School of Public Health

Schistosomiasis Control Initiative

The Schistosomiasis Control Initiative (SCI)

The Schistosomiasis Control Initiative (SCI)

Schistosomiasis is a parasitic disease that leads to chronic ill-health and affects more than 200 million people in developing countries, 85% of them in sub Saharan Africa. Approximately 600 million people are at risk of contracting schistosomiasis because they live in tropical regions where water supply and sanitation are inadequate or non-existent.

With the June 2002 Bill and Melinda Gates Foundation award of £20 million, the Schistosomiasis Control Initiative (SCI) was established in DIDE, from where SCI partners the World Health Organisation in schistosomiasis and intestinal helminths research and control activities. Other partners include the DBL-Institute for Health Research and Development, responsible for in-country training and in-country operational research, and the eight countries, Burundi, Burkina Faso, Mali, Niger, Rwanda, Tanzania (including Zanzibar), Uganda and Zambia.

The SCI has assisted these eight African countries to establish nation-wide control of schistosomiasis and intestinal helminths. In each country, the most heavily infected regions have been identified; local health staff and teachers have been trained, and health education has been provided to the people in those regions; and the drugs praziquantel and albendazole have been distributed to treat against schistosomiasis and intestinal helminths respectively.

As the programmes expanded, the effects were monitored in each country to demonstrate the impact of the treatments on health and well being. SCI has contributed to the development of local capacity for sustained implementation of schistosomiasis and helminth control programs. Local and international partnerships have been forged to improve training and treatment delivery, and to assist other African nations in the development of national control plans and research programmes. Cameroon, Kenya, Malawi, and Mozambique have all benefited in one way or another from small grants from SCI.

The drug praziquantel, which is safe, effective and now reasonably priced had previously been used successfully in Brazil, China and Egypt, to control the serious effects of schistosomiasis. However in sub-Saharan Africa very few people ever received treatment prior to 2002 either because they did not know they have the disease, or the drug was not available. SCI has changed this situation.

Children with schistosomiasis

School children in Niger with gross haematuria (blood in urine) caused by schistosomiasis (photo courtesy of Jurg Utzinger)

Praziquantel came on the market in the late 1980’s at a price of approximately £2 per treatment but since 1996 there has been a dramatic reduction in price to less than 15 pence per treatment, making the timing of this project so appropriate. Chinese and Korean pharmaceutical companies now supply the active ingredient, at a price which leads to tablets being available at this lower price.

Uganda was the first country to receive assistance from SCI and launched its national programme in March 2003. By 2008 over 3 million people living near Lake Albert, Lake Victoria and the Albert Nile had received sevaeral annual treatments. The results of the follow up of the cohorts of children being monitored for infection have now neen published in the Bulletin of the World Health Organisation..

During 2004 high profile official control programme launches were held in Zanzibar, Mali, Niger, and Burkina Faso. By 2008, in Burkina Faso Mali and Niger over 2 million children had been treated in each country. Zanzibar completed island wide treatments in 2004 and 2006, and on the Tanzania mainland over 4 million children were treated after the official launch of the country programme on April 27 2005. These children were treated again in 2007, and a further 2 million children in other districts were treated for the first time in 2008.

By 2008 approximately 40 million praziquantel treatments had been dispensed, and many more albendazole against intestinal worms in children. In 2008, thanks to support from USAID and RTI, SCI expanded its activities to encompass five neglected tropical diseases with four drugs being dispensed, praziquantel, albendazole, mectizan and zithromax as necessary to treat schistosomiasis, onchocerciasis, lymphatic filariasis, intestinal worms and trachoma. Burundi and rwanda were more recent additions to the SCI assisted countries thanks to support from the donor Legatum

SCI receives continuing support from the Billand Melinda gates Foundation for the staff including scientists allocated to assist the countries, a GIS expert, two bio-statisticians, a health economist and support staff. Further information on this project can be found on the SCI website at www.sci-ntds.org.

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