Schistosomiasis Control Program Research Articles

Urogenital schistosomiasis and risk factors of infection in mothers and preschool children in an endemic district in Zimbabwe

BackgroundTo design appropriate schistosomiasis control programmes that include women and preschool-aged children (PSAC) it is essential to assess their disease profile and the risk factors predisposing them to infection. This study aimed to determine the prevalence of urogenital schistosomiasis and the risk factors of infection among PSAC and their caregivers in an endemic area of Zimbabwe.MethodsA cross-sectional study involving screening for urogenital schistosomiasis infections and treatment of 860 participants [535 children aged ≤ 5 years and 325 caregivers (≥ 15 years)] was carried out in five communities, namely Chihuri, Mupfure, Chakondora, Nduna and Kaziro, in February 2016. Haematuria was recorded for each participant and urine filtration was performed to determine the presence and infection intensity of Schistosoma haematobium. A pre-tested questionnaire was administered to the caregivers seeking knowledge, practices and perceptions regarding schistosomiasis. Data analysis was performed using descriptive statistics and logistic regression.ResultsOverall 132 (15.4%) of the 860 participants had S. haematobium infections. Among these, 61 (18.7%) of the 325 caregivers and 71 (13.3%) of the 535 children were infected. The infection prevalence was significantly different between caregivers and PSAC (χ2 = 4.7040, df = 1, P = 0.030). Children whose caregivers used river water for bathing were more likely to be infected compared to children whose caregivers used protected well water (OR: 2.2, 95% CI: 1.3–3.7). The risks of being infected with schistosomiasis were higher in children whose caregivers were infected compared to children whose caregivers had no infection (AOR: 3.9, 95% CI: 1.7–8.6). In caregivers, those who bathed in river water were at higher risk of schistosomiasis infection compared to those who used water from a protected well (AOR: 3.0, 95% CI: 1.4–6.4).ConclusionsAccording to the World Health Organization guidelines, the observed overall prevalence of urogenital schistosomiasis qualifies this area as a moderate risk area requiring mass chemotherapy once every two years. Water contact practices of caregivers, and their perceptions and knowledge regarding schistosomiasis are risk factors for infection in both themselves and PSAC. Thus, disease control efforts targeting caregivers or PSAC should include health education and provision of alternative clean and safe water sources.

Unavoidable Risks: Local Perspectives on Water Contact Behavior and Implications for Schistosomiasis Control in an Agricultural Region of Northern Senegal.

.Human schistosomiasis is a snail-borne parasitic disease affecting more than 200 million people worldwide. Direct contact with snail-infested freshwater is the primary route of exposure. Water management infrastructure, including dams and irrigation schemes, expands snail habitat, increasing the risk across the landscape. The Diama Dam, built on the lower basin of the Senegal River to prevent saltwater intrusion and promote year-round agriculture in the drought-prone Sahel, is a paradigmatic case. Since dam completion in 1986, the rural population—whose livelihoods rely mostly on agriculture—has suffered high rates of schistosome infection. The region remains one of the most hyperendemic regions in the world. Because of the convergence between livelihoods and environmental conditions favorable to transmission, schistosomiasis is considered an illustrative case of a disease-driven poverty trap (DDPT). The literature to date on the topic, however, remains largely theoretical. With qualitative data generated from 12 focus groups in four villages, we conducted team-based theme analysis to investigate how perception of schistosomiasis risk and reported preventive behaviors may suggest the presence of a DDPT. Our analysis reveals three key findings: 1) rural villagers understand schistosomiasis risk (i.e., where and when infections occur), 2) accordingly, they adopt some preventive behaviors, but ultimately, 3) exposure persists, because of circumstances characteristic of rural livelihoods. These findings highlight the capacity of local populations to participate actively in schistosomiasis control programs and the limitations of widespread drug treatment campaigns. Interventions that target the environmental reservoir of disease may provide opportunities to reduce exposure while maintaining resource-dependent livelihoods.

