Category Archives: schistosomiasis

The Global NGO Deworming Inventory: Taking Stock of Progress against NTDs

Child receiving treatment CameroonAccording to the World Health Organization (WHO), an estimated 873 million children are at risk of soil-transmitted helminths (STH), including roundworm, hookworm and whipworm. In children, STH infections can lead to malnutrition, anemia and stunting. In both adults and children, they can cause fatigue, intense abdominal pain and chronic diarrhea. In severe cases they can even cause bowel obstruction, rectal prolapse and appendicitis.

To improve health and development in infected communities and reduce the prevalence of neglected tropical diseases (NTDs), WHO aims to control STH and schistosomiasis by 2020. Meeting this goal requires regularly deworming at minimum 75 percent of the preschool-age and school-age children who are at risk of STH or schistosomiasis. To ensure such an ambitious global goal is met, it is paramount that ministries of health, WHO and non-governmental organizations (NGOs) coordinate and share data.

WHO operates the Preventive Chemotherapy and Transmission Control (PCT) Databank, which tracks the number of children given PCT for STH, schistosomiasis and three other NTDs. The databank is populated largely by information reported by ministries of health and helps policymakers and implementers understand where deworming programs are active and where more interventions are needed to meet the WHO target of controlling STH and schistosomiasis by 2020.

However, gaps in the PCT Databank have become apparent. The 2013 STH preschool treatment data was recently revised when supplementary data was submitted by UNICEF. This data caused a 104 percent increase in the recorded number of preschool-age children treated for STH. Clearly, better coordination is needed to ensure the global community meets 2020 goals.

To facilitate better coordination among WHO, ministries of health and NGOs, the Global NGO Deworming Inventory collects data from NGOs administering deworming treatments for STH and schistosomiasis. The data are compiled into a single database with disease-specific information by Children Without Worms (CWW).

After the data are compiled, WHO will merge the CWW database with national program data provided by ministries of health to the PCT Databank. This effort will make deworming dollars go even further by strengthening program monitoring and leading to an efficient use of resources. Ultimately, it will be an important step in controlling STH and schistosomiasis.

You can learn more about the Global NGO Deworming Inventory — and implementers can submit their data — at

Children at dusk in Malawi

Calling Time on Urogenital Schistosomiasis

I spent many of my teenage years living in Malawi, enjoying swimming in beautiful Lake Malawi. Wind on to age 30, and I was struggling to get pregnant. Eventually, following illness, I was diagnosed with schistosomiasis by a consultant and colleague at the Liverpool School of Tropical Medicine. I was told that I had probably been infected for a while and that it might be affecting my fertility. So I took praziquantel, the only available drug against the parasite, and soon after I was pregnant. Today my first born daughter is 10 years old. Whilst the links between urogenital schistosomiasis, sub-fertility and HIV have become increasingly well-established over my first born daughter’s life time, a combined and robust health systems action that brings together neglected tropical disease, sexual and reproductive health and HIV communities to address and scale up treatment for urogenital schistosomiasis is sadly lacking.

It is 20 years since the Beijing Women’s Conference and the International Conference Population and Development and the sexual and reproductive community have been taking stock on progress, challenges and future priorities. I attended a research agenda setting meeting on sexual and reproductive health, rights and gender at the WHO on 12th and 13th of January, where we discussed how to best decide priorities for action. Scaling up treatment for urogenital schistosomiasis is arguably a win-win.

The global burden of disease

Schistosomiasis is wide spread and there are two forms of disease, intestinal and urogenital. An estimated 600 million people are at risk of being infected and approximately 200-220 million people are living with schistosomiasis in Africa. Of the people infected with urogenital schistosomiasis it is thought that between about 100 and 120 million suffer from urinary and reproductive tract damage, which also impacts directly with HIV co-infection and sub-fertility in general. Typically many adolescent girls and women exhibit several symptoms in their lower genital tract where overt bleeding and unpleasant discharge, general discomfort and pain during sex can lead to low self-esteem, depression and stigma.

Peter Hotez estimates that globally there are between 67-200 million cases of urogenital schistosomiasis among girls and women. Hotez argues that between 20 million and 150 million girls are affected, possibly making it one of the most common gynaecological conditions in sub-Saharan Africa but unfortunately much under-reported. Urogenital schistosomiasis, as in my experience, also affects fertility and it is estimated to reduce a woman’s reproductive health capacity by up to 75%.

