Schistosomiasis Control Activities Research Articles

Cross-sectoral role and community empowerment in controlling schistosomiasis in Indonesia

The role of cross-sectors in synergy with community empowerment in controlling schistosomiasis is a very effective model. Until mid-2017, the incidence rate of disease in humans in 28 endemic villages still ranged 0.00-2.15%. This research aims to evaluate schistosomiasis control activities that have been carried out across sectors based on a road map for schistosomiasis eradication and community empowerment in controlling schistosomiasis. The study was mixed method. Data were obtained by in-depth interview with key informants and evaluation of the results of cross-sectoral and community activities. The research was carried out in an endemic area for schistosomiasis on the Bada Plateau, Indonesia, from January to November 2019. In conclusion, the potential of cross-sector collaboration in controlling schistosomiasis has not been fully realized due to budget constraints. Community empowerment is carried out to eliminate snail foci, increase the scope of feces collection and change community behavior for the better in order to avoid infection and always try to clean up snail foci.

Capacity building in schistosomiasis control institutions in China: a cross-sectional study

To understand the current status of capacity building in schistosomiasis control institutes in schistosomiasis-endemic provinces (municipality, autonomous region) of China. The responsibilities and construction requirements of various schistosomiasis control institutions were surveyed by expert discussions, and field interviews and visits during the period between May and June, 2023, and the questionnaire for capacity maintenance and consolidation in schistosomiasis control institutions was designed. An online questionnaire survey was conducted in county-, municipal-, and provincial-level institutions that undertook schistosomiasis control and surveillance activities through the Wenjuanxing program. The distribution of schistosomiasis control institutions, the status of institutions, departments and staff undertaking schistosomiasis control activities and the translation of scientific researches on schistosomiasis control in China were analyzed. The laboratories accredited by China National Accreditation Service for Conformity Assessment (CNAS) were considered to be capable for testing associated with schistosomiasis control, and the testing capability of schistosomiasis control institutions was analyzed. A total of 486 valid questionnaires were recovered from 486 schistosomiasis control institutions in 12 endemic provinces (municipality, autonomous region) of China, including 12 provincial-level institutions (2.5%), 77 municipal-level institutions (15.8%) and 397 county-level institutions (81.7%). Of all schistosomiasis control institutions, 376 (77.4%) were centers for disease control and prevention or public health centers, 102 (21.0%) were institutions for schistosomiasis, endemic disease and parasitic disease control, and 8 (1.6%) were hospitals, healthcare centers or others. There were 37 713 active employees in the 486 schistosomiasis control institutions, including 5 675 employees related to schistosomiasis control, and the proportions of employees associated with schistosomiasis control among all active employees were 5.9% (231/3 897), 5.5% (566/10 134), and 20.6% (4 878/23 682) in provincial-, municipal-, and county-level institutions, respectively. There were 3 826 full-time employees working in schistosomiasis control activities, with 30.5% (1 166/3 826), 34.6% (1 324) and 34.9% (1 336/3 826) at ages of 40 years and below, 41 to 50 years and over 50 years, and there were 1 571 (41.0%) full-time schistosomiasis control employees with duration of schistosomiasis control activities for over 25 years, and 1 358 (35.5%) employees with junior professional titles and 1 290 with intermediate professional titles (35.5%), while 712 (18.6%) full-time employees working in schistosomiasis control activities had no professional titles. The three core schistosomiasis control activities included snail control (26.3%, 374/1 420), epidemics surveillance and management (25.4%, 361/1 420) and health education (18.8%, 267/1 420) in schistosomiasis control institutions. The Kato-Katz method, miracidium hatching test with nylon gauzes, and indirect haemagglutination assay (IHA) were the most commonly used techniques for detection of schistosomiasis, and there were less than 50% laboratories that had capabilities or experimental conditions for performing enzyme-linked immunosorbent assay (ELISA), dipstick dye immunoassay (DDIA), dot immunogold filtration assay (DIG-FA), loop-mediated isothermal amplification (LAMP) and polymerase chain reaction (PCR) assays. During the period from 2018 to 2022, schistosomiasis control institutions had undertaken a total of 211 research projects for schistosomiasis control, with a total funding of 18.596 million RMB, published 619 articles, participated in formulation of 13 schistosomiasis control-related criteria, and applied for 113 schistosomiasis control-related patents, including 101 that were granted, and commercialized 4 scientific research outcomes. The proportion of independent specialized schistosomiasis control institutions is low in schistosomiasis control institutions in China, which suffers from problems of unsatisfactory laboratory testing capabilities, aging of staff and a high proportion of low-level professional titles. More investment into and intensified schistosomiasis control activities and improved capability building and talent cultivation in schistosomiasis control institutions are recommended to provide a powerful support for high-quality elimination of schistosomiasis in China.