The prevalence of schistosomiasis in Uganda: A nationally representative population estimate to inform control programs and water and sanitation interventions.

BackgroundTo improve schistosomiasis control programs in Uganda, where intestinal schistosomiasis is a widespread public health problem, a country-wide assessment of the disease prevalence among all age ranges is needed. Few studies have aimed to quantify the relationships between disease prevalence and water and sanitation characteristics across Uganda to understand the potential to interrupt disease transmission with an integrated package of interventions.Methodology/Principal findingsA nationally representative survey was undertaken that included a household and individual questionnaire followed by disease testing based on detection of worm antigens (circulating cathodic antigen–CCA), diagnosis and treatment. A comprehensive set of questions was asked of randomly sampled individuals, two years of age and above, to understand their water and sanitation infrastructure, open defecation behaviors, exposure to surface water bodies, and knowledge of schistosomiasis. From a set of 170 randomly sampled, geographically diverse enumeration areas, a total of 9,183 study participants were included. After adjustment with sample weights, the national prevalence of schistosomiasis was 25.6% (95% confidence interval (CI): 22.3, 29.0) with children ages two to four most at risk for the disease with 36.1% infected (95% CI: 30.1, 42.2). The defecation behaviors of an individual were more strongly associated with infection status than the household water and sanitation infrastructure, indicating the importance of incorporating behavior change into community-led total sanitation coverage.Conclusions/SignificanceOur results highlight the importance of incorporating monitoring and evaluation data into control programs in Uganda to understand the geographic distribution of schistosomiasis prevalence outside of communities where endemicity is known to be high. The high prevalence of schistosomiasis among the youngest age group, ineligible to receive drug treatment, shows the imperative to develop a child-appropriate drug protocol that can be safely administered to preschool-aged children. Water and sanitation interventions should be considered an essential investment for elimination alongside drug treatment.

Development and model of health education and health promotion for schistosomiasis control in mountainous and hilly endemic areas

Transmission control and interruption of schistosomiasis has been gradually achieved in the mountainous and hilly endemic areas with the implementation of the schistosomiasis control programmes, which are moving towards the progress of schistosomiasis elimination. As an important measure of schistosomiasis control, health education is experiencing new challenges and problems in the new situation, and conventional health education of schistosomiasis control has already failed to meet the needs of socioeconomic and cultural development and the increasing changes of human production and life styles in the endemic areas. Therefore, a precision health education model for schistosomiasis control is of great need to be established to highly effectively promote the implementation of schistosomiasis control measures. This review summarizes the important role of health education in schistosomiasis control in mountainous and hilly endemic areas, and describes the new health education model based on optimization of the policy environment and creation of the community atmosphere according to the changes in the endemic situation of schistosomiasis and requirements of the schistosomiasis control target, so as to promote the precision and sustainable implementation of health education and health promotion in schistosomiasis control.

High-resolution remote sensing-based spatial modeling for the prediction of potential risk areas of schistosomiasis in the Dongting Lake area, China

The geographical distribution of snail (i.e., the intermediate host of schistosomiasis) is consistent with that of endemic areas. The suitable snail habitus requires necessary environmental conditions for snail population. The high-resolution remote sensing provides an important tool for the spatio-temporal analysis of disease monitoring and prediction. This study conducted a typical schistosomiasis epidemic area in the marshland and lake regions along the Yangtze River, Yueyang City, Hunan Province of China. And three types of environmental factors, i.e., NDVI, soil moisture, and shortest distance to water body, associated with the geographical distribution of snail population, were extracted from the high-resolution remoting sensing data. The predicted distribution of snail habitus from the high-resolution environmental factors were compared with the data of annual program of snail survey. The results have shown that the application of high-resolution remote sensing can improve the accuracy of the modeled and predicted the potential risk areas of schistosomiasis, and may become an important tool for the ongoing national schistosomiasis control program.