The links between urogenital schistosomiasis in women (female genital schistosomiasis) and HIV are well established. Writing in the Lancet, Stoever and colleagues argue that up to 75% of girls and women infected with female genital schistosomiasis develop often irreversible lesions in the vulva, vagina, cervix, and uterus, creating a lasting entry point for HIV and discuss how research in Zimbabwe showed that women with female genital schistosomiasis had a threefold increased risk of having HIV. In a recent review of the evidence Pamela Mbabazi and colleagues argue that “Studies support the hypothesis that urogenital schistosomiasis in women and men constitutes a significant risk factor for HIV acquisition due both to local genital tract and global immunological effects”.

Gender, equity and rights

There is remarkable overlap between the maps showing high HIV prevalence in Africa (particularly amongst women and adolescents girls) and those showing cases of female genital schistosomiasis. A complex interplay of biological, social and cultural factors means that young women are particularly vulnerable to HIV in sub-Saharan Africa. Gender norms also shape exposure to urogenital schistosomiasis, with women being particularly responsible for activities involving water in many communities (washing, cleaning, collecting water etc). Drawing on work from Ghana, Vlassoff and Manderson have shown that women interact with water significantly more often than men.

What to do?

Several tens of millions of praziquantel tablets are now donated each year by Merck-KGaA for mass drug administration campaigns as a cost-effective method to protect people from the urogenital schistosomiasis. Hotez argues that by preventing female genital schistosomiasis in sexually active women we have an innovative and timely opportunity to reduce and likely much reduce HIV transmission throughout many rural areas of sub-Saharan Africa.

But in infected communities treatment also needs to start early.

Stoever and colleagues argue that periodic and regular treatment with praziquantel from when children are first infected should prevent the development of genital lesions, which increase HIV risk and cause gynaecological problems. Treatment, however, may need to be started even earlier as the extent and burden of schistosomiasis in pre-school-aged children is being more fully described.

To make progress in this area we need joint action between the HIV, sexual and reproductive health and neglected tropical disease communities. Health workers and communities need more information on the multiple impacts of urogenital schistosomiasis and how it can be treated.

The lack of action to date on urogenital schistosomiasis clearly illustrates the importance of new partnerships and new approaches to scaling up strategies to address neglected tropical diseases. COUNTDOWN, a new initiative in Cameroon, Ghana and Liberia, will be paying close attention to the potential role of close-to-community providers such as drug distributors in providing an interface between communities and health systems.   We will also evaluate how to deliver equitable drug delivery for schistosomiasis through the inclusion of preschool-aged-children, out-of-school-children and adults. The Director of COUNTDOWN is helping to co-organise a meeting in South Africa later in the month where several members of COUNTDOWN will also attend. It brings together world leaders in the field of schistosomiasis, HIV and paediatrics to present on the current state and future direction of research on female genital schistosomiasis.

COUNTDOWN is set to foster and to stimulate others in thinking of innovative ways of prompting a synergistic approach to neglected tropical diseases which crosses sectors and builds strength in national health systems.

If you would like to find out more follow us on Twitter or email Rachael Thompson.

This blog post was writtem by Sally Theobald, COUNTDOWN Consortium & Research in Gender and Ethics: Building stronger health systems (RinGs), and was originally posted on Cross-Talk: A Place to Share New approaches to Neglected Tropical Diseases.

Photo courtesy of Andrew Whalley. Children at Dusk.

Government of Nigeria Releases New Data on the Prevalence of Schistosomiasis and Intestinal Worms



On Thursday June 4, Nigeria’s Federal Ministry of Health released, for the first time, comprehensive data on the national distribution of two major neglected tropical diseases (NTDs) — schistosomiasis and intestinal worms. This new information, gathered by the government of Nigeria and a network of partners, found that across 19 states and the Federal Capital Territory (FCT) approximately 24 million Nigerians were at risk for schistosomiasis and 21 million were at risk for intestinal worms. Children between the ages of 5 – 10 had the highest prevalence of infection. The results also showed that men were more likely than females to have one of the diseases.

Nigeria is said to have the highest burden of NTDs in sub-Saharan Africa. While the government and NGO partners have already taken several steps to address the burden of disease, comprehensive epidemiological mapping had not been available until recently. Moving forward, the data gathered from this mapping project will aid the Federal Ministry of Health in planning effective intervention measures for both schistosomiasis and intestinal worms.

People infected with NTDs like schistosomiasis and intestinal worms are often unable to work or attend school – resulting in an endless cycle of economic hardship. Treating these diseases is critical to reducing poverty and boosting economic prosperity. Given the strong association between NTDs and economic development, NTD control and elimination should be considered an important factor in achieving the Sustainable Development Goals (SDGs) in Nigeria. Nigeria’s quest to be one of the 20 major economic players globally by 2020 as captured in it Vision 20: 2020 will depend on a healthy and productive society that does not neglect the less fortunate.