Shifting the dynamics: implementation of locally driven, mixed-methods modelling to inform schistosomiasis control and elimination activities

IntroductionThe integration of more diverse perspectives into the development of evidence for decision-making has been elusive, despite years of rhetoric to the contrary. This has led to cycles of population-based...

Primary health care facilities capacity gaps regarding diagnosis, treatment and knowledge of schistosomiasis among healthcare workers in North-western Tanzania: a call to strengthen the horizontal system

BackgroundThe World Health Organization (WHO) calls for schistosomiasis endemic countries to integrate schistosomiasis control measures into the primary health care (PHC) services; however, in Tanzania, little is known about the capacity of the primary health care system to assume this role. The objective of this study was to assess the capacity of the primary health care system to diagnose and treat schistosomiasis in endemic regions of north-western Tanzania.MethodsA total of 80 randomly-selected primary health care facilities located in the Uyui, Geita and Ukerewe districts of North-western Tanzania participated in the study. At each facility, the in-charge clinician, or any other healthcare worker appointed by the in-charge clinician, participated in the questionnaire survey. A quantitative questionnaire installed in a Data Tool Kit software was used to collect data. Healthcare workers working at various stations (laboratory, pharmacy, data clerks, outpatient section) were interviewed. The questionnaire collected information related to healthcare workers’ knowledge about urogenital and intestinal schistosomiasis symptoms, human and material resources, laboratory services, data capture, and anti-schistosomiasis treatment availability.ResultsA total of 80 healthcare workers were interviewed. Bloody stool (78.3 %) and haematuria (98.7 %) were the most common symptoms of intestinal and urogenital schistosomiasis mentioned by healthcare workers. Knowledge on the chronic symptoms such as hepatosplenomegaly and hematemesis for intestinal schistosomiasis, and oliguria and dysuria for urogenital schistosomiasis, were inadequate. Laboratory services were only available in 33.8 % (27/80) of the health facilities and direct wet preparation was the most common diagnostic technique used for both urine and stool samples. All healthcare workers knew that praziquantel was the drug of choice for the treatment of schistosomiasis and the drug was available in 91.3 % (73/80) of the health facilities.ConclusionsThe capacity of the primary health care facilities included in the current study is inadequate in terms of diagnosis, treatment, reporting and healthcare workers’ knowledge of schistosomiasis. Thus, the integration of schistosomiasis control activities into the primary healthcare system requires these gaps to be addressed.

Prevalence, infection intensity and geographical distribution of schistosomiasis among pre-school and school aged children in villages surrounding Lake Nyasa, Tanzania

