Quantitative evaluation of integrated schistosomiasis control: the example of passive case finding in Ghana.

Passive case finding based on adequate diagnosis and treatment of symptomatic individuals with praziquantel by the health care facilities is a minimum requirement for integrated schistosomiasis control. Two field studies were conducted in Ghana to obtain quantifications about the steps in this process: (1) a study of health-seeking behaviour through interview of individuals with reported schistosomiasis-related symptoms; (2) a study of the performance of the Ghanaian health system with regard to schistosomiasis case management by presenting clinical scenarios to health workers and collecting information about availability of praziquantel. It appeared that cases of blood in urine (the most typical symptom of Schistosoma haematobium) and blood in stool (the most typical symptom of S. mansoni) have a very small probability of receiving praziquantel (4.4% and 1.4%, respectively) from health facilities. Programmes aimed at making the drug available at all levels of the health care delivery system and encouraging health-seeking behaviour through health education are not likely to increase these probabilities beyond 30%. This is because many cases with blood in urine do not consider it serious enough to seek health care, and blood in stool usually requires (imperfect) diagnostic testing and referral. We therefore conclude that additional control activities, especially for high-risk groups, will remain necessary.