High-resolution remote sensing-based spatial modeling for the prediction of potential risk areas of schistosomiasis in the Dongting Lake area, China

The geographical distribution of snail (i.e., the intermediate host of schistosomiasis) is consistent with that of endemic areas. The suitable snail habitus requires necessary environmental conditions for snail population. The high-resolution remote sensing provides an important tool for the spatio-temporal analysis of disease monitoring and prediction. This study conducted a typical schistosomiasis epidemic area in the marshland and lake regions along the Yangtze River, Yueyang City, Hunan Province of China. And three types of environmental factors, i.e., NDVI, soil moisture, and shortest distance to water body, associated with the geographical distribution of snail population, were extracted from the high-resolution remoting sensing data. The predicted distribution of snail habitus from the high-resolution environmental factors were compared with the data of annual program of snail survey. The results have shown that the application of high-resolution remote sensing can improve the accuracy of the modeled and predicted the potential risk areas of schistosomiasis, and may become an important tool for the ongoing national schistosomiasis control program.

Prevalence and risk factors of schistosomiasis and soil-transmitted helminthiases among preschool aged children (1\u20135\u2009years) in rural KwaZulu-Natal, South Africa: a cross-sectional study

BackgroundDespite efforts to control neglected tropical diseases (NTDs), schistosomiasis and soil-transmitted helminthiases remain widely prevalent in sub-Saharan Africa. Recent data suggest that these infections are prevalent among preschool aged children (PSAC) in poor communities. Evidence of schistosomiasis and soil-transmitted helminths (STH) infection patterns and prevalence among PSAC is essential for effective treatment and control programmes. The aim of the study was to determine the prevalence, intensity and risk factors of schistosomiasis and STH infection among PSAC in the Ingwavuma area of uMkhanyakude District, South Africa.MethodsA cross-sectional study was conducted among 1143 PSAC aged 1–5 years in 34 preschools and early childhood development (ECD) centres. Data on risk factors was collected using a semi-structured questionnaire. A Kruskal–Wallis test was used to compare the differences in infection intensity with age. Pearson Chi-square test and multivariate logistic regression were performed to assess the association between PSAC infection status, sociodemographic, household, water and sanitation variables and hygiene practices of PSAC and their caregivers.ResultsWe observed a low prevalence of Schistosoma haematobium (1.0%) and S. mansoni (0.9%). The prevalence of Ascaris lumbricoides (18.3%) was high compared to Trichuris trichiura (1.2%), hookworms (1.6%) and Taenia (6.4%). The odds of schistosome infection were lowest among PSAC under younger (15–24 years) caregivers (0.1, 95% CI: 0.02–0.54) and those who used tap water (0.3, 95% CI: 0.09–0.78) for domestic purposes. Schistosome infection was however higher among PSAC who bathed in river water (17.4, 95% CI: 5.96–51.04). STH infection on the other hand was lowest among PSAC who did not play in soil (0.1, 95% CI: 0.51–0.28), were from households that used tap water for domestic purposes (0.5, 95% CI: 0.27–0.80) and PSAC under the care of younger (25–35 years) caregivers (0.3, 95% CI: 0.10–0.75). The risk of STH infection was highest among PSAC who did not wash their hands with soap (3.5, 95% CI: 1.04–11.67) and PSAC whose nails were not trimmed (3.6, 95% CI: 1.75–7.26).ConclusionsThe findings show low prevalence and infection intensity of schistosomiasis and STH infection except A. lumbricoides among PSAC. Factors predicting schistosomiasis and STH infection among PSAC were related to caregivers’ age, educational status, water and hygiene practices. STH infection was exclusively associated with PSAC playing and handwashing habits. These findings highlight the need to include PSAC caregivers in schistosomiasis and STH prevention and control programmes.

