Approaches in scaling up schistosomiasis intervention towards transmission elimination in Africa: Leveraging from the Chinese experience and lessons
Graphical abstract
Introduction
The persistence of schistosomiasis endemicity in the tropical and subtropical regions is debilitating on children and adult population health, eroding national economic growth and development of the world (King 2015; 2010; Van der Werf et al., 2003). It is prevalent in approximately 78 countries and territories located in Africa, South America, Middle East and the southern Asia with an estimated 800 million people at risk and more than 250 million people infected with schistosome parasites globally (Colley et al., 2014; Rollinson et al., 2013; Mone et al., 2010; Hotez et al., 2007a; Engels et al., 2002). More than 95% of all infections of this water-associated disease caused by trematode parasites belonging to the genus Schistosoma are concentrated in Africa (Steinmann et al., 2006; Utzinger et al., 2009).
Schistosomiasis continued transmission is attributed to snail host distribution, which are required for asexual development of the trematode parasites in environment characterized with persistent neglect and poor access to and weak implementation of contextual WASH programmes (WHO, 2002; Gryseel et al., 2006; Hotez and Kamath, 2009; Stothard et al., 2009; Utzinger et al., 2011). Drug treatment through mass drug administration (MDA) is the major national schistosomiasis control effort aimed at reducing morbidity in most African countries. However, this approach remains challenged by diverse local barriers and health systems bottlenecks including lack of early diagnosis, late care seeking behaviours (Mafe et al., 2005; WHO, 2006; Hotez et al., 2007b; Doenhoff et al., 2008) and re-infection after treatment. Efforts are continually made to provide useful data (Ekpo et al., 2012a; Opisa et al., 2011; Ekpo et al., 2010; Pullan et al., 2014) to initiate effective schistosomiasis control plan in Africa but reliable data on accurate epidemiological status and geographic distribution are lacking in most endemic settings. Fig. 1 shows the endemicity status of schistosomiasis in Africa. Schistosoma japonicum epidemiology differs from the African species including S. mansoni and S. haematobium. S. japonicum is zoonotic as it infects both human and animals including domestic ruminant animals such as cattle and animals from the wild. The epidemiology of both S. mansoni and S. haematobium is only limited to humans (definitive hosts) and the snail intermediate hosts (https://www.cdc.gov/globalhealth/ntd/diseases/schisto_burden.).
China's efforts to effectively control S. japonicum transmission is laudable (Zhang et al., 2016), they were once plagued with widespread S. japonicum transmission across the country with endemicity reported in 12 provinces, 11,600,000 people and 1200,000 cattle infected in the 1950s (Chen and Feng, 1999). Through government political-will and implementation of integrated control strategies, they eliminated schistosomiasis as a public health problem in the country (Zhang et al., 2016; Li et al., 2014; Collins et al., 2012). The strategies employed by China interrupted schistosomiasis transmission in five provinces, including Shanghai (1985), Guangdong (1985), Guangxi (1988), Fujian (1987) and Zhejiang (1995) (Utzinger et al., 2005; Wang et al., 2008) and finally attained elimination in 2016 (NRAS, 2016). The elimination status attained in 2016 in these provinces was a product of the ten years medium- and long- term target for the national schistosomiasis control programmes implemented since 2004. Transmission-controlled status was also achieved in seven other provinces including Sichuan (2008), Yunnan (2009), Jiangsu (2010), Hubei (2013), Jiangxi (2015), Anhui (2015) and Hunan (2015). All counties have achieved the criteria for schistosomiasis elimination as public health problem with village prevalence level < 1%, at the end of 2015 (Zhou, 2016).
Considering China's success story in schistosomiasis elimination and other parasitic diseases such as filariasis and malaria, the China-Africa collaboration on schistosomiasis elimination in Africa is an important cooperative health development initiative, that offers support to African countries from China in order to control schistosomiasis transmission in Africa. This review examines the importance of China-Africa collaboration on schistosomiasis elimination using effective surveillance-response intervention strategy as the platform to effectively drive schistosomiasis elimination in Africa.
Section snippets
Epidemiological trends and pattern in China and Africa
Schistosomiasis is termed neglected because it is associated with poverty and people that lives in communities that lack access to basic infrastructure such as good potable water sources, sanitary facilities, and also indulge in habits that promotes schistosomiasis transmission such as open defecation near waterbodies, swimming in water contaminated with infective schistosome cercariae (Ekpo et al., 2013). Being neglected and ignorance arising from poor knowledge of the disease epidemiology in
Conclusion
Evidence-based schistosomiasis control programme should be guided by the outcome of schistosomiasis mapping in providing a robust understanding of schistosomiasis distribution and transmission dynamics and also inform stakeholders especially programme managers on the tools needed. There is need for the implementation of efficient monitoring and surveillance system mechanism to facilitate contextual and effective management of schistosomiasis elimination across different environment (
Declaration of Competing Interest
None.
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