Planning and implementation of schistosomiasis control activities requires an understanding of the prevalence, intensity of infection and geographical distribution of the disease in different epidemiological settings. Although, Tanzania is known to be highly endemic to schistosomiasis, there is paucity of data on the geographical distribution of schistosomiasis in potential large water bodies in the country. Thus, the present study was conducted to determine the prevalence, infection intensities and geographical distribution of schistosomiasis along villages located on the shoreline of Lake Nyasa, southern Tanzania. A cross-sectional study was conducted among 1560 children aged 1–13 years old living in villages located along the shoreline of Lake Nyasa. A single urine and stool sample was obtained from each participating child and screened for S.mansoni using Kato Katz (KK) technique to detect eggs and using point-of-care circulating Cathodic Antigen (POC-CCA) test to detect antigen in urine. Urine filtration technique was used to screen for S.haematobium eggs in urine samples. Villages/primary school were mapped using geographical information system and prevalence map was generated using ArcView GIS software. The overall prevalence of S.mansoni based on KK technique and POC-CCA test was 15.1% (95%CI: 13.4–16.9) and 21.8% (95%CI: 18.5–25.3) respectively. The prevalence S.haematobium was 0.83% (95%CI: 0.5–1.4) and that of haematuria was 0.9%. The arithmetic mean egg intensities for S.haematobium and S.mansoni were 18.5 mean eggs/10 ml (95%CI: 5.9–57.6) of urine and 34.7 mean epg (95%CI: 27.7–41.7) respectively. Villages located on the southern end of the lake had significantly high prevalence of S.mansoni than those located on the northern part (χ2 = 178.7838, P = 0.001). Cases of S.haematobium were detected only in three villages. Both S.mansoni and S.haematobium infections occur in villages located along the shoreline of Lake Nyasa at varying prevalence. These finding provide insights that can provide guidance in planning and implementation of MDA approach and other recommended measures such as improvement in sanitation, provision of clean water and behaviour changes through public health education.

Flood disasters and schistosomiasis control

Currently, the endemic situation of schistosomiasis has dropped to the lowest level in China; however, there are still factors affecting the transmission of schistosomiasis. Flood disasters may pose a great impact on the transmission of schistosomiasis and even affect the progress of schistosomiasis control and the consolidation of schistosomiasis control achievements. In 2020, major flood disasters occur across China. This paper analyzes the current status of schistosomiasis and the impact of flood disasters on the transmission of schistosomiasis in China, and systematically describes the assessment of and response to schistosomiasis transmission risk before flood disasters, the prevention of Schistosoma japonicum infections during flood disasters and the assessment of the endemic situation of schistosomiasis and surveillance of schistosomiasis after flood disasters. It is considered that schistosomiasis control is an important part of conventional schistosomiasis control activities and an important part of anti-flood and schistosomiasis-preventive activities in flood disaster-affected areas. It is recommended that emergence response interventions are implemented in a scientific and well-organized manner to avoid or reduce the risk of schistosomiasis transmission caused by flood disasters. In addition, the research on early surveillance and forecast approaches for schistosomiasis should be emphasized and reinforced to provide the scientific and precise tools for achieving the goal of the 13th Five-year Plan for Schistosomiasis Control and elimination of schistosomiasis in China.

Challenges of schistosomiasis control in China during the coronavirus disease 2019 (COVID-19) epidemic

To investigate the implementation of schistosomiasis control activities in China during the coronavirus disease 2019 (COVID-19) epidemic, so as to evaluate the impact of COVID-19 epidemic on the national schistosomiasis control program in China. On April 2020, 3 counties (districts) were randomly selected from each of the 12 schistosomiasis-endemic provinces (municipality, autonomous region), and a questionnaire survey was conducted to investigate the implementation of schistosomiasis control activities in these counties (districts) from January to March 2020. Then, the impact of the COVID-19 epidemics on the national schistosomiasis control program of China was evaluated using a comparative analysis approach. Among the 36 counties (cities, districts) sampled from 12 provinces (municipality, autonomous region), 66.67% were at a high and medium risk of COVID-19 epidemics. The implementation of schistosomiasis control activities assignment, human schistosomiasis examination and treatment, snail control with chemical treatment and health education reduced by 44.26% to 91.56% as compared to 2019 during the same time period, and the schistosomiasis control program was more affected by COVID-19 in transmission-controlled provinces. The gross funds invested into the schistosomiasis control program reduced by 23.39% in relative to the expected, while the total expenditure increased by 41.22%. In addition, all 36 surveyed counties (districts) considered that the COVID-19 epidemic had a short-term impact on the schistosomiasis control program, with the most predominant impact on schistosomiasis control activities assignment, human resources and monitoring of endemic situation of schistosomiasis. The COVID-19 epidemics affect the routine schistosomiasis control program across the endemic-foci of China. Policy and financial support should be strengthened to ensure the completion of the schistosomiasis control program.

