Importance of schistosomiasis in the Isoka district of Zambia: a prerequisite for its control using community participation.

The opinion has long been held that only by treating cases individually could diseases be controlled or eradicated. This view has been adopted from time immemorial and has failed miserably in, for instance, the control of schistosomiasis. This paper presents views of the head teachers on the prominence of schistosomiasis in the Isoka district, Zambia, as a step towards their involvement in a community mediated programme for the control of schistosomiasis. Information was sought on the importance of schistosomiasis in the district by means of two questionnaires, one distributed to head teachers, and the other to school children. Lack of clean water was considered to be the leading factor by 71 (82.6%) teachers. Generally, schistosomiasis was not considered to be a prominent disease in the district. Nevertheless, teachers from highly infected areas ranked schistosomiasis as a health problem higher than those teachers from schools with lower prevalences (P = 0.002). The implications of these results to implementing a district wide schistosomiasis control programme covering both infected and uninfected areas are discussed.

Case management and patient reactions: a study of STD care in a province in Zambia.

Sexually transmitted disease (STD) case management was evaluated through observation and interviews at 2 urban and 4 rural health centres and 2 district hospital STD clinics in one urban and 2 rural districts in Central Province, Zambia. The analysis was limited to 59 patients (42 men and 17 women) who paid first visits for their disease and were managed by a clinical officer. The evaluation suffered from the lack of a standard for case management. Results showed that the patients engaged in risky sexual behaviour without being aware of the risks. At the health institutions, few patients were informed about condoms, the risk of HIV, and abstinence from sex during treatment and few were asked to notify their partners. Clinical officers with special STD training performed better than others but sill informed only one-fifth of the patients. Few clinical officers managed patients according to the syndromic approach recommended by the STD control programme.

PIP: Sexually transmitted disease (STD) case management was evaluated through observation and interviews at two urban and four rural health centers and two district hospital STD clinics in one urban and two rural districts in Central Province, Zambia. The analysis was limited to 59 patients (42 men and 17 women) who made first visits for their disease and were managed by a clinical officer. The evaluation suffered from the lack of a standard for case management. Results showed that the patients engaged in risky sexual behavior without being aware of the risks. At the health institutions, few patients were informed about condoms, the risk of HIV, and abstinence from sex during treatment and few were asked to notify their partners. Clinical officers with special STD training performed better than others, but still informed only one-fifth of the patients. Few clinical officers managed patients according to the syndromic approach recommended by the STD control program.

Diagnostic and cost comparisons of a questionnaire against a chemical reagent strip test in identifying high risk communities for Schistosoma haematobium infection in northern Zambia.

A comparative study was conducted in northern Zambia in order to compare both the economical and diagnostic performance of a questionnaire with that of the chemical reagent strip test in diagnosing urinary schistosomiasis with a view to replacing the more economically expensive reagent strip test with the questionnaire in the identification of high risk communities. A total of 57 schools participated in the study and each school was considered as a community. Among the symptoms and conditions of blood in urine, pain when passing urine and bilharzia for urinary schistosomiasis, blood in the urine was the best predictor for urinary schistosomiasis with 73.9 pc (95 pc CI 56.0 to 91.9 pc) sensitivity, 82.4 pc (95 pc CI 69.5 to 95.2 pc) specificity and 78.9 pc (95 pc CI 68.4 to 89.5 pc) diagnostic efficiency in the identification of schools with high levels of infection. A diagnostic questionnaire for urinary schistosomiasis was two times cheaper than the reagent strip test in economical terms. The questionnaire approach in identifying high risk communities for urinary schistosomiasis is promising and should be tried in other endemic areas.

The distribution of Schistosoma haematobium in the Isoka district, Zambia; and a possible strategy for its control.

The distribution of schools prevalent for Schistosoma haematobium in the Isoka district, Zambia was estimated by examining haematuria in the urine of the pupils found in Grades Three, Four or Five using reagent sticks. Thirty three (57 pc) schools had prevalence rates of 25 pc or more. The distribution of S. haematobium was patchy with significant differences in prevalence rates between some areas only short distances apart. A sociological study in the same schools showed that 68 (97 pc) head/senior teachers associated the disease with blood in urine and agreed to perform a reagent stick test on their pupils' urine. Thirty five (50 pc) of these respondents considered S. haematobium infection as a major problem and 66 (94 pc) of them were ready to administer a diagnostic questionnaire to their pupils in a study to identify high risk schools for S. haematobium. We conclude that the identification of high risk schools in the Isoka district, Zambia, using a diagnostic questionnaire and reagent stick testing by teachers, should proceed as a step to controlling S. haematobium infection in the district.

The problems of a social survey in epidemiology: an experience from a Zambian rural community.

A socio-economic study of 1097 people was carried out between November and December 1979. Demographic data and other health characteristics were obtained by census of the entire study population. Interviews covered disease awareness, perceived morbidity, health-care utilization, knowledge, attitudes and practices; all adults aged 15 years and above were interviewed 2 weeks before physical examinations were made. Age and literacy level were found to have no effect on the people's health-seeking behaviour in Kabinga. The results of this social survey failed to reveal the real practices of the community's use of both ethno-medicine and biomedicine.

PIP: A population segment was investigated in Kabinga, northern Zambia, in order to explore the use of biomedical ethnomedical health services and assess the knowledge of disease vectors. In this community schistosomiasis, malaria, anemia, and hookworm infestation was widespread. The population of 11 villages numbered 1097 people (545 males and 552 females) including 220 adults aged 15049. A WHO standardized questionnaire containing demographic and sociological questions was administered. The subjects were asked what action they would take when afflicted by malaria. The majority of 218 responders were women. The mean age for females was 35.2 years and for males it was 37.5 years. 4 responders did not know what to do if struck with malaria. Only .9% of both literate and illiterate adults indicated the use of African medicine in case of malaria. 62% of them went to the clinic or hospital for treatment during the last sickness episode. 29.2% of both genders did nothing, and only 2.4% of women turned to traditional medicine. 1 female could not recall what she did. 81% of the adult population attended either a clinic or a hospital for treatment during the previous 8 months. Most remembered using these facilities at least one (14 could not remember it). There was a significant correlation between refraining from the use of traditional medicine and utilization of the services of a clinic or hospital. Despite these findings, the answers were probably biased, because most women depend on their male counterparts for making decisions. Anthropologically oriented research methods could ensure reliability of data and reveal epidemiological problems in this community.