Two practical and cost effective methods for urinary schistosomiasis screening in Yemeni Schoolchildren

The study was conducted to estimate and compare the validity and performance of two screening methods for urinary schistosomiasis: the interview - reporting blood in urine - and detecting microhematuria by reagent strip. In year 2003, 515 schoolchildren from five schools in Abyan and Taiz governorates in Yemen, were interviewed by healthworker for hematuria, and then urine samples were collected and tested for microhematuria by urine strip and for the presence and count of Schistosoma hematobium by filtration method. Validity and performance indicators were estimated and compared for the two methods using the filtration method as the reference -standard - test. The mean age of the schoolchildren was 10.7 +/- 2.5 years. Boys represented 65% of the sample. The prevalence of the infection as determined by filtration, interview and reagent strip methods was 21.4%, 22.15, and 30.9%, respectively. Sensitivity, specificity, PPV, NPV of the urine strip was higher than the same indicators for the interview method. Combining the results of both screening methods increased all validity and performance indicators. A statistically significant [P<0.001] association was found between urine strip positivity level and infection intensity. The urine strip had higher validity and performance indicators than the interview method. For its low-cost, simple and rapid application, we recommend using it for screening infected schoolchildren in area endemic with S.hematobium in combination with the interview method to enhance its performance

Appreciation of school deworming program by parents in Ha Giang Province (Vietnam).

School-based deworming programs are one of the most cost-effective public health strategies to reach children with anthelminthics and health education. However, despite their low cost and high health impact, they are not implemented on a large scale. The present survey investigated a school-based deworming program in Ha Giang Province, Vietnam, to assess the community perception and support towards these programs. Information from 81 households, 88 primary school students, 25 teachers and 9 people in charge of commune health stations was collected by structured questionnaires. The survey displayed complete satisfaction and a high level of support within all 4 questioned groups. In addition 96.1% of all parents noticed an improvement in their children's health. The great appreciation of the deworming program by the community is an additional argument to convince decision makers to implement and scale up these programs. Even teachers that did not receive any specific training were able to distribute the drug successfully following the page of written instructions accompanying the drug.

Evaluation of coverage of deworming interventions in Vietnam.

In 2004-2005, the school deworming program in Vietnam targeted 2,400,000 school-children in 25 provinces. A questionnaire survey of a random sample of schools throughout the country was organized to validate the teacher feedback, assess the real coverage of the program and estimate the occurrence of side-effects. A total of 91 schools in four different provinces were visited few days after drug distribution. A total of 2,323 children and 80 teachers were questioned. The total cost of the monitoring has been estimated at US dollar 7,000 (less than 10% of the deworming program). The survey demonstrated a coverage of 95% for school-children and of 86.3% for teachers (on average a coverage 2% lower than the one reported by the teachers through forms on the day of drug administration). Approximately 0.4% of those interviewed reported side-effects after deworming, while the occurrence of side effects through routine reports was 0.15%. In both cases, the side effects were described as mild forms of nausea, abdominal pain, or headaches that did no required pharmacological treatment. The survey confirmed the positive results of routine reporting; we consider the survey a cost-effective activity to maintain the control activities under monitoring.

Cost-effectiveness of audiometric screening of first-year preparatory pupils in Dhofar region, Oman

Audiometric screening was conducted in Dhofar region to study the magnitude of ear problems and cost-effectiveness of screening first-year preparatory-school children in Oman. None of the 1894 pupils had otitis media with effusion or sensory neuronal hearing loss. Six children [0.32%] had impacted wax, 4 [0.21%] chronic suppurative otitis media and 2 [0.11%] dry perforation of eardrum. In all, 14 children [0.74%] with suspected hearing impairment were referred to a specialist but only 2 attended. Physicians and nurses spent 8-10 minutes for ear examination per child for a yield of less than 1%. The screening expenditure was US$ 5 per pupil. As the prevalence of serious ear conditions was low, we conclude that exp and ing the audiometric screening of schoolchildren to first-year preparatory pupils is not cost-effective

Costs, benefits and operational implications of using quantitative techniques to screen for schistosomiasis haematobium in Egypt.

The official strategy for schistosomiasis control in Egypt relies on individual case detection and treatment. Screening for Schistosoma haematobium has traditionally involved urine sedimentation which shows whether or not eggs are present in the urine, thereby providing only a qualitative assessment of infection status. Recently the Ministry of Health introduced the nucleopore filtration technique into a few villages to assess its applicability for broader use in areas where S. haematobium is endemic. This method gives an indirect quantitative measure of morbidity in terms of egg counts/10 ml urine. The overall purpose of this study was to provide rapid feedback to the Ministry on the likely implications of expanding the use of the filtration technique by examining the benefits, costs and operational problems that may be involved. From 2 villages in Giza Governorate, systematic random samples were taken from the general populations and from schools. Each selected person provided a urine specimen on which the two diagnostic techniques were performed. Filtration offered no additional benefits over sedimentation in terms of defining if a person was infected or not, with sensitivities ranging from 59.6%-75% for filtration and from 60%-73.1% for sedimentation. The additional non-labor costs of using the filtration technique in the two villages were calculated and showed that, if extended to all rural health units in Egypt, the Ministry would need to find an additional 31.6 million pounds (US$9.5 million) each year. A number of operational problems would also be involved in the wider application of the technique.

Las políticas de salud y su impacto en los sectores populares: Chile, 1974-1986 / Health policies and their impact in population: Chile, 1974-1986

En el presente trabajo se analizan los antecedentes con respecto al gasto público en salud poniendo énfasis en su evolución, comportamiento pro-cíclico y su caracter redistributivo. A continuación se estudian el proceso de privatización de la salud y el traspaso de su costo a los usuarios, tratando de identificar los mecanismos a través de los cuales las reformas implementadas en el área de la salud ha tendido a producir una mayor segmentación en la calidad de las atenciones y prestaciones que reciben los chilenos según su nivel de ingresos. Finalmente, se analizan los programas de salud implementados y sus resultados. Nos centramos en el impacto de la política de salud y nutricional sobre: a) los escolares, jóvenes y adolescentes, grupo particularmente desatendidos por los programas públicos y, b) el sector materno infantil, grupo definido como prioritario por las autoridades del sector salud. El análisis y los antecedentes presentados a lo largo de todo el trabajo se refieren al periodo 1974-1986 en que se han producido importantes cambios estructurales en el área salud