Simple school questionnaires can map both Schistosoma mansoni and Schistosoma haematobium in the Democratic Republic of Congo

Abstract

The use of self-administered questionnaires has been shown in different African countries to be inexpensive and reliable for the rapid identification of communities at highest risk of urinary schistosomiasis. For intestinal schistosomiasis due to Schistosoma mansoni there is a clear need for a similar approach. We report the results from a large-scale study undertaken in the western part of the Democratic Republic of Congo (DRC, formerly Zaı̈re). Within 4 weeks questionnaires were correctly completed in 136 out of 160 schools (85%). In 57 of these schools children were screened for infections with schistosomes and geohelminths. The prevalence of ‘schistosomiasis’ as reported in the questionnaires showed the best correlation with the prevalence of S. mansoni infections (r=0.77, P<0.0001). Calculations of the diagnostic performance of reported ‘schistosomiasis’ to detect schools with a high risk of intestinal schistosomiasis gave positive predictive values of 87 and 62%, and negative predictive values of 74 and 87% for moderate and high infection thresholds, respectively. Reported ‘blood in stool’ was another useful indicator for intestinal schistosomiasis. Reported ‘blood in urine’ showed the best correlation with urinary schistosomiasis (r=0.75, P<0.001) and the positive predictive values were 81 and 50%, and the negative predictive values were 89 and 95% for moderate and high infection thresholds, respectively. We conclude that school children in DRC have a distinct perception of intestinal and urinary schistosomiasis and that questionnaires could be useful to identify high-risk schools for both parasites.