Challenges and countermeasures of schistosomiasis control in Hunan Province in the new era

This paper describes the current epidemic characteristics and endemic status of schistosomiasis, analyzes the main challenges of schistosomiasis control and proposes the emphasis and interventions for future schistosomiasis control activities in Hunan Province, so as to provide insights into the elimination of schistosomiasis in Hunan Province.

Progress of schistosomiasis control in Dongting Lake regions

As an ancient parasitic disease, schistosomiasis has been endemic in Dongting Lake areas for more than 2 100 years. In the early 20th century, the first human case of schistosomiasis in China was reported in Dongting Lake areas, which was paid extensive attention. After the founding of the People's Republic of China, large-scale schistosomiasis control activities were launched promptly in Dongting Lake areas, and great successes have been achieved following the three stages of control efforts, including the snail control-based stage, synchronous chemotherapy for humans and livestock-based control stage and infectious source control-based control stage. In 2015, transmission control of schistosomiasis was achieved in Hunan Province. This paper comprehensively describes the discovery and control of schistosomiasis, analyzes the challenges for the current schistosomiasis control programs and proposes the emphasis for future control activities in Dongting Lake areas, so as to provide insights into the schistosomiasis control program in this area.

Status of grass-roots schistosomiasis control professionals in Jiangsu Province: a cross-sectional study

To understand the status of grass-roots schistosomiasis control professionals in Jiangsu Province, so as to provide scientific evidence for the rational resource allocation and the improvement of capability building. A cross-sectional survey was conducted by telephone interview and e-mail among city- and county-level disease prevention and control institutions that undertook schistosomiasis control activities in Jiangsu Province, and the age, educational background, major, duration of working, professional title and professional capability were descriptively analyzed. There were totally 274 fulltime schistosomiasis control professionals working at grass-roots institutions in Jiangsu Province, with a mean age of (43.19 ± 9.47) years. The least professionals were below 30 years of age (12.77%, 35/274), and the most professionals were aged from 41 to 50 years (36.86%, 101/274). Among the 274 professionals, 43.07% (118/274) had duration of working of less than 10 years, 62.04% (170/274) had a bachelor degree, and 40.88% (112/274) had the medium-level professional title. A schistosomiasis control team with a relatively high academic degree and professional title has been built at the grassroot level in Jiangsu Province. However, capability building remains to be improved through the participation of more young professionals and professional training with adaptation to local conditions.

Capability building and professional staff of schistosomiasis control institutions in Yunnan Province: a cross-sectional survey

To understand the current status of professional staff and capacity building among schistosomiasis control institutions in Yunnan Province, the data pertaining to the current status of professional staff and capacity building were captured from the schistosomiasis control institutions at all levels in Yunnan Province. There were 20 schistosomiasis control institutions at a level of above county in Yunnan Province, with 411 employees, and there were 11 institutions with an independent legal personality, with a mean building area of 69.83 m2 per capita. Among all institutions, the number of posts was 382, and the actual number of employees was 360, with 22 job vacancies. The mean age of professional staff was 41.6 years at a province level, 44.1 years at a city level and 42.4 years at a county level, and there were no professionals at ages of < 30 years in city-level institutions. Of all professionals, there were 45.76% with a college degree or below, and 54.26% with a bachelor degree or higher, and 16.55%, 24.57% and 39.90% had senior, moderate and primary professional titles, with mean ages of 49.10, 44.37 years and 38.36 years, respectively. The results of the cross-sectional study demonstrate that there are problems of job vacancy, population aging and low education levels in schistosomiasis control institutions in Yunnan Province. Therefore, the capability building and professional quality should be further improved in schistosomiasis control institutions to meet the requirements of schistosomiasis control activities in Yunnan Province.

