Preparing for national school‐based deworming in Kenya: the validation and large‐scale distribution of school questionnaires with urinary schistosomiasis

Summary Objective School questionnaires of self‐reported schistosomiasis provide a rapid and simple approach for identifying schools at high risk of Schistosoma haematobium and requiring mass treatment. This study investigates the reliability of school questionnaires to identify such schools and infected children within the context of a national school‐based deworming programme in Kenya. Methods Between November 2008 and March 2009, 6182 children from 61 schools in Coast Province, Kenya were asked by an interviewer whether they had blood in urine or urinary schistosomiasis (kichocho), and their results were compared with results from microscopic examination of urine samples. Subsequently, in 2009, a school‐based questionnaire survey for self‐reported schistosomiasis was distributed by the Ministry of Education to all schools in Coast Province, and its results were compared against results from the parasitological survey. The questionnaire survey results were linked to a schools database and mapped. Results Prevalence of self‐reported blood in urine was lower among girls than boys among all ages. The use of a 30% threshold of reported blood in urine was both highly sensitive (91.7%) and specific (100%) in identifying high (>50%) prevalence schools in Coast Province. Questionnaires were however less reliable in diagnosing S. haematobium infection in individuals, particularly among young girls. Comparable levels of reliability were observed when the questionnaire was distributed through the existing education systems and administered by class teachers. Conclusions The results confirm that blood in urine questionnaires can be reliably used to target mass treatment with praziquantel at national scales. The mapped results of the Ministry of Education survey serve to describe the spatial variation of urinary schistosomiasis and identify schools requiring mass treatment. Objectif: Les questionnaires scolaires offrent une approche simple et rapide pour identifier les écoles à haut risque pour Schistosoma haematobium et nécessitant un traitement de masse. Cette étude examine la fiabilité des questionnaires scolaires à identifier de telles écoles dans le cadre d’un programme national de déparasitage en milieu scolaire au Kenya. Méthodes: Entre novembre 2008 et mars 2009, 6182 enfants de 61 écoles dans la Province Côtière, au Kenya ont été interrogés pour savoir s’ils avaient du sang dans l’urine ou la schistosomiase urinaire (kichocho) et leurs réponses ont été