Scoliosis Screening in Public Schools in Antananarivo
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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.
Asher MA, Burton DC. Adolescent idiopathic scoliosis: natural history and long term treatment effects. Scoliosis. 2006;1(1):2. doi:10.1186/1748-7161-1-2
Zou Y, Lin Y, Meng J, Li J, Gu F, Zhang R. The Prevalence of Scoliosis Screening Positive and Its Influencing Factors: A School-Based Cross-Sectional Study in Zhejiang Province, China. Front Public Health. 2022;10. doi:10.3389/fpubh.2022.773594
Altaf F, Gibson A, Dannawi Z, Noordeen H. Adolescent idiopathic scoliosis. BMJ. 2013;346:f2508. doi:10.1136/bmj.f2508
Hu M, Zhang Z, Zhou X, et al. Prevalence and determinants of adolescent idiopathic scoliosis from school screening in Huangpu district, Shanghai, China. Am J Transl Res. 2022;14(6):4132-4138.
Simon AL. [Detection and surveillance of idiopathic scoliosis]. Rev Prat. 2015;65(9):1155-1158.
Lechevallier J, Leroux J, Abu Amara S. Scoliose idiopathique de l’enfant et de l’adolescent. EMC - Traité de médecine AKOS. 2012;15(3):1-11. doi:10.1016/S1634-6939(12)56324-6
Mary P. Prise en charge de la scoliose idiopathique de l’enfant et de l’adolescent. Revue du Rhumatisme. 2004;71(2):160-170. doi:10.1016/j.rhum.2003.11.009
R V. Comment faire le dépistage d’une scoliose ? Réalités Pédiatriques. October 6, 2012. Accessed February 6, 2026. https://www.realites-pediatriques.com/comment-faire-le-depistage-dune-scoliose/
Wang Y, Yang F, Wang D, et al. Correlation analysis between the pulmonary function test and the radiological parameters of the main right thoracic curve in adolescent idiopathic scoliosis. J Orthop Surg Res. 2019;14(1):443. doi:10.1186/s13018-019-1451-z
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. JAMA. 2003;289(5):559-567. doi:10.1001/jama.289.5.559
Linker B. A Dangerous Curve: The Role of History in America’s Scoliosis Screening Programs. Am J Public Health. 2012;102(4):606-616. doi:10.2105/AJPH.2011.300531
Hresko MT, Schwend RM, Hostin RA. Early Detection of Scoliosis-What the USPSTF “I” Means for Us. JAMA Pediatr. 2018;172(3):216-217. doi:10.1001/jamapediatrics.2017.5585
Dufour, Anne-Sophie (2018), Dépistage et prise en charge de la scoliose idiopathique de l’enfant et de l’adolescent en médecine générale [Thèse d’exercice].
Santé Maghreb en Algérie - Revue de presse. Accessed February 6, 2026. https://www.santemaghreb.com/algerie_2015/actus.asp?id=5353
Lavieeco. Médecine scolaire et dépistage précoce de la scoliose. La Vie éco. January 8, 2009. Accessed October 10, 2022. https://www.lavieeco.com/influences/medecine-scolaire-et-depistage-precoce-de-la-scoliose-12647/
Coopération ivoiro-turque: 2 patients opérés de la scoliose à Tiassalé. Journal de Bangui. November 26, 2021. Accessed October 10, 2022. https://www.journaldebangui.com/cooperation-ivoiro-turque-2-patients-operes-de-la-scoliose-a-tiassale/
US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for Adolescent Idiopathic Scoliosis: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(2):165-172. doi:10.1001/jama.2017.19342
Garg RK, Somvanshi DS. Spinal tuberculosis: A review. The Journal of Spinal Cord Medicine. 2011;34(5):440-454. doi:10.1179/2045772311Y.0000000023
Shetty A, Kanna RM, Rajasekaran S. TB spine—Current aspects on clinical presentation, diagnosis, and management options. Seminars in Spine Surgery. 2016;28(3):150-162. doi:10.1053/j.semss.2015.07.006
Ferrer MF, Torres LG, Ramírez OA, Zarzuelo MR, Del Prado González N. Tuberculosis of the spine. A systematic review of case series. International Orthopaedics (SICOT). 2012;36(2):221-231. doi:10.1007/s00264-011-1414-4
Hresko MT, Talwalkar V, Schwend R. Early Detection of Idiopathic Scoliosis in Adolescents. The Journal of Bone and Joint Surgery. 2016;98(16):e67. doi:10.2106/JBJS.16.00224
Luk KDK, Lee CF, Cheung KMC, et al. Clinical Effectiveness of School Screening for Adolescent Idiopathic Scoliosis: A Large Population-Based Retrospective Cohort Study. Spine. 2010;35(17):1607-1614. doi:10.1097/BRS.0b013e3181c7cb8c
Lein GA. Screening for adolecent idiopathic scoliosis: A literature review. Pediatr Traum Orthop Reconstr Surg. 2022;10(3):309-320. doi:10.17816/PTORS107136
Heemskerk JL, de Groot C, Willigenburg NW, Altena MC, Kempen DHR. Screening for adolescent idiopathic scoliosis is more accurate when performed by healthcare professionals compared to untrained parents: a diagnostic accuracy study. Eur Spine J. 2022;31(9):2339-2347. doi:10.1007/s00586-022-07115-z
Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. doi:10.1186/s13013-017-0145-8
Coelho DM, Bonagamba GH, Oliveira AS. Scoliometer measurements of patients with idiopathic scoliosis. Braz J Phys Ther. 2013;17(2):179-184. doi:10.1590/S1413-35552012005000081
Huang J, Zhou X, Li X, et al. Regional disparity in epidemiological characteristics of adolescent scoliosis in China: Data from a screening program. Front Public Health. 2022;10:935040. doi:10.3389/fpubh.2022.935040
Grivas TB, Vasiliadis E, Savvidou O, Mouzakis V, Koufopoulos G. Geographic latitude and prevalence of adolescent idiopathic scoliosis. Stud Health Technol Inform. 2006;123:84-89.
Yamamoto S, Shigematsu H, Kadono F, et al. Adolescent Scoliosis Screening in Nara City Schools: A 23-Year Retrospective Cross-Sectional Study. Asian Spine J. 2015;9(3):407-415. doi:10.4184/asj.2015.9.3.407
Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013;7(1):3-9. doi:10.1007/s11832-012-0457-4
Dunn J, Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Lin JS. Screening for Adolescent Idiopathic Scoliosis: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(2):173-187. doi:10.1001/jama.2017.11669
De Bodman C, Zambelli PY, Dayer R. [Adolescent idiopathic scoliosis : diagnostic criteria and management]. Rev Med Suisse. 2017;13(550):422-426.
Laura Tejo Mariano. Dépistage de la scoliose chez les enfants et les adolescents : pratique des médecins généralistes de Picardie. Médecine humaine et pathologie. 2019;(dumas-02108886).
