Expert opinion on Schistosomiasis and soil transmitted helminths in Africa

With World Health Organization(WHO’s) road map for neglected tropical diseases2021−2030 requiring countries to eliminate at least one Neglected Tropical Diseases(NTDs) by 2030, countries are making tremendous efforts worldwide to end the devastating health, social and economic impacts caused by these NTDs.

In an exclusive interview with AfriSMC (Africa Science Media Centre), Dr. Pauline Mwinzi, Regional technical officer for Schistosomiasis and Soil Transmitted Helminths, WHO, talks about the progress African countries are making towards the elimination of two NTDs, bilharzia and soil transmitted helminths (STH), and what countries need to do in order to attain the elimination target. 

What is the burden of Schistosomiasis and soil transmitted helminths in Africa?

Schistosomiasis (also known as Bilharzia) and Soil Transmitted Helminths  (STH) are some of the leading diseases requiring preventive chemotherapy in up to 44 countries in Africa. 

They are very widespread and the burden of these diseases globally are almost entirely in Africa, accounting for 92% of the burden of these diseases.

It is a very big problem locally especially among school aged children because of the way children frequently interact with water  bodies during play, since you acquire the disease when you interact with water that has the intermediate host (snails) that then transmit the diseases to humans as a result of poor sanitation.

Therefore, besides preventive chemotherapy (mass treatments using the drug praziquantel) we encourage WASH interventions that involves sanitation, safe use of water and protection of water bodies where children play, and adults work, by ensuring that proper disposal of human waste and sanitation is observed in communities.

Are there countries that have achieved elimination in these diseases?

At the moment, countries have made  tremendous progress in the last ten years guided by our previous roadmap. We are now in a new dispensation of the Neglected Tropical Diseases(NTDs) Roadmap 2021- 2030 where we are expecting that countries would be moving towards elimination. Currently, none of the countries have achieved elimination within the current intervention measures because it is such a large burden. However, Mauritius needs an evaluation to confirm that transmission has been interrupted, while in Algeria we need to confirm the status and whether it is no longer a public health problem. 

Further, there are a number of countries where we can expect that with the current trajectory, that in the next three years, by 2025, would no longer be requiring mass treatment. For instance, Rwanda is making very great commitments to treatments, investing, the political will and trying to reach all the communities that are affected.

What can countries do to reach elimination?

WHO is working towards ensuring that countries refine their data so that the population that need these treatments are very well defined.

This requires moving away from looking at endemic areas as districts or at regional levels to looking at specific communities where people are interacting with  infected snail-infested water bodies where transmission occurs.

When we can identify those communities by looking at data and understanding transmission at the local levels, then we know we are reaching the exact population that requires  treatment.

For this, we need mapping and that is where the biggest gap is. We need to invest in mapping which involves collecting and understanding data at the community level as opposed to regionally and beginning to implement at those lower administrative levels.

Through this, we are able to make better estimations of populations that need treatments and the medicines that are needed for the same. This will enhance efficiency in distribution of medicines, this way we will target people that need the medicines and avoid wastage- treating people who do not need the medicines or leaving out people that needs treatment a situation which happens when you don’t have adequate community level data.

So, currently we want to ensure that countries can find resources to map. We have guidelines and tools in place to help them conduct this kind of evaluations, so they begin to use the data even at community levels.

Is it only mass drug administrations that can help in bilharzia and soil transmitted helminths?

For both Bilharzia and Soil Transmitted Helminths, the central intervention that we are providing is the mass treatment, or the mass drug administration (MDA). We are using Praziquantel for Schistosomiasis and Albendazole or Mebendazole for Soil Transmitted Helminths, which are all donated through WHO.However, this alone is not enough and that is why we keep treating every year because people get re-infected.

Therefore, we should also be able to work a lot towards prevention by ensuring that we have adequate sanitation at the community level, and adequate WASH measures; access to safe water, and ensuring that the water bodies that we interact with either for entertainment or domestic use are safe from raw human waste, by avoiding open defecation or open urination. In addition, there’s need to ensure snail control where feasible, so  that areas that have water bodies infested with these snails are controlled using available molluscicides like niclosamide in eligible areas 

Then of course, behaviour change communication (BCC) and health education is another important component because when people or communities do not know what they are dealing with, they are not likely to participate in the preventive measures. Therefore, health education and health communication in schools and communities is a very important component, which should be implemented in line with the local context in which people live. We are working with countries to ensure that this area is very well supported with communication materials and that countries submit to us their annual work plans, to ensure that such activities are well planned and budgeted for.

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