Abstract
Recent work has estimated that sub-Saharan Africa could lose US$3.5 billion of economic productivity every year as a result of schistosomiasis and soil-transmitted helminthiasis. One of the main interventions to control schistosomiasis is the provision of safe water to limit the contact with infected water bodies and break the cycle of transmission. To date, a rigorous quantification of the impact of safe water supplies on schistosomiasis is lacking. Using data from one of Africa's largest population-based cohorts, we establish the impact of the scale-up of piped water in a typical rural South African population over a seven-year time horizon. High coverage of piped water in the community decreased a child's risk of urogenital schistosomiasis infection eight-fold (adjusted odds ratio = 0.12, 95% CI 0.06-0.26, p<0.001). The provision of safe water could drive levels of urogenital schistosomiasis infection to low levels of endemicity in rural African settings.
Highlights
Schistosomiasis is a chronic parasitic disease caused by blood flukes of the genus Schistosoma and transmitted by snails found in fresh water bodies that have been contaminated by Schistosoma eggs
Our results reveal a large impact of piped water scale-up on urogenital schistosomiasis infection
This impact is substantially greater than previous results had suggested (Grimes et al, 2014), based on measurement of access to safe water supplies at the household or individual level
Summary
Schistosomiasis is a chronic parasitic disease caused by blood flukes of the genus Schistosoma and transmitted by snails found in fresh water bodies that have been contaminated by Schistosoma eggs. 240 million people worldwide (WHO, 2010; Stothard et al, 2009) are infected with schistosomiasis, with a disease burden of 3.3 million disability-adjusted life-years (Murray et al, 2012). Following the London declaration (Uniting to Combat Neglected Tropical Diseases, 2012), the World Health Organization (WHO) has set a goal of increasing mass drug administration coverage to 75% of at-risk children in endemic countries (WHO, 2013). Despite progress in many so-called ‘neglected tropical diseases’, the fourth progress report of the London Declaration records that schistosomiasis has the lowest coverage of all helminth diseases treatable by mass drug administration (Uniting to Combat Neglected Tropical Diseases, 2016)
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