The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002-2008.

Schistosomiasis remains one of the most prevalent parasitic diseases in developing countries. After malaria, schistosomiasis is the most important tropical disease in terms of human morbidity with significant economic and public health consequences. Although schistosomiasis has recently attracted increased focus and funding for control, it has been estimated that less than 20% of the funding needed to control the disease in Africa is currently available. In this article the following issues are discussed: the rationale, development and objectives of the Schistosomiasis Control Initiative (SCI)-supported programmes; the management approaches followed to achieve implementation by each country; mapping, monitoring and evaluation activities with quantifiable impact of control programmes; monitoring for any potential drug resistance; and finally exit strategies within each country. The results have demonstrated that morbidity due to schistosomiasis has been reduced by the control programmes. While challenges remain, the case for the control of schistosomiasis has been strengthened by research by SCI teams and the principle that a national programme using 'preventive chemotherapy' can be successfully implemented in sub-Saharan Africa, whenever the resources are available. SCI and partners are now actively striving to raise further funds to expand the coverage of integrated control of neglected tropical diseases (NTDs) in sub-Saharan Africa.

Bayesian spatial analysis of a national urinary schistosomiasis questionnaire to assist geographic targeting of schistosomiasis control in Tanzania, East Africa.

Spatial modelling was applied to self-reported schistosomiasis data from over 2.5 million school students from 12,399 schools in all regions of mainland Tanzania. The aims were to derive statistically robust prevalence estimates in small geographical units (wards), to identify spatial clusters of high and low prevalence and to quantify uncertainty surrounding prevalence estimates. The objective was to permit informed decision-making for targeting of resources by the Tanzanian national schistosomiasis control programme. Bayesian logistic regression models were constructed to investigate the risk of schistosomiasis in each ward, based on the prevalence of self-reported schistosomiasis and blood in urine. Models contained covariates representing climatic and demographic effects and random effects for spatial clustering. Degree of urbanisation, median elevation of the ward and median normalised difference vegetation index (NDVI) were significantly and negatively associated with schistosomiasis prevalence. Most regions contained wards that had >95% certainty of schistosomiasis prevalence being >10%, the selected threshold for bi-annual mass chemotherapy of school-age children. Wards with >95% certainty of schistosomiasis prevalence being >30%, the selected threshold for annual mass chemotherapy of school-age children, were clustered in north-western, south-western and south-eastern regions. Large sample sizes in most wards meant raw prevalence estimates were robust. However, when uncertainties were investigated, intervention status was equivocal in 6.7-13.0% of wards depending on the criterion used. The resulting maps are being used to plan the distribution of praziquantel to participating districts; they will be applied to prioritising control in those wards where prevalence was unequivocally above thresholds for intervention and might direct decision-makers to obtain more information in wards where intervention status was uncertain.

Schistosomiasis, helminth infection and health education in Tanzania: achieving behaviour change in primary schools.

Over a period of one school year a study was carried out into the feasibility and effectiveness of introducing active teaching methods into primary schools in Tanzania with a view to enhancing health education. The Lushoto Enhanced Health Education Project had as a focus personal hygiene with reference to the control of schistosomiasis and helminth infections. When a randomly selected group of children were compared with a comparison group there was evidence of changes in both knowledge and health-seeking behaviour. The passing of messages from children to the community met with mixed results. The observed changes were still evident over 1 year after the project had ended.

Participation of primary school teachers in oral health education in Rungwe District, Tanzania.

BACKGROUND: Tanzanian primary school teachers have long been utilised as oral health educators but little is known about their level of participation. OBJECTIVES: To asses the participation of primary school teachers as general and oral health educators. DESIGN: Cross-sectional, using structured self-administered questionnaires. SETTING: Rural and urban Primary Schools in Rungwe District, Mbeya Tanzania. PARTICIPANTS: Primary school teachers from 15 rural and 4 urban schools. MAIN OUTCOME VARIABLES: Provision of oral health education. RESULTS: Teachers with primary education, who are teaching in lower grades were significantly more active in providing general and oral health education (OHE) than those with secondary education and who teach pupils in higher grades. CONCLUSION: Oral health education seems to be given mainly to primary school pupils in lower grades; teachers involved in oral health education provision were mainly female juniors in the profession and relatively young by age (below 40 years old). RECOMMENDATION: There is a need for influencing teachers of pupils in higher grades and males to be involved in oral health education programmes throughout their teaching profession.

Participation, willingness and abilities of school-teachers in oral health education in Tanzania.

In Tanzania, teachers in primary schools conduct oral health education as part of the school syllabus, most of them without any training for the task. The participation, willingness and abilities of teachers involved in this duty were studied by means of questionnaire, interviews, oral hygiene examinations and practical exercises. The teachers' knowledge of oral health matters and their skills in toothbrushing were poor. Health lessons in general were not accorded high priority. The teachers preferred parents to instruct their children on toothbrushing, and were reluctant to teach pupils about dietary matters. They stressed the shortage of time and materials for teaching health lessons and their heavy workload at school. These findings indicate a necessity, and a point of departure, for organising training for oral health education and encouraging teachers to undertake this task.

Oral health knowledge, attitudes, behaviour and skills of children entering school in urban and rural areas in Tanzania.

This study analysed the prevailing oral health-related knowledge, attitudes and behaviour of children entering school in Tanzania. The assessment was conducted in a random sample of 200 children who were newly enrolled in first grade in urban and rural areas of the Ilala district, by means of interviews, oral hygiene check-ups and practical exercises. Toothbrushing was a prevalent habit among these children, but its efficiency was low. Modern toothbrushes were commonly used and preferred to wooden toothbrushes. Toothpaste was considered essential and commonly used in urban areas but, instead, charcoal or ash were used in rural areas. The children's sugar consumption was low, but they widely valued sugary snacks. They had low awareness of gum disease and tooth decay, and poor knowledge about the causes and prevention of these diseases. These findings indicate gaps in the children's oral health ideas and practices acquired from home. The ongoing school oral health education is a crucial opportunity for the required improvements.