Optimising cluster survey design for planning schistosomiasis preventive chemotherapy

PLoS Negl Trop Dis. 2017 May 26;11(5):e0005599. doi: 10.1371/journal.pntd.0005599. eCollection 2017 May.


Background: The cornerstone of current schistosomiasis control programmes is delivery of praziquantel to at-risk populations. Such preventive chemotherapy requires accurate information on the geographic distribution of infection, yet the performance of alternative survey designs for estimating prevalence and converting this into treatment decisions has not been thoroughly evaluated.

Methodology/principal findings: We used baseline schistosomiasis mapping surveys from three countries (Malawi, Côte d'Ivoire and Liberia) to generate spatially realistic gold standard datasets, against which we tested alternative two-stage cluster survey designs. We assessed how sampling different numbers of schools per district (2-20) and children per school (10-50) influences the accuracy of prevalence estimates and treatment class assignment, and we compared survey cost-efficiency using data from Malawi. Due to the focal nature of schistosomiasis, up to 53% simulated surveys involving 2-5 schools per district failed to detect schistosomiasis in low endemicity areas (1-10% prevalence). Increasing the number of schools surveyed per district improved treatment class assignment far more than increasing the number of children sampled per school. For Malawi, surveys of 15 schools per district and 20-30 children per school reliably detected endemic schistosomiasis and maximised cost-efficiency. In sensitivity analyses where treatment costs and the country considered were varied, optimal survey size was remarkably consistent, with cost-efficiency maximised at 15-20 schools per district.

Conclusions/significance: Among two-stage cluster surveys for schistosomiasis, our simulations indicated that surveying 15-20 schools per district and 20-30 children per school optimised cost-efficiency and minimised the risk of under-treatment, with surveys involving more schools of greater cost-efficiency as treatment costs rose.

MeSH terms

  • Adolescent
  • Chemoprevention / economics*
  • Child
  • Child, Preschool
  • Cote d'Ivoire / epidemiology
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Liberia / epidemiology
  • Logistic Models
  • Malawi / epidemiology
  • Male
  • Practice Guidelines as Topic
  • Praziquantel / therapeutic use*
  • Schistosomiasis / epidemiology
  • Schistosomiasis / prevention & control*
  • Schools
  • Surveys and Questionnaires / standards*
  • World Health Organization


  • Praziquantel

Grant support

This work was supported by the Department for International Development: Integrated Control of Schistosomiasis and Intestinal Helminths in Sub-Saharan Africa (ICOSA)—Phase 1 & 2 [GB-1-200706] grant to AF. https://devtracker.dfid.gov.uk/projects/GB-1-200706/documents. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.