Application and effect of integrated control model of schistosomiasis interruption in mountainous and hilly endemic regions

To explore the integrated schistosomiasis control model in mountainous and hilly endemic regions, so as to provide insights into the development of the schistosomiasis elimination strategy. Five hilly and mountainous areas endemic for schistosomiasis were selected as the integrated control demonstration areas in Sichuan Province from 2011 to 2015. According to the epidemic characteristics, economic levels and overall development planning of the demonstration areas, the goals, strategies and measures were developed, and the effectiveness of schistosomiasis control was evaluated following implementation of the integrated control. The support system of the integrated schistosomiasis control model was built in the integrated control demonstration areas in Sichuan Province from 2011 to 2015, and five ecological, industrialized and sustainable development models of integrated schistosomiasis control were developed, including integration of balancing rural and urban development, systematic ecological improvement, intensified ecological agriculture, scientific management and health education of schistosomiasis control and ecological ethnic circular economy. Since the implementation of the integrated schistosomiasis control model, the snail habitats were completely changed. Until 2015, 92.0% of all historical areas with snails were managed, the coverage of safe drinking water was 100.0%, and more than 95.0% of the livestock were fenced. The coverage of sanitary toilets increased by 93.0%, 96.8%, 78.8%, 87.1% and 82.0% from 2011 to 2015, respectively, and the farmers'mean yearly income increased by 32.7% in the demonstration areas. From 2011 to 2015, the seroprevalence of human Schistosoma japonicum infections reduced from 3.1% in 2011 to 1.6% in 2015 in the demonstration areas, and no egg-positives were identified. In addition, the number of fenced bovines reduced year by year, and no egg-positives were detected. The areas of snail habitats were 398.7, 108.2 hm2 and 52.9 hm2 in the demonstration areas from 2011 to 2013, with no infected snails found, and no snails were detected since 2014. The awareness of schistosomiasis control knowledge and percentage of correct behavior formation increased year by year among residents in the demonstration areas from 2011 to 2015. The five integrated schistosomiasis control models meet the needs of the current schistosomiasis control activities in mountainous and hilly endemic areas of Sichuan Province, and achieve the goals of controlling the sources of S. japonicum infections, economic development, social progress and improving the ecological environment, which provides new insights into schistosomiasis elimination in the country.

Urinary schistosomiasis in Nigeria: a 50year review of prevalence, distribution and disease burden.

We reviewed survey data deposited in the Global Neglected Tropical Diseases database and many other articles on the prevalence and distribution of Schistosoma haematobium in Nigeria. Schistosoma haematobium surveys conducted over the period of 50 years under review using different diagnostic tools revealed that Ogun State has the highest prevalence, followed by Ekiti state, while the lowest prevalence was recorded in Adamawa. No incidence of Schistosoma haematobium was recorded for states such as Akwa Ibom, Bayelsa, Nasarawa, Jigawa and Gombe. In terms of endemicity, this review has shown that Nigeria is divided into four zones: hyperendemic, moderately endemic, low endemic, and no endemic zones. A survey of 47 (15%) of the 323 dams in Nigeria revealed that 45 out of the 47 dams are located in the hyperendemic zone, while the remaining two are located in the moderately endemic zone. Twenty (43%) of the total surveyed dams harboured Bulinus globosus and/or Biomphalaria pfeifferi, the local intermediate hosts of schistosomes, and 18 of these are located in the hyperendemic zone, while the other two are in the moderately endemic zone. We conclude that there is an urgent need to carry out a nationwide survey to help in planning, coordinating, and evaluating schistosomiasis control activities.