Strengthening the research on novel molluscicides to accelerate the progress towards elimination of schistosomiasis

Oncomelania hupensis is the only intermediate host of Schistosoma japonicum, and control of Oncomelania snails is an important measure to control and interrupt the transmission of schistosomiasis. Therefore, snail control plays a very critical role in the national schistosomiasis control programmes of China. Pyriclobenzuron, which was recently developed by National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, is the latest great advance in the research on molluscicides and is expected to solve the problem of toxicity to fish, which is worthy of expanding experiments.

Strengthening the development and application of molecular diagnostic techniques to facilitate precision schistosomiasis control in China

Oncomelania hupensis is the only intermediate host of Schistosoma japonicum, and S. japonicum-infected Oncomelania snail is one of the major risk factor of schistosomiasis transmission. Therefore, the detection of S. japonicum-infected Oncomelania snails plays a vital role in the national schistosomiasis control programmes of China. Recently, a florescent recombinaseaided amplification (RAA) assay, developed by Jiangsu Institute of Parasitic Diseases, has shown rapid, sensitive and simple to detect S. japonicum-infected Oncomelania snails, which deserves expanded experiments.

Hyper-endemicity of urinary schistosomiasis in two communities in lower Niger Delta, southern Nigeria

Urinary schistosomiasis is an acute and chronic human parasitic infections initiated by Schistosoma haematobium. This cross-sectional survey of 844 children from two communities (Aviara and Igbide) in lower Niger Delta, Nigeria was carried out to determine the prevalence and intensity of S. haematobium from single urine samples by filtration techniques. Of the 844 urine samples examined, 479(56.75%) were infected with urinary schistosomiasis. Of the two populations investigated, Aviara community had the highest prevalence of 251(61.07%) and Igbide community with 228(52.66%). These observed difference in prevalence was statistically significantly (p = 0.4506). Irrespective of age, the female children recorded higher prevalence than male. In females the infection rates were 94 (62.67%) and 87(56.13) in Aviara and Igbide communities respectively, while the infection rates in males were 157 (62.55%) and 141 (50.72%) %) in the two communities, respectively. Intensity trend, like the prevalence values, peaked at age 11-13 years with an arithmetic mean of 2.20 and 1.90 (eggs/10 ml of urine) in Aviara and Igbide communities respectively. Generally, intensity of infection was higher in all age groups in Aviara than Igbide community. Urinary schistosomiasis is endemic in Aviara and Igbide communities with significant variation in the level of infections among children investigated. The results support the necessity to reinvigorate and put in place an integrated and effective schistosomiasis control programme to put a stop to the spread of the disease.Keywords: Schistosoma haematobium; prevalence; intensity; endemicity; Delta State; Nigeria

Upholding Chinese spirit on schistosomiasis control in the new era to accelerate the progress towards schistosomiasis elimination in China

China is one of the schistosomiasis-endemic countries with the highest burden of disease across the world. Following the control efforts for over 60 years, great successes have been achieved in schistosomiasis control in the country, and the control program is moving towards transmission interruption and elimination. To commemorate the 60th anniversary of publishing Chairman Mao Zedong's two poems entitled "Farewell to the God of Plague", a series of activities that disseminate schistosomiasis control achievements have been conducted in China throughout 2018, including the development of Chinese spirit on schistosomiasis control in the new era. After extensive discussion, collection and screening, and "Integration of all efforts, scientific control, willingness to dedication and swearing to wipe out the 'God of Plague' " was proposed as Chinese spirit on schistosomiasis control in the new era. Integration of all efforts is a summary of administrative policy-making and population participation in Chinese schistosomiasis control programs; scientific control is the refinement of the Chinese national schistosmiasis control strategy that is developed and implemented tailoring to time and circumstances; willingness to dedication is a valuable spiritual wealth and inexhaustible source of power for Chinese schistosomiasis control professionals in the new era; and swearing to wipe out the "God of Plague" is a sacred mission assigned to Chinese professionals participating in the national schistosomiasis control program in the new era. Chinese spirit on schistosomiasis control in the new era will further strengthen our belief in achieving the goal of schistosomiasis elimination in China eventually.

