School-based control of urinary schistosomiasis on Zanzibar, Tanzania: monitoring micro-haematuria with reagent strips as a rapid urological assessment.

OBJECTIVE: To evaluate micro-haematuria, detected by Haemastix reagent strips, for diagnosis of urinary schistosomiasis during a 3-year period of school-based control on Zanzibar. PATIENTS AND METHODS: A sub-set of school children, from a total of 135,000 who were receiving treatment for urinary schistosomiasis and soil-transmitted helminthiasis, were monitored by parasitological and questionnaire methods for Schistosoma haematobium infections: at treatment baseline in 2004 (n=2002), follow up with re-treatment in 2005 (n=3278) and further follow up with re-treatment in 2006 (n=3993). Standard diagnostic scores for micro-haematuria were calculated against parasitological assessment.
RESULTS: Diagnostic scores of Haemastix remained strong throughout the 3-year period. In 2006, scores were: sensitivity (SS)=0.86 (95% CI: 0.86-0.88), specificity (SP)=0.99 (0.98-1.00), positive predictive value (PPV)=0.90 (0.88-0.91), negative predictive value (NPV)=0.98 (0.98-0.99) in boys; and SS=0.84 (0.82-0.86), SP=0.98 (0.98-0.99), PPV=0.77 (0.75-0.79) and NPV=0.99 (0.99-1.00) in girls. By comparison, reported blood in urine and pain upon urination were much lower and not as informative.
CONCLUSION: At a cost of approximately pound sterling 0.20/test, further use of reagent strips for monitoring of urinary schistosomiasis during ongoing control programmes should be advocated as a rapid, cost-effective and informative disease surveillance tool.