Evaluation of efficacy of school-based anthelmintic treatments against anaemia in children in the United Republic of Tanzania.

OBJECTIVE: To determine the impact of deworming on anaemia as part of a large-scale school-based anthelmintic treatment programme in the Tanga Region of the United Republic of Tanzania. METHODS: Both the reduction in the prevalence of anaemia and the cost per case prevented were taken into consideration. Cross-sectional studies involved parasitological examination and anaemia evaluation before and at 10 months and 15 months after schoolchildren were dewormed. FINDINGS: Baseline studies indicated that the prevalence of anaemia (haemoglobin < 110 g/l) was high (54%) among schoolchildren, particularly those with high intensities of hookworm and schistosomiasis. Attributable fraction analysis suggested that hookworm and schistosomiasis were responsible for 6% and 15% of anaemia cases, respectively. Fifteen months after deworming with albendazole and praziquantel the prevalence of anaemia was reduced by a quarter and that of moderate-to-severe anaemia (haemoglobin <90 g/l) was reduced by nearly a half. The delivery of these anthelmintics through the school system was achieved at the relatively low cost of US$ 1 per treated child. The cost per anaemia case prevented by deworming schoolchildren was in the range US$ 6-8, depending on the haemoglobin threshold used. CONCLUSIONS: The results suggested that deworming programmes should be included in public health strategies for the control of anaemia in schoolchildren where there are high prevalences of hookworm and schistosomiasis.     

Surveillance of Trypanosoma cruzi transmission by serological screening of schoolchildren.

The seroprevalence of Trypanosoma cruzi infection among children is a sensitive indicator for assessing the effectiveness of programmes for control of Chagas disease. In this study we report the result of a cross-sectional serological survey carried out among schoolchildren living in a poor rural area in central Brazil. Eluates of blood collected on filter-paper were tested for anti-T. cruzi antibodies using immunofluorescence, haemagglutination, and enzyme-linked immunosorbent assays. The overall seroprevalence of T. cruzi infection was 7.9%, which compared with the findings of the national survey carried out in 1975-80 indicates that a twofold-to-threefold reduction in prevalence has occurred over the last 10 years. This is consistent with a reduction of transmission in the area, probably related to vector control efforts. Based on our results, the incidence of new cases was estimated to be 44 per annum in the study region. In rural areas with a scattered population, surveillance of T. cruzi transmission by serological screening of children at school entry is more practical and economical than entomological evaluation for assessing both the risk of transmission in the community and the efficacy of vector control measures. A sample size of around 1000 schoolchildren is sufficient to detect prevalences as low as 2%, and such an approach would be practical and applicable to most areas where Chagas disease is endemic.     

Lung function in preadolescents after pertussis infection. Results of the epidemiologic study in Krakow

The main goal of the study was to check the hypothesis that pertussis infection may cause a lung function deterioration in children. Cross sectional study was carried out in 1997 among 992 schoolchildren attending the fourth form of elementary schools in Krakow. In the course of the study the epidemiologic interviews on respiratory health of children and spirometric testing were performed. Spirometric indices (FVC, FEV1 and FEF25-75%) were inversely correlated with allergic diseases, wheezing symptoms and tobacco smoking of mother in pregnancy, however, the effect of the latter variable was of border significance. Socio-economic status of the family and number of infections in lower respiratory tract in children reported over the last year were not related to the lung function level. Children who reported pertussis infection in the past showed significantly lower values of FEV1 and FEF25-75%. The results obtained suggest that pertussis infection may have a detrimental effect on the lung function of preadolescent children. Since these children may be more susceptible to environmental hazards and development of obstructive lung disease, therefore, it is justified to postulate a monitoring of lung function in children after pertussis infection throughout a longer period to detect early lung obstruction and setting up proper prophylactic measures.     

Overweight and obesity in prepubertal schoolchildren: the association with low birth weight and family antecedents of cardiovascular disease. Embu - metropolitan region of São Paulo, 2006

The aim was to determine the prevalence of overweight and obesity in schoolchildren and the association with birth weight and family antecedents of cardiovascular disease. This cross-sectional study used a probabilistic sample of 929 schoolchildren aged 6 to 10 years. The variables were: body mass index (BMI), birth weight and family antecedents of cardiovascular disease. The statistical analysis consisted of the chi-square test (Pearson) and odds ratio, as association measurements. Of the schoolchildren (54.6% of which were female), 14.4% and 13.3% were overweight and obese, respectively. Low birth weight was reported among 9.4% and family antecedents of cardiovascular disease among 35.2%. Overweight or obesity (BMI e" P85) was associated with the presence of family antecedents of cardiovascular disease (OR = 1.66; 95% CI 1.23-2.23) and male sex (OR = 1.37; 95%CI 1.02-1.83); there was no association with birth weight. The results indicate the need for preventive actions for children with family antecedents of cardiovascular disease.     

