SummaryOur aim was to compare the performance of the Sahli and Colour Scale methods in diagnosing anaemia in school children, where the prevalence of anaemia is low and the haemoglobin level ranges from mild to moderate (8-11 g/dl). The study was conducted in February 2001, in Qena Governorate, Upper Egypt. The haemoglobin level measured by the two methods in each child were compared with the result obtained by using a portable haemoglobin photometer ÔHemoCueÕ. A total of 149 school children were included in the study. Using HemoCue, 17.4% children were anaemic; using the Sahli method (SM), 66.4% children were anaemic; and using the Haemoglobin Colour Scale (HCS) method, 57.7% children were anaemic. Neither method detected any cases of severe anaemia (Hb < 7 g/dl). Both the Sahli and Colour Scale methods are sensitive but have low specificity, giving a high rate of false positive results. Both methods perform perform very similarly in haemoglobin measurement; they fulfil many of the criteria for their use at primary health care level and detect almost all cases of anaemia in a given population, even if the level of anaemia is mild. Standards for collection, handling and disposal of blood samples are guaranteed more easily by the HCS than the SM. Moreover, lay people can easily manage the HCS with success after brief training. We suggest to gradually replace the SM by the HCS method in primary health care (PHC) centres. Where anaemia levels are moderate to mild, the use of SM and HCS as tools to define anaemia prevalence might be limited, as they often label healthy individuals as anaemic. Both methods remain a useful diagnostic tool to confirm the diagnosis of clinically suspected anaemia in areas where the prevalence of anaemia is low and the haemoglobin level ranges from mild to moderate.keywords haemoglobin measurement, Haemoglobin Colour Scale method, Sahli method, Egypt

Several studies have reported a higher prevalence of infection for human fascioliasis among girls than among boys. To investigate this aspect further a sufficiently large data set was assembled comprising of 21,477 subjects with 932 positive cases. Subjects were primary school children covered by a control programme implemented by the Egyptian Ministry of Health and Population in the Nile Delta from 1988 to 2002. Stool analyses were performed by the Kato-Katz thick smear technique for a quantitative diagnosis on the intensity of infection. Both prevalence and intensity of infection, indirectly measured as mean number of eggs per gram of faeces, were significantly higher among girls than boys. The higher level of infection in girls was consistent across different years and in different survey areas. Co-infection with Schistosoma mansoni was present and associated with fascioliasis, but schistosomiasis was significantly more prevalent among boys. In Egypt rural girls are often involved in household and farm work and are exposed more than boys to infected foci. The lower school attendance for girls in rural areas appears to be an important factor increasing risk of infection. The precise mode of transmission and behavioural risk factors for human infection need to be investigated further to identify those related to gender.

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Praziquantel is still very effective for the treatment of schistosomiasis, but there are rising concerns on the potential risk of developing resistances because of the extensive use of this drug. Triclabendazole, a systemic anthelmintic, is very effective against other trematodes such as Paragonimus spp. and Fasciola spp. It has been reported to be effective in vitro and in experimental animals against Schistosoma mansoni. However, its antischistosomal efficacy in humans has not yet been evaluated. The objective of the study was to evaluate the efficacy of triclabendazole at the dosage currently used for the treatment of human fascioliasis (10mg/kg body weight) in subjects co-infected with S. mansoni and Fasciola spp. The study was carried out in Behera, a highly endemic area for both parasites, by personnel of the Egyptian Ministry of Health and Population. Ten subjects (m = 4, f = 6; age, 8-58years), who were infected at the same time by Fasciola spp. and S. mansoni, were enrolled. Six weeks after therapy, seven subjects were still excreting ova of S. mansoni, whereas none was excreting Fasciola spp. ova. At the given dosage, triclabendazole appeared not to be sufficiently effective in the treatment of S. mansoni.

A study was carried out during January/February 2001 in Deshna and Armant Districts of Qena Governorate, Upper Egypt, to establish the prevalence of anaemia among schoolchildren aged 6 to 11 years and define appropriate control interventions in the area. Haemoglobin levels were measured directly in schools using a portable spectrophotometer. The mean [SD] level of haemoglobin in 1844 schoolchildren in 37 schools was 12.79 [1.15] g/dL. Only 12% of children were below the WHO cut-off for anaemia for this age group [< 11.5 g/dL] and no cases of severe anaemia [< 7.0 g/dL] were detected. The low prevalence of mild to moderate anaemia indicates that mass iron supplementation is not justifiable, but routine monitoring of haemoglobin levels should be part of the public health activities in the schools