Health-Related Quality of Life among School Children with Parasitic Infections: Findings from a National Cross- Sectional Survey in Co ˆ te d’Ivoire Eveline Hu ¨ rlimann 1,2,3 , Clarisse A. Houngbedji 1,2,3,4 , Richard B. Yapi 1,2,3,5 , Prisca B. Ndri 3,4 , Kigbafori D. Silue ´ 3,5 , Gotianwa Soro 6 , Ferdinand N. Kouame ´ 6 , Thomas Fu ¨ rst 7,8 , Ju ¨ rg Utzinger 1,2 , Elie ´ zer K. N’Goran 3,5 , Giovanna Raso 1,2,3 * 1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland, 2 University of Basel, Basel, Switzerland, 3 De ´partement Environnement et Sante ´, Centre Suisse de Recherches Scientifiques en Co ˆ te d’Ivoire, Abidjan, Co ˆ te d’Ivoire, 4 Unite ´ de Formation et de Recherche Sciences de la Nature, Universite ´ Nangui Abrogoua, Abidjan, Co ˆ te d’Ivoire, 5 Unite ´ de Formation et de Recherche Biosciences, Universite ´ Fe ´lix Houphoue ¨ t-Boigny, Abidjan, Co ˆ te d’Ivoire, 6 Programme National de Sante ´ Scolaire et Universitaire, Abidjan, Co ˆ te d’Ivoire, 7 Centre for Health Policy, Imperial College London, London, United Kingdom, 8 Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom Abstract Background: Parasitic infections are still of considerable public health relevance, notably among children in low- and middle-income countries. Measures to assess the magnitude of ill-health in infected individuals, however, are debated and patient-based proxies through generic health-related quality of life (HrQoL) instruments are among the proposed strategies. Disability estimates based on HrQoL are still scarce and conflicting, and hence, there is a need to strengthen the current evidence-base. Methodology: Between November 2011 and February 2012, a national school-based cross-sectional survey was conducted in Co ˆ te d’Ivoire. Children underwent parasitological and clinical examination to assess infection status with Plasmodium and helminth species and clinical parameters, and responded to a questionnaire interview incorporating sociodemographic characteristics, self-reported morbidity, and HrQoL. Validity analysis of the HrQoL instrument was performed, assessing floor and ceiling effects, internal consistency, and correlation with morbidity scores. Multivariate regression models were applied to identify significant associations between HrQoL and children’s parasitic infection and clinical status. Principal Findings: Parasitological examination of 4,848 children aged 5–16 years revealed Plasmodium spp., hookworm, Schistosoma haematobium, Schistosoma mansoni, Ascaris lumbricoides, and Trichuris trichiura prevalences of 75.0%, 17.2%, 5.7%, 3.7%, 1.8%, and 1.3%, respectively. Anemic children showed a significant 1-point reduction in self-rated HrQoL on a scale from 0 to 100, whereas no significant negative association between HrQoL and parasite infection was observed. The 12-item HrQoL questionnaire proofed useful, as floor and ceiling effects were negligible, internally consistent (Cronbach’s alpha = 0.71), and valid, as revealed by significant negative correlations and associations with children’s self-reported and clinically assessed morbidity. Conclusions/Significance: Our results suggest that HrQoL tools are not sufficiently sensitive to assess subtle morbidities due to parasitic infection in Ivorian school-aged children. However, more advanced morbid sequelae (e.g., anemia), were measurable by the instrument’s health construct. Further investigations on health impacts of parasitic infection among school-aged children and refinement of generic HrQoL questionnaires are warranted. Citation: Hu ¨ rlimann E, Houngbedji CA, Yapi RB, Ndri PB, Silue ´ KD, et al. (2014) Health-Related Quality of Life among School Children with Parasitic Infections: Findings from a National Cross-Sectional Survey in Co ˆ te d’Ivoire. PLoS Negl Trop Dis 8(12): e3287. doi:10.1371/journal.pntd.0003287 Editor: Ronald Edward Blanton, Case Western Reserve University, United States of America Received May 19, 2014; Accepted September 22, 2014; Published December 4, 2014 Copyright: ß 2014 Hu ¨ rlimann et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. Data are available within the Supporting Information files. Funding: This investigation received financial support from the Swiss National Science Foundation (SNSF, project no. 32003B_132949). TF is grateful to the SNSF for an Early Postdoc Mobility fellowship (project no. PBBSP3-146869). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * Email: giovanna.raso@unibas.ch Introduction Malaria and the neglected tropical diseases (NTDs) are still of considerable public health relevance in the tropics and subtropics and their successful control is a key issue toward progress of the millennium development goals (MDGs) and the post-2015 agenda of sustainable development [1–4]. Preschool-aged children are considered at highest risk of malaria, whereas school-aged children are the most affected by parasitic worm infections (helminthiases) [5–7]. The assessment of the precise burden attributable to PLOS Neglected Tropical Diseases | www.plosntds.org 1 December 2014 | Volume 8 | Issue 12 | e3287