Burkina Faso, Mali, Niger, Zambia and Tanzania, will be supported by the Schistosomiasis Control Initiative (SCI), based at Imperial College London and funded by the Bill & Melinda Gates Foundation. In these countries children and adults in affected areas will receive annual treatment through a national plan which will be supported by the SCI for a period of up to four years. Over this period the respective governments will gradually assume financial responsibility for schistosomiasis control.
Schistosomiasis is a disease affecting around 200 million people worldwide, but 85% of infections are confined to sub Saharan Africa. The disease affects anyone who comes into contact with fresh water contaminated with human sewage and the fresh water snails that harbour the schistosomiasis parasite. This has included Prince William, who recently contracted the disease during a stay in Africa.
The SCI's target is to deliver treatment, beginning in early 2004, to 15 million people, mainly of primary school age. Of these three million are in Tanzania, two million each in Zambia, Mali, Burkina Faso and Niger, and four million in Uganda, the first country selected for SCI support.
The treatment for schistosomiasis consists of a medicine called praziquantel given in tablet form. At the same time, patients will be given albendazole, a treatment used against intestinal worms which often co-infect with schistosomiasis. Both drugs will be provided once a year for up to four years. Alongside this there is also a substantial programme of surveillance and monitoring. Urine samples of all the people to be treated are assessed for the symptoms of schistosomiasis at the beginning of the programme; and they are then monitored annually to measure the degree of improvement in their health status.
Uganda has been supported by the SCI since March 2003, with around 500,000 having already received treatment for schistosomiasis, and plans to treat another 800,000 by the end of 2004.
Dr Alan Fenwick, Director of the SCI, comments: "This programme is a great example of how the developing world is able to help itself with help from the developed world. Schistosomiasis is a visible and growing problem in sub-Saharan Africa and Tanzania, Zambia, Mali, Burkina Faso and Niger have now joined Uganda in grasping the nettle and tackling this disease on a national scale."
"With these extra countries now on board it will be possible to roll out a truly multi-national programme to control this disease across Africa. We also hope this will become a model which other countries will use to tackle this growing problem."
The SCI has set up a programme in Ugandan schools to ensure all children are treated with praziquantel, the drug needed to treat schistosomiasis.
Until fairly recently, schistosomiasis was not considered to be a significant cause of mortality in Africa, but as more acute illnesses such as polio and tuberculosis have been controlled, doctors have realised just how important neglected diseases such as schistosomiasis are.
Professor Roy Anderson from Imperial College London adds: "Although schistosomiasis is not an acute disease, it does eventually kill those suffering from it. In the past, most of the population in Africa did not live long enough for it take effect, but now that the population is living for longer it is a growing problem."
This programme has been made possible through the lowering in price of the drug praziquantel, which has dropped from $1 a tablet in 1990 to around US6 cents today, a 94 percent reduction in cost. This has come about, partially through the patent expiring on the tablet, and also through lobbying of drug manufacturers by the SCI.
On average, adults need four tablets for effective treatment of schistosomiasis, while children need two or three tablets. In a community of around 1000 people, 3000 tablets will be needed.
Schistosomiasis is a chronic parasitic disease caused by infection with the blood fluke (worm) Schistosoma spp. It is one of the most common parasitic diseases in the world, affecting some 200 million people and causing severe disease in approximately 20 million people. In Africa, as illnesses such as polio and tuberculosis have been controlled, schistosomiasis has emerged as a major silent killer, typically infecting children but striking around the age of 35.
The parasite, which multiplies in fresh water snails, enters the human body through the skin, when people come into contact with fresh water, polluted by human sewage. After entering the body, the parasite travels to the liver, where it grows to a worm about a centimetre in length. Male and female worms pair up and then live for many years in the blood vessels around the bladder and intestine, feeding off the blood. Female worms lay many eggs per day, which escape from the body back to the water during urination and defecation.
In heavy infections, thousands of eggs escape from the body daily, but in doing so rupture capillary blood vessels causing heavy blood loss. Those eggs which do not escape become trapped in the liver, causing a blockage and extreme damage, eventually leading to death.
Those most at risk of schistosomiasis are school-age children, women, and those involved in occupations such as irrigation farming and fishing.
Notes to editors:
1. In May 2001, the World Health Assembly passed a resolution that treatment for schistosomiasis and intestinal helminths in all member states in infected regions should reach 75 per cent of all school aged children by the year 2010.
2. The Schistosomiasis Control Initiative aims to assist in the implementation of this resolution within Africa.
3. The Bill & Melinda Gates Foundation is building upon the unprecedented opportunities of the 21st century to improve equity in global health and learning. Led by Bill Gates' father, William H. Gates, Sr., and Patty Stonesifer, the Seattle-based foundation has an endowment of approximately $25 billion.. www.gatesfoundation.org
4. SCI is based at the Department of Infectious Disease Epidemiology, Imperial College London. www.schisto.org
5. The Head of the Department of Infectious Disease Epidemiology is Professor Roy Anderson FRS, and the Director of the Schistosomiasis Control Initiative (SCI) is Dr Alan Fenwick OBE, who has recently returned to the UK after working in Tanzania, Sudan and Egypt for many years.
6. Consistently rated in the top three UK university institutions, Imperial College London is a world leading science-based university whose reputation for excellence in teaching and research attracts students (10,000) and staff (5,000) of the highest international quality. Innovative research at the College explores the interface between science, medicine, engineering and management and delivers practical solutions that enhance the quality of life and the environment - underpinned by a dynamic enterprise culture. Website: www.imperial.ac.uk.