Analysis on the situation of schistosome infections in floating population in national schistosomiasis surveillance sites of China

To understand the situation of Schistosoma japonicum infections in foating population and its epidemiological characteristics in China, so as to provide insights into the development of the surveillance strategy and interventions for schistosomiasis. According to the protocol of national surveillance project, indirect hemagglutination test (IHA) was employed for serological screening of S. japonicum infections among the floating population in the national schistosomiasis surveillance sites of China from 2005 to 2014, and the sero-positives were subjected to parasitological examinations. In addition, epidemiological analyses were performed to describe the characteristics of schistosomiasis in the floating population. A total of 11 834 floating population were monitored at the national schistosomiasis surveillance sites of China during the study period, and 11 558 persons received serological tests, with 419 sero-positives screened. Then, 370 sero-positive floating populations were detected using parasitological examinations, and 25 stool positives were detected. The prevalence of S. japonicum infections significantly varied in time (χ2 = 15.103 7), occupations (χ2 = 115.182 7) and regions (χ2 = 13.177 5) in the study subjects during the study period (all P < 0.05) . A high adjusted prevalence of S. japonicum infections was seen in the boatmen and fishermen in several provinces. Boatmen and fishermen are at a high risk of S. japonicum infections among the floating population, and should be paid more attention to in future schistosomiasis surveillance and control activities due to their strong mobility and difficulty of monitoring.

Challenges and strategies of health education and health promotion in stage of schistosomiasis elimination

Health education and health promotion are important measures for comprehensive control of schistosomiasis in China, which can improve the compliance rate of residents involved in schistosomiasis control activities, reduce the water contact behavior of the target population, thus avoiding or decreasing the infection of schistosome in endemic areas. In recent years, the comprehensive control of schistosomiasis in China has achieved remarkable results. China has reached the goal of transmission control and is moving toward the transmission interruption or even elimination of schistosomiasis. This article analyzes the role of health education and health promotion in schistosomiasis control programme and the current challenges. Meanwhile, suggestions are also put forward on how to conduct health education and health promotionin the stage of schistosomiasis elimination.

Evaluation of schistosomiasis control activities in the Family Health Strategy in municipalities in the Jequitinhonha Valley, Minas Gerais, Brazil.

Observational study that examined the quality of the preventive actions for schistosomiasis control in the Brazilian Family Health Strategy (FHS) in an endemic area. Structured questionnaires were used to interview 97 health professionals of the FHS and the Secretary of Health of 25 municipalities belonging to the State Health Department of Pedra Azul, Minas Gerais, Brazil. Models of latent variables were used to define a score to evaluate the quality of the process. The results showed that 57.8% of the FHS teams' actions were unsatisfactory or critical. The professionals did not perform effective activities for the control of the infection and 8.1% did not use the diagnostic methods required by the government. Similarly, the professionals did not receive adequate training for the development of schistosomiasis prevention and control. There was a lack of educational materials to carry out health education activities, and the FHS teams conducted educational activities in only 48% of the schools of municipalities. Less than half of the professionals interviewed knew about the Schistosomiasis Control Program. We concluded that it is necessary to integrate this Program's practices to the FHS, and seek a suitable support of municipal management through pacts and social control.

A real-time platform for monitoring schistosomiasis transmission supported by Google Earth and a web-based geographical information system

A basic framework for the rapid assessment of the risk for schistosomiasis was developed by combining spatial data from Google Earth® with a geographical information system (GIS) package, bundling the modules together with an Internet connection into a WebGIS platform. It operates through functions such as "search", "evaluation", "risk analysis" and "prediction" and is primarily aimed to be a dynamic, early-warning system (EWS) providing user-friendly, evidence-based, near real-time awareness of the status of an important endemic disease. It contributes to rapid information-sharing at all levels of decision-making, facilitating "point-of-care" response, i.e. treatment provided at newly discovered transmission sites. The experience using the platform is encouraging and it has the potential to improve support systems and strengthen schistosomiasis control activities, in particular with regard to surveillance and EWS. It can quickly and intuitively locate early, high-risk areas, retrieve all important data needed as well as provide detailed, up-to-date information on the performance of the control programme. This WebGIS, the first of its kind in the People's Republic of China, is not only applicable for schistosomiasis but can easily be adapted for improving control of any endemic disease in any geographical area.

