SCHISTOSOMIASIS CONTROL INITIATIVE (SCI)

Website: <www.schisto.org>

Contact person(s): Alan Fenwick at [email protected]

Introduction and background

The Schistosomiasis Control Initiative (SCI) encourages the development of national plans for the control and treatment of schistosomiasis and STH in sub- Saharan Africa by targeting those at high risk of developing severe morbidity, especially school-age children, women and those in high risk occupations. SCI follows the World Health Assembly resolution that all member states in endemic regions should reach 75% of all school-age children by the year 2010 with drugs against schistosomiasis and intestinal helminths. By assisting selected countries to implement successful national control programmes, SCI expects to create a demand for treatment throughout Africa.

The main objective of the SCI is to encourage the development of a sustainable schistosomiasis and STH control programme in sub-Saharan Africa.

In selected countries, the objectives are:

• To reach at least 75% of school-age children and other high risk groups with chemotherapy – praziquantel and albendazole.

• Reduce schistosomiasis-related morbidity in high risk groups. • Reduce prevalence and intensity of schistosomiasis infections. • Reduce burdens due to intestinal helminths in targeted populations. • Create a demand for sustained schistosomiasis control.

• To promote access to anthelmintic drugs and good case management in the regular health system.

Activities and programmes

The SCI is working with both the Ministries of Health and Education in Burkina Faso, Mali, Niger, the United Republic of Tanzania, Uganda and Zambia to establish sustainable nationwide programmes for the control of schistosomiasis and intestinal helminths. The programme has been running since 2003 in Uganda, and approximately 1 year less in the other five countries. In this period over 30 million treatments have been dispensed, mostly to school-age children and through the school system, but also to adults in high prevalence areas.

In each country SCI has provided financial and technical support for:

• Prevalence mapping using GIS − there was an initial need to identify the regions/districts with heavy infections.

• Training of key stakeholders at the national and district levels. • Procurement of the required drugs.

• Training of teachers and community drug distributors to carry out mass drug administration of praziquantel and albendazole.

• Mass drug administration campaigns to target groups.

• Monitoring and surveillance of the programme to measure the health impact and the evaluation of satisfaction and coverage.

• Advocacy and increase in funding from partnerships for the national programmes to ensure sustainability.

Topics on policy and advocacy work

Topic Topic

Human rights, discrimination and stigma

reduction Services for students with special needs School feeding programmes Violence prevention

Immunization, vaccination Gender and sexual diversity Ethnic and religious diversity Environmental concerns Skills-based health education including

reproductive health/HIV&AIDS prevention ✔

Access to safe water Tobacco, drugs, alcohol prevention Promotion of adequate

sanitation/latrines Health and nutrition services, including

deworming ✔ Partnerships and participation ✔

Promotion of a safe school environment Malaria care and prevention

Work place issues Other:

Partnerships, advocacy, research and participation

SCI promotes partnerships between both the Ministries of Health and Education at national level down to community level as the responsibility of treating school-age children falls under both ministries. This has been successful in most countries and particularly in those where the national control team has members from both ministries. Collaboration is usually between the Ministry of Health (Department of Disease Control) and the Ministry of Education (School Health Departments).

The role of teachers is central to the delivery of the control programmes as they are trained and then act as drug distributors. Teachers have the opportunity to voice their opinions and make suggestions during training and again during the process evaluation, which is carried out by independent evaluators; and where children also have the opportunity to express themselves.

SCI has many partners ranging from:

• Governments: Burkina Faso, Mali, Niger, the United Republic of Tanzania,

Uganda and Zambia.

• Multilateral agencies: UNICEF, WFP and WHO.

• Bilateral agencies: DFID, European Union and USAID.

• NGOs: AXIOS, HKI, Ivo de Carneri Foundation and Save the Children.

• Drug companies: Shin Poong, International Dispensary Association,

Chemical Industrial Pharmaceutical Laboratories, Medpharm, GlaxoSmithKline, Flamingo, Shelly’s, and Tanzania Pharmaceutical Industries

• Academic institutions: DBL, Liverpool School of Tropical Medicine, London

School of Hygiene and Tropical Medicine, and PCD.

SCI is involved in advocacy on a variety of issues including schistosomiasis and STH control, child health and neglected disease control. These topics are aimed at all stakeholders, communities, schoolchildren and international organizations.

Operational research is carried out by SCI in all countries in order to assess the degree in which SCI’s objectives are being met. This is first done by a baseline and then annual data collection looking at the following:

• Parasitological: Prevalence and intensity of schistosomiasis and STH.

• Morbidity: Degree of liver and bladder damage as measured by ultrasound.

• Process monitoring: To evaluate the achievements, successes and

challenges in the implementation in order to improve further treatment campaigns.

• Costs: Cost-effectiveness of the interventions.

• Socioeconomic status: Measured through questionnaires.

Future plans

SCI activities will be changed in the current countries over the next 2 years as the planned implementation three rounds are completed. SCI will aim to improve the sustainability of the national programmes making them more government funded. It is planned that in Burkina Faso, Niger and the United Republic of Tanzania SCI will continue assisting the governments with a move towards integration of the programmes against all neglected tropical diseases e.g. schistosomiasis, STH, lymphatic filariasis, onchocerciasis and trachoma.

The aims will be to strengthen the collaboration and coordination between all partners involved, to have a greater impact on the health of the children infected with these diseases and to reduce the duplication of efforts that are currently a problem of today’s vertical disease control programmes.