Field Testing Integrated Interventions for Schistosomiasis Elimination in the People's Republic of China: Outcomes of a Multifactorial Cluster-Randomized Controlled Trial.

Despite significant progress, China faces the challenge of re-emerging schistosomiasis transmission in currently controlled areas due, in part, to the presence of a range of animal reservoirs, notably water buffalo and cattle, which can harbor Schistosoma japonicum infections. Environmental, ecological and social-demographic changes in China, shown to affect the distribution of oncomelanid snails, can also impact future schistosomiasis transmission. In light of their importance in the S. japonicum, lifecycle, vaccination has been proposed as a means to reduce the excretion of egg from cattle and buffalo, thereby interrupting transmission from these reservoir hosts to snails. A DNA-based vaccine (SjCTPI) our team developed showed encouraging efficacy against S. japonicum in Chinese water buffaloes. Here we report the results of a double-blind cluster randomized trial aimed at determining the impact of a combination of the SjCTPI bovine vaccine (given as a prime-boost regimen), human mass chemotherapy and snail control on the transmission of S. japonicum in 12 selected administrative villages around the Dongting Lake in Hunan province. The trial confirmed human praziquantel treatment is an effective intervention at the population level. Further, mollusciciding had an indirect ~50% efficacy in reducing human infection rates. Serology showed that the SjCTPI vaccine produced an effective antibody response in vaccinated bovines, resulting in a negative correlation with bovine egg counts observed at all post-vaccination time points. Despite these encouraging outcomes, the effect of the vaccine in preventing human infection was inconclusive. This was likely due to activities undertaken by the China National Schistosomiasis Control Program, notably the treatment, sacrifice or removal of bovines from trial villages, over which we had no control; as a result, the trial design was compromised, reducing power and contaminating outcome measures. This highlights the difficulties in undertaking field trials of this nature and magnitude, particularly over a long period, and emphasizes the importance of mathematical modeling in predicting the potential impact of control intervention measures. A transmission blocking vaccine targeting bovines for the prevention of S. japonicum with the required protective efficacy would be invaluable in tandem with other preventive intervention measures if the goal of eliminating schistosomiasis from China is to become a reality.

Institution-based Network on China-Africa Cooperation for Schistosomiasis Elimination (INCAS): Driving schistosomiasis elimination in Africa

Abstract The burden of schistosomiasis remains a global public health problem, especially in sub-Saharan Africa despite progress in terms of morbidity control. Successful control efforts achieved by China in the last six decades came with considerable experience and lessons that could benefit schistosomiasis control programs in other endemic countries. China's role and commitment to global health cooperation has become increasingly important; this has created a platform for partnership with developing partners for the establishment of Forum on China–Africa health cooperation which prioritizes the pursuit of global elimination target for schistosomiasis and malaria, control of HIV/AIDS, and improved access to reproductive health care. Chinese government's commitment towards achieving schistosomiasis elimination in Africa prompted the establishment of Institution-based Network on China–Africa Cooperation for Schistosomiasis Elimination (INCAS), by the National Institute of Parasitic Diseases to promote schistosomiasis elimination in Africa. Schistosomiasis experts from six provincial institutions and counterparts from 10 African countries participated in the first workshop on China–Africa cooperation for Schistosomiasis Elimination in Africa at Lilongwe, Malawi, in 2015. Experts at the inaugural meeting shared experiences from their national schistosomiasis control programs, as well as identified areas for collaborative synergy targeting schistosomiasis elimination in Africa. The establishment of INCAS, which comprises of 28 member-institutions from China and Africa, was proposed at this meeting. We, therefore, provide information on INCAS activities, cooperation mechanism, as well as assess the strengths, weaknesses, opportunities, and threats as we target schistosomiasis elimination in Africa using the INCAS platform.