Praziquantel efficacy and long-term appraisal of schistosomiasis control in Pemba Island

To determine whether praziquantel (PZQ) has retained its efficacy against Schistosoma haematobium on Pemba Island after 20 years of mass administration--albeit discontinuous--and to analyse retrospectively the performance of schistosomiasis control programmes. A sample of Pemba schoolchildren was examined before and after PZQ treatment by urine filtration, macro- and micro-haematuria and viability of excreted eggs. Although 5% of treated children continued to pass some eggs in the urine up to the seventh week after PZQ administration, none of these eggs was viable, indicating an effective schistosomicidal activity followed by a slow release of dead eggs from host tissues. No signs of PZQ resistance could be detected in the population under study. An overall retrospective analysis of schistosomiasis control activities in Pemba Island revealed that mass drug administration is clearly effective in reducing infection prevalence, but soon after interruption of drug distribution prevalence returns rapidly to pre-intervention levels.

Present and future schistosomiasis control activities with support from the Schistosomiasis Control Initiative in West Africa

Since 2004 the West African countries of Burkina Faso, Mali and Niger have implemented national schistosomiasis and soil-transmitted helminthiasis control programmes with financial and technical support from the Schistosomiasis Control Initiative (SCI). In the first three years of the control programmes, nearly 13.5 million doses of praziquantel and albendazole have been administered against schistosomiasis and soil-transmitted helminthiasis with coverage rates varying between 67.0% and 93.9%. These treatments have resulted in a reduction of the prevalence and intensity of Schistosoma infection in the sentinel cohorts that were set up to monitor and evaluate the national control programmes. The challenges currently faced by these national control programmes are the ability to maintain the reduction in morbidity achieved thus far due to the mass treatment campaigns and ensuring sustainability. For reinforcement of surveillance, the establishment of a geographical information system is suggested in order to contribute towards enhanced sustainability of these programmes. Our new working hypothesis is that targeted control accompanied by periodic mass treatment campaigns (every two to three years) can contribute to maintaining the low levels of morbidity achieved thus far. The implementation of integrated neglected tropical disease control programmes in these countries will provide means to ensure the financial sustainability of control activities for the years to come.

Prevalence distribution and risk factors for Schistosoma hematobium infection among school children in Blantyre, Malawi.

BackgroundSchistosomiasis is a public health problem in Malawi but estimates of its prevalence vary widely. There is need for updated information on the extent of disease burden, communities at risk and factors associated with infection at the district and sub-district level to facilitate effective prioritization and monitoring while ensuring ownership and sustainability of prevention and control programs at the local level.Methods and FindingsWe conducted a cross-sectional study between May and July 2006 among pupils in Blantyre district from a stratified random sample of 23 primary schools. Information on socio-demographic factors, schistosomiasis symptoms and other risk factors was obtained using questionnaires. Urine samples were examined for Schistosoma hematobium ova using filtration method. Bivariate and multiple logistic regressions with robust estimates were used to assess risk factors for S. hematobium. One thousand one hundred and fifty (1,150) pupils were enrolled with a mean age of 10.5 years and 51.5% of them were boys. One thousand one hundred and thirty-nine (1,139) pupils submitted urine and S. hematobium ova were detected in 10.4% (95%CI 5.43–15.41%). Male gender (OR 1.81; 95% CI 1.06–3.07), child's knowledge of an existing open water source (includes river, dam, springs, lake, etc.) in the area (OR 1.90; 95% CI 1.14–3.46), history of urinary schistosomiasis in the past month (OR 3.65; 95% CI 2.22–6.00), distance of less than 1 km from school to the nearest open water source (OR 5.39; 95% CI 1.67–17.42) and age 8–10 years (OR 4.55; 95% CI 1.53–13.50) compared to those 14 years or older were associated with infection. Using urine microscopy as a gold standard, the sensitivity and specificity of self-reported hematuria was 68.3% and 73.6%, respectively. However, the positive predictive value was low at 23.9% and was associated with age.ConclusionThe study provides an important update on the status of infection in this part of sub-Saharan Africa and exemplifies the success of deliberate national efforts to advance active participation in schistosomiasis prevention and control activities at the sub-national or sub-district levels. In this population, children who attend schools close to open water sources are at an increased risk of infection and self-reported hematuria may still be useful in older children in this region.