Feature Medicine in Developing Countries

Do schools hold the key to controlling parasitic disease?

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1565 (Published 26 March 2010) Cite this as: BMJ 2010;340:c1565
  1. Gavin Yamey, lead
  1. 1Evidence to Policy Initiative (E2Pi), Global Health Group, University of California San Francisco, USA
  1. YameyG{at}globalhealth.ucsf.edu

    The rising rate of school attendance in many African countries is providing an unparalleled opportunity to reach children burdened by parasitic disease. Gavin Yamey explores how Kenya is seizing its chance

    Jimmy Kihara, a 52 year old parasitologist, picks up a clear plastic bottle containing a urine sample given a few minutes ago by a child at the Mkunumbi Primary School on Kenya’s northern coast. The urine is stained deep red with blood.

    “This child has bilharzia,” he says.

    Throughout the morning I visited the school, children lined up with great excitement to give samples of urine, stool, and blood. They were being tested not just for schistosomiasis (bilharzia), but for two other parasitic diseases—malaria and intestinal worms—as part of a national prevalence survey.

    The national survey is one of the ways in which Kenya is capitalising on its impressive progress towards the second millennium development goal: universal primary school education by 2015. With school attendance on the rise, the country has a tremendous opportunity to reach children infected with parasites. Schools are fast becoming a crucial venue for disease control.

    Intolerable burden

    Parasite infection is common among school aged children in Kenya. In a recent survey at Mililani primary school in the southern coastal district of Kwale, three in four children were infested with worms and one in six had malaria parasitaemia.

    Chimwaga Manga, headmaster of Mililani school, blamed the high rate of schistosomiasis on the nearby lake where children play. “It has stagnant water with snails,” he said.

    Children also get infected with intestinal worms, or soil transmitted helminths, when they ingest eggs from contaminated soil or when larvae in the soil penetrate their skin. These worms spread easily around the community, explained Mr Manga, because few families have latrines and the soil in the village gets contaminated with faeces …

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