Farewell to the God of plague: China for the world disease control program

Abstract Schistosomiasis was one of the most prevalent severe infectious diseases in China. Most of the control plans implemented were based on local settings; thus, the national schistosomiasis control program involved different control phases. These included a working mechanism based on multisectoral cooperation which involved government at all levels, communities, and professionals. It also involved updating the technical strategies and interventions through intensive research, to provide adequate support for programs at different stages with changing natural and social features. To commemorate the 61st anniversary of publishing Chairman Mao Zedong's two poems titled Farewell to the god of plague, we have distilled lessons learnt from national schistosomiasis control programs, which could be transferred to other endemic countries. Based on this work, we published a series of articles to demonstrate the successive programs in different areas or levels in China, and also discussed how best to apply those successive experiences into African countries where schistosomiasis is still a public health problem. There are three major lessons learnt from the Chinese national schistosomiasis control program over the last six decades: (1) sustained commitment by the Chinese governments, from central to local levels; (2) continuous update of control strategies and interventions applied at the village level, based on local settings; and (3) maintaining surveillance-response systems implementation in programs at all levels. With sustained efforts, only 37,000 patients including 2.9% advanced patient cases were found in the country, with six provinces out of the 12 endemic provinces yet to achieve transmission interruption, based on the epidemiological report in 2017. Therefore, Chinese experiences in disease control program are sufficient to promote disease control programs in other developing countries, which would also improve the visibility of Chinese contribution to the world disease control programs. Pursuit of this global engagement will also provide the impetus to maintain our surveillance-response capacity in the post-elimination stage. Download : Download full-size image

Pre-school aged children are exposed to Schistosoma through Lake Kivu in Rwanda.

Background: Schistosomiasis is prevalent in many sub-Saharan African countries and transmission is through waters contaminated by infected snails. In Rwanda, although schistosomiasis is endemic, very few epidemiological studies exist; of these, schoolchildren have been the focus, neglecting pre-school-aged children (PSAC). Furthermore, malacological surveys to indicate the potential for transmission are scarce in the country. The aim of this study was to determine the prevalence of schistosomiasis among PSAC living on Nkombo Island in Lake Kivu and to map the distribution and infectivity of snails in the area. Methods: Stool and urine samples were collected from children aged 1 to 4 years and tested for schistosomiasis using the Kato Katz and the point-of-care circulating cathodic antigen (POC-CCA) diagnostic techniques respectively. Snails were collected along the shores at five different locations with human-water contact activities and cercaria shedding was microscopically examined. GPS receivers were used to collect geographical coordinates and snail distribution maps were generated using ArcGIS. A questionnaire was used to assess water contact activities and frequency. Results: A total of 278 PSAC were recruited. Overall, 9.5% (excluding traces) of the tested children reacted positively to the POC-CCA, although there were no ova detected in their stool via Kato Katz. The questionnaire revealed that 48.2% of parents/guardians use Lake Kivu's water for household activities while 42.4% children are taken to the Lake shores daily. Overall, 13.5% of collected snails shed cercariae. Conclusions: PSAC of Nkombo Island are exposed to Schistosoma parasites through contact with Lake Kivu, which hosts a number of snails shedding cercaria. Exposure is through recreational activities but also through bathing as safe water is scarce in the area. Health education of parents/guardians of these young children should be promoted and the national schistosomiasis control program should be integrated into water supply projects.

