi tunafanya uchunguzi ili kujaribu kungundua kwanini watoto wingi wanaendelea kuwa na kichocho katika Zanzibar.Madaktari wa Makumbusho ya Historia Asili na Maabara ya Afya ya Jamii Pemba tunafanya uchunguzi huu ili tuweze kupata njia mathubuti za kuzuia maradhi haya.
Kama una masuala yoyote kuhusu uchunguzi huu saa yoyote, tafadhali wasiliana na Mkurugenzi wa Uchunguzi,Maabara ya Afya ya Jamii Pemba Dr.Ramsan.(simu 2452003) nyakati za kazi
| Jina la shule: |
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Tarehe (siku/mwezi/mwaka): |
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| Darasa: |
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| Kata: |
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Mkondo (if only one class, write A): |
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| Idadi ya wanafunzi wa kiume walioandikishwa: |
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| Jina la Mwalimu: |
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Idadi ya wanafunzi wa kike walioandikishwa: |
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| Idadi ya wanafunzi wa kiume waliohukuduria leo: |
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| Jinsia yako (Me au Ke): |
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UKUMTA namba ya shule |
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Idadi ya wanafunzi wa kike waliohukuduria leo: |
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Class Questionnaire Form:Afya ya watoto wa shule. Fomu ya Walimu wa madarasa ya kudodosa wanafunzi.
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| Admission Number | |||||||||||
| Umri (miaka) | |||||||||||
| Jinsia (Me au Ke) |
Orodha ya masuali kwa mwalimu wa darasa kuuliza kila mtoto
Anza kwa kumuuliza mtoto "Je umeumwa kichwa mwaka iliyopita?"
Jibu ndio (N) au Hapana (H) au Sijui(?)
Katika mwaka uliopita:
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| 1. Kuumwa kichwa? | |||||||||||
| 2. Kuumwa tumbo? | |||||||||||
| 3. Unafursa y kukaribia kisima au mfereji? | |||||||||||
| 4. Uliwahii kucheza baharini? | |||||||||||
| 5a. Uliwahi
kuchezea maji yaliyotuwama(dimbwi) au mto mitaani kwenu? 5b. Kama ndio --- kwa muda gani? |
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| 6. Uliwahi kusaidia kazi mabonde ya mpunga? | |||||||||||
| 7. Unafua au kusaidia kufua nguo zako katika vidimbi? | |||||||||||
| 8a. Umetembelea
mashamba yaliyo karibu na mji Mkongwe(kwa mfano Chuini, Kidichi,
Kinyasini)? 8b. Kama ndio -umewahi kucheza,kufua au kufanya shughuli yoyote katika madimbwi au vijito? |
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| 9. Mkojo
wako rangi gani? Mwekudu - Ndio, Sio mwekundu - Hapana |
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| 10. Mwalimu
ana weza kuthibitisha rangi hiyo kwa kuangalia mkojo uliomo ndani ya kichupa? |
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| 11. Unajua nini kuhusu kichocho? | |||||||||||
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12a. Uliwahi kutibiwa kichocho? 12b. Kama ndio - mara ngapi? |
download questionaires used to record children's KA on schistosomiasis and malaria (MS Word format document): English version - Swahili version
download MS Powerpoint file (6 MB file) providing more information on the project and presenting preliminary results (information presented at Royal Society of Tropical Medicine and Hygiene's "Research in Progress" Meeting, December 2005 - full RSTMH Meeting Report).