The control of morbidity in endemic and high risk populations can be accomplished with currently available antischistosomal drugs. This study measured the impact of community-based distribution of metrifonate to people with presumptive infection with S. haematobium Urinary schistosomiasis is endemic in the Diamare division of the Far-North province of Cameroon and is an important cause of morbidity in the population, especially among school-age children. W.H.O. proposes the use of the primary health care approach in controlling morbidity This community-based, controlled field experiment involved three villages and two interventions. Two case villages received either health education alone (HE) or health education in addition to the availability of single-dose metrifonate therapy dispensed by community health workers, on presumptive diagnosis of schistosomiasis (HE/CHW). A control village received no intervention. The objectives were to determine (a) if health education increased knowledge about the disease, (b) if treatment-seeking behaviour changed with either intervention, and (c) if there was a reduction in the total S. haematobium egg output in each village, depending on the intervention received The baseline prevalence of infection in the study populations of the three villages was less than 10 percent, but the prevalence in the 10-19 year olds was much higher (49%, 19% and 4% in the three villages respectively) The study showed that health education did indeed increase knowledge about schistosomiasis. It was also demonstrated that the positive predictive value of microscopic haematuria was adequate to be used for presumptive diagnosis of urinary schistosomiasis. The results, however, indicated that increased knowledge about the disease was not sufficient to affect treatment-seeking behaviour. Rather, the convenient availability of inexpensive and safe medication in the immediate community provided the key incentive for infected people to seek treatment. There was a 99.8 percent reduction in the total number of eggs shed by infected persons who received a single 10mg/kg dose of metrifonate between baseline and final surveys The use of community health workers in diagnosing and treating urinary schistosomiasis would greatly assist in morbidity control and in improving the health delivery system of medically underserved areas of Cameroon