The prevalence mapping survey was completed by analyzing 50 – 55 children from five randomly selected schools in the 19 states and FCT. The Federal Ministry of Health partnered with the Children’s Investment Fund Foundation, Sightsavers, Helen Keller International, DFID and RTI/ENVISION to carry out the survey. Epidemiological data on both diseases were collected using a novel technique; the LINKS system developed by the Task Force for Global Health which uses smart phones for data collection and cloud based data reporting and management.

Map of Nigeria displaying study area

Map of Nigeria displaying study area

The results showed an overall prevalence rate of 9.5 percent for schistosomiasis and 27 percent for intestinal worms.

The data gathered from the mapping survey will enable Nigeria to receive the appropriate amount of donated medicines to treat schistosomiasis and intestinal worms, so that they can deliver the medicine to where it is most needed. In addition to providing actionable data, the mapping project helped build and improve the capacity of health workers across Nigeria for the country’s NTD programme. The project also fostered a platform for cross-sector learning and skills sharing, which ultimately improved programme coordination.

Moving forward, the Federal Ministry of Health has recommended that all levels of government (Federal, State and LGAs), NTD partners and other stakeholders — with the cooperation of the communities — scale up uninterrupted provision and administration of appropriate medicines alongside other environmental improvement interventions such as clean water and sanitation provisions. Plans should also be put in place for impact assessment after the third year of consistent Mass Administration of Medicines.

While there is much work to be done, the successful completion of epidemiological mapping for schistosomiasis and intestinal worms is a promising sign. Armed with this information, Nigeria can strategically and effectively scale up their efforts to control and eliminate these debilitating diseases for a more prosperous Nigeria.  Nigeria’s new government, led by President Buhari, should take advantage of this cost effective and relatively simple intervention in order to make a tremendous impact on the country’s most vulnerable populations.

Photos provided by Nigeria’s Federal Ministry of Health. 

Al Jazeera’s Documentary Series Highlights Neglected Tropical Diseases


In a fight between the world’s worst diseases and the human population, there are those that dream of a world free of diseases and poverty. Lifelines, a global health television series produced by Al Jazeera with support from the Bill & Melinda Gates Foundation, highlights the efforts of global health workers and professionals who are vigorously working to end neglected tropical diseases (NTDs).

Lifelines’ “River of Hope” documentary highlights the devastating effects of schistosomiasis on poor, rural communities in Senegal. The health crisis started when the Diama dam was built across the Senegal River in 1986. Construction of the dam stopped the river’s flow and created a growing population of infected snails, which left 90 percent of the population living near the river basin infected with schistosomiasis. Schisosomiasis is a water-borne parasite that affects 240 million people in mostly Sub-Saharan Africa and is linked to deadly chronic diseases such as cancer and organ failure.

Lifelines also covered the innovative work of Alassane Ndiaye and Elizabeth Huttinger who are working together on “Project Crevette,” a novel experiment to restore prawns — natural predators of the disease carrying snails — in the lower Senegal River basin to control the spread of schistosomiasis. They plan on convincing political leaders responsible for the Diama dam to build a fish ladder in the dam to allow prawns to maintain their migration upstream where the snails harboring schistosomiasis are heavily populated.

Lifelines also highlighted blinding trachoma and river blindness (onchocerciasis) in the “The End is in Sight” documentary. In Part One of “The End is in Sight,” Lifelines takes us into the Amhara province in Ethiopia, a region that has the highest prevalence of trachoma in the world. Trachoma is an infectious bacterial disease of the eye that blinds approximately half a million people annually. The documentary follows Aba Wolde, an 85-year old citizen of the Amhara region, and his daughter, Amalda. They both have advanced trachoma and must walk over 20 kilometers to a health clinic to receive surgical treatment.

Part Two of “The End is in Sight” takes place in the rural areas of Uganda with a high prevalence of river blindness. River blindness is transmitted by infected black flies and causes severe itching and visual impairment. In 1987, Merck declared that they would donate a medication called Mectizan to treat river blindness for as long as needed through the Mectizan Donation Program (MDP). In Uganda, where about 3.5 million people are infected with river blindness, Dr. Moses Katabarwa introduced an innovative administrative system of mobilizing, educating and providing communities in endemic areas with Mectizan. This approach of mass drug administration (MDA), along with environmental control measures for controlling fly larvae, has produced successful results for eliminating river blindness in multiple regions in Uganda.

Whether you’re an expert in the field of NTDs or someone who is curious to learn more about diseases that keep communities in poverty, we highly recommend that you watch these impactful stories from Aljazeera’s ‘Lifelines’ series.