SWOT analysis on snail control measures applied in the national schistosomiasis control programme in the People\u2019s Republic of China

BackgroundSnail control is an important component in the national schistosomiasis control programme in China, by application of chemical molluscicides, forestry projects, agriculture projects and water conservancy projects in recent decades. However, there are still wide areas of snail inhabited in China which remains a great challenge to achieve the goal of schistosomiasis elimination by 2025. Therefore, a SWOT (strengths, weaknesses, opportunities and threats) analysis on snail control measures is required for precision schistosomiasis control.MethodsThe SWOT approach, which is a well-known structured analysis tool, was used to identify and evaluate the specific characteristics of four types of snail control measures in China, including chemical mollusciciding, forestry, agriculture, and water conservancy projects. The analysis were carried out based on the information collection from literature review, of research papers, books, annual report database of national schistosomiasis control programme in China, reports from the academic forums, and so on.ResultsFor chemical mollusciciding, application strategy needs to focus on specific local settings, such as stage of schistosomiasis control, environmental factors, and limitations from external policies and internal deficiencies. Regarding forestry projects, the optimal strategies are to cooperate with other national forestry programmes to share the investment costs and pay attention on wetland protection. In agriculture projects, it is necessary to develop related cash crop industries and combine with national farmland consolidation projects simultaneously to increase the total economic benefits. Concerning water conservancy projects, the main purpose is to control snail migration from snail area to snail-free areas nationwide.ConclusionsIntegrated strategies for various measures application and a top-level designed cooperation mechanism will be the necessary to eliminate snail and schistosomiasis in China.

Engaging multi-sectoral collaboration to combat schistosomiasis in Napu highlands, Poso District, Central Sulawesi

Background. In Indonesia, schistosomiasis is endemic in Napu and Bada Highlands in Poso District and Lindu Highland in Sigi District, Central Sulawesi. Schistosomiasis in Indonesia is caused by blood fluke (trematode worm) Schistosoma japonicum with Oncomelania hupensis lindoensis snail as an intermediate host. The presence of Oncomelania hupensis lindoensis is an indicator of an area to be called a focus area for Schistosoma japonicum. Integrated control of schistosomiasis is vital in schistosomiasis control. However, lack of coordination and collaboration between multiple sectors has occurred many times. The objective of this study was to identify the role of multi-sectoral in schistosomiasis control. The identification process was needed to engage multisectoral in schistosomiasis control program. Methods. A comprehensive snail survey was conducted in Napu, Lindu and Bada Highland in 2017 which found 242 O.h. lindoensis foci area in 21 villages where 208 snail foci located in 14 villages in Napu highland. This research was part of 2017 study of ‘Mapping of Oncomelania hupensis lindoensis snail’, the intermediate host of schistosomiasis in the endemic area in Indonesia. After the mapping was carried out, an action plan to control schistosomiasis was designed by invited related sectors from the province and Poso district to develop the action plan together. Results. In order to eliminate schistosomiasis, several sectors both from province and Poso district were committed to engaging in schistosomiasis control. Those sectors were Agency for Regional Development, Agriculture Office, Maritime and Fisheries Office, Plantation and Livestock Office, Public Works Office, Environmental Office, Health Service and Lore Lindu National Park Agency. To eliminate schistosomiasis, integrated control of schistosomiasis has played a significant role. The responsibility and task of each sector involved were made clear according to each sector duty and function with the goal of the elimination of schistosomiasis by 2020.

Evaluation of implementation effect of schistosomiasis control program in Jiangsu Province from 2010 to 2015

To evaluate the actual effect of the schistosomiasis control program in Jiangsu Province from 2010 to 2015. A total of 67 schistosomiasis-endemic counties in 10 cities were selected, and a combination of retrospective investigation and on-site investigation was adopted to collect and record the epidemic data of the counties from 2010 to 2015, and a retrospective survey database of epidemic situation was established. The effects of integrated control strategies with both Oncomelania hupensis snail control and infection source control were evaluated. From 2010 to 2015, 2 465 911 persons who lived in endemic areas were detected for schistosomiasis, with 16 974 positive cases of blood examinations, and 8 positive cases of fecal examinations. Totally 5 145 people with advanced schistosomiasis were treated and 40 460 people with the history of schistosome cercarial-infested water contact received the expanded chemotherapy. A total of 127 636 cattle raised in the endemic areas were detected, and 51 619 cattle (head-times) with the history of cercarial-infested water contact also received the expanded chemotherapy. The area with snails control by molluscicides was 18 604.84 hm2. By the end of 2015, schistosomeinfected snails had not been found and there was no zoological schistosome infection for 5 consecutive years, and in addition, there had been no acute schistosome-infected persons for 6 consecutive years in the whole province. The area with snails dropped to 1 977.18 hm2, with a decreasing rate of 55.24% compared with that in 2010. After the implementation of the plan for the prevention and control of schistosomiasis in Jiangsu Province (2010-2015), the prevention and control of schistosomiasis has achieved remarkable effects and realized the goal of the plan.