Knowledge on malaria transmission and its prevention among schoolchildren in Kyela District, south-western Tanzania

A school-based study was carried out to assess the knowledge on malaria and its prevention among children in Kyela District, south-western, Tanzania in August-September 2004. A total of 400 schoolchildren (age = 10-20 years) from four schools were selected. A structured questionnaire was used to collect data on knowledge on malaria transmission, methods of prevention, source of information and use of mosquito nets. More than 85% of the respondents were knowledgeable on malaria and preventive measures. Sources of information about malaria and its control were mainly from their teachers (47.4%), print materials (21.9%), family members (20.4%), television and radio (7.3%) and medical personnel (2.2.%). The perceived best control measures were untreated nets (32.1%), treated nets (21.4%), environmental management (25.7%) and burning mosquito coils and insect repellents (20.8%). Availability of mosquito nets was relatively high (70%), but only 38% of the pupils were using insecticide treated nets (ITNs). Low ITN use was due to its unavailability (57.5%), cost (35%) and foul smell and fear of side effects (7.5%). These findings suggest schoolchildren are aware about malaria and its prevention methods, but are not well-informed of the benefits of using ITNs. More education and advocacies on use of ITNs to parents and children is needed.     

Home and leisure injuries among fifth-grade schoolchildren in 2004-2005

A survey was conducted among a representative national sample of fifth-grade schoolchildren between September 2004 and June 2005. 97% of all injuries reported by 6,836 schoolchildren interviewed in Metropolitan France were home and leisure injuries (HLI). Quarterly incidence was established at 9.2 HLIs or traffic accidents per 100 children (confidence interval [8.3; 10.1]). One third of HLIs were found to occur at school, 20% at home, and 54% during a sport or physical activity. HLIs involved treatment in an emergency department in 60% of cases, a limitation of activities in 76% of cases, and exemption from physical education and sports in 57% of cases. The occurrence of severe HLIs was 1.4 times higher in children aged 11 and over ([1.03; 1.8] and in children who take part in sport on a regular basis ([1.1; 1.8]). The risk of a severe HLI was 1.8 times higher in children from families of four children or more ([1.1; 3.0]). No association was found between the occurrence of HLIs and gender, visual acuity and parents' occupational status. Based on data relating to fifth-grade schoolchildren, the results of this study require further research on specific age groups. Prevention efforts will need to reduce morbidity and mortality as a result of HLIs (over 250 child deaths per year).     

2001~2004年上海市中小学生伤害死亡流行病学分析

[目的]　了解上海市中小学生伤害死亡流行状况及相关特征,为政府部门制定预防控制措施提供依据。　[方法]　对上海市2001~2004年中小学生伤害死亡者入户询问调查,对资料进行统计分析。　[结果]　2001~2004年上海市中小学生伤害年均死亡率为8. 68 /10万,伤害致死占总死亡38. 71%,是中小学生第一位死因;伤害死亡主要原因为交通事故、中毒、意外跌落、淹死和自杀;不同性别年龄中小学生的伤害死亡构成不同。　[结论]　上海市中小学生伤害死亡有明显的年龄性别特征,应采取针对性措施预防控制伤害发生。     

Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden

BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.     

Dental caries activity in primary dentition, Indaiatuba, São Paulo, Brazil, 2004

This study aimed to verify caries activity and analyze caries experience, treatment needs, and enamel defects in 5-year-old preschool children in Indaiatuba, S?o Paulo State, Brazil. 624 children were selected by systematic random sampling in 2004. WHO criteria were used to measure caries experience and treatment needs. Nyvad et al. diagnostic criteria were used to analyze caries activity. Mann-Whitney and chi-square tests were used to analyze the results, with 5% significance. 40.5% of schoolchildren displayed caries activity. The dfmt was 1.62 (95%CI: 1.35-1.89). Among children with dfmt > 0, the index was 3.81 (95%CI: 3.36-4.26), and 91.4% of these children presented caries activity. Care Index was 12.3%. These results suggest that treatment measures and health promotion should continue to be prioritized, since the control measures and caries interruption during the initial stages are well known. Dental care should especially target schoolchildren with more significant caries experience.     

The relationship between malaria parasitaemia and availability of healthcare facility in Mpwapwa district, central Tanzania

A study was carried out in six villages located at different altitudes in Mpwapwa district of central Tanzania to determine malaria parasitaemia and transmission levels in villages with or without health care facilities. A total of 1119 schoolchildren (age = 5.9-12.3 years) were examined for malaria parasitaemia. Plasmodiumfalciparum was the predominant malaria species accounting for 92.8% of all species. The average malaria prevalence rate among schoolchildren was 25.8% (range 1.5-53.8%). The geometric mean parasite densities for P.falciparum was 361 (N = 286). Higher malaria prevalence was observed in villages at lower (< 1000 m) than at intermediate (1000-1500m) or higher (> 1500m) altitudes. Schoolchildren in areas with health care facilities were less at risk of acquiring malaria by 33.4% as compared with those living in areas without health facilities. Mean packed cell volume in schoolchildren was 38.5% (range = 35.2-41.0%). Splenomegaly was observed in 18.1% (0-40.2%) of the schoolchildren examined and it was higher among those in villages without health care facilities. Anopheles gambiae sensu lato was the only malaria vector found in the district and was found in all villages and at all altitudes. Sporozoite rate in An. gambiae s.l. ranged from 0-10.5%, with the lowland villages recording the highest rates. This study indicates that altitude and geographical accessibility to healthcare service are important determinants of malaria infection among rural communities in Tanzania.