Scoliosis Screening in Public Schools in Antananarivo

 Background : Scoliosis affects the growing spine, so it is essential to monitor it regularly during this period ; hence, there is a need for early detection.

Objective : To establish initial reference data and raise awareness of the relevance of systematic and early school-based screening for scoliosis owing to its potential progression and long-term repercussions.

Methods : A descriptive and analytical multicenter cross-sectional study was conducted in public schools located in the districts of Antananarivo Renivohitra and Ambohidratrimo. Stratified cluster sampling was then performed.

Results : Among 780 students, the proportion of screening-positive suspected scoliosis was 10.25% (N=80), based on clinical screening without radiographic confirmation. Distribution by district was more predominant in Antananarivo Renivohitra (52 cases, 65%) than in Ambohidratrimo (28 cases, 35%), with a statistically significant difference (adjusted Odds Ratio (aOR) = 2.3; 95% CI :1.4-3.9 ; P=0.001). The "adolescent scoliosis" category was the most predominant (79 cases, 98.75%). Female were predominantly diagnosed (sex ratio =0.63). Back pain was reported (10.13%) and was associated with higher odds of screening positivity (aOR = 2.1 ; 95% CI : 1.1-3.8 ; P = 0.02). Of these, 26.92% were in late puberty (Tanner stage IV), and compared to Tanner stage I, stage V was associated with an 18-fold increase in odds (aOR 18.4, 95% CI 5.2–65.0 ; P < 0.001). The most frequent curve patterns of screened scoliosis was right thoracic (34.28%).

Conclusions : Adolescent scoliosis was the most screened form, affecting the pubertal stage, with a variable geographical distribution. These findings highlight both the importance and feasibility of early and school-based scoliosis detection, enabling timely identification of "at-risk students" before developing severe spinal deformities with their consequences in adulthood, for which conservative treatments such as Physical Therapy and bracing, are available in the country.

Ethical Compliance : The studies were conducted as medical check-ups in accordance with the local legislation institutional requirements and ethical standards, such as mandatory medical visits before starting the school year. All participants provided written informed consent to participate in this study. Prior consent from the CISCO (Circonsription Scolaire) Chiefs of Antananarivo Renivohitra and Ambohidratrimo, as well as those from the principals of each school, was also required before informing parents or legal guardians of each student. Written informed consent was obtained from the parents and minors’legal guardians for the publication of any potentially identifiable images or data included in this article. There were no possible harms of the screening procedures, and we relied on global expert opinions, considering the perceived harm written in the scientific literature. Ethical approval was not required for this study.

Author Contributions : RPR and GDS designed the research ; RPR and SBR conducted the research ; RPR analyzed the data ; RPR wrote the paper ; RPR, SBR, and GDS had primary responsibility for the final content ; and GDS Academic Advisor. All authors have read and approved the final manuscript.