Schistosomiasis.

Schistosomiasis is a major cause of morbidity in the world; it is second only to malaria as a major infectious disease. Globally, it is estimated that the disease affects over 250million people in 78 countries of the world and is responsible for some 280,000 deaths each year. The three major schistosomes infecting humans are Schistosoma mansoni, S. japonicum, and S. haematobium. This chapter covers a wide range of aspects of schistosomiasis, including basic biology of the parasites, epidemiology, immunopathology, treatment, control, vaccines, and genomics/proteomics. In this chapter, the reader will understand the significant toll this disease takes in terms of mortality and morbidity. A description of the various life stages of schistosomes is presented, which will be informative for both those unfamiliar with the disease and experienced scientists. Clinical and public health aspects are addressed that cover acute and chronic disease, diagnosis, current treatment regimens and alternative drugs, and schistosomiasis control programs. A brief overview of genomics and proteomics is included that details recent advances in the field that will help scientists investigate the molecular biology of schistosomes. The reader will take away an appreciation for general aspects of schistosomiasis and research advances.

Epidemiological Findings and Policy Implications from the Nationwide Schistosomiasis and Intestinal Helminthiasis Survey in Sudan

Background: The World Health Assembly endorsed the WHO Neglected Tropical Disease (NTD) Roadmap in 2013, in which NTDs were suggested as tracers of equity in the assessment of progress towards the Sustainable Development Goals. Nationwide surveys were undertaken in all 18 states of Sudan to identify the geographical distribution and estimate the prevalence and intensity of schistosomiasis and other helminthiases from December 2016 to March 2017. Improved water and sanitation coverage at the household and school levels and the proportion of respondents who engaged in risk behaviours were assessed. Methods: Using two-stage random sampling, each locality was subdivided into one to three different ecological zones (EZs) based on proximity to water bodies. Probability-proportional-to-size sampling was used to select schools from each EZ. We estimated schistosomiasis and intestinal helminthiasis prevalence in 105,167 school children by urine concentration microscopy and Kato-Katz smears. Risk factors and the impact thereof were investigated using multi-level mixed-effect models. Findings: The overall egg-positive rates were: Schistosoma haematobium, 5·2%; S. mansoni, 0·06%; and intestinal helminths, 5·47%. Severe endemic areas were concentrated in East and South Darfur States (S. haematobium prevalence, 25·23% and 13·91%, respectively). Households and schools with latrines, and especially improved latrines (ventilated improved pit latrines or flush toilets) were associated with lower odds of schistosomiasis infection. Open defecation was strongly associated with schistosomiasis (aOR: 1·50, 95% CI: 1·35-1·66). EZ-level mass drug administration was estimated to be more cost-effective than district-level administration under all circumstances. Interpretation: Endemic schistosomiasis is concentrated in fragile border states. This study provides insight into possible programmes to effectively reduce infections by presenting possible diverse, innovative strategies to disrupt the transmission cycle. Funding Statement: This project was supported by the Korea International Cooperation Agency (KOICA) under the Integrated schistosomiasis and soil-transmitted helminthiasis control program, Sudan. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study protocol was reviewed and approved by the institutional review board of the Federal Ministry of Health, Sudan (FMOH/DGP/RD/TC/2016) and the Korea Association of Health Promotion (130750-20,164-HR-020).