WHO©

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The Burden of Schistosomiasis:

GAKUU ESBON MWANGI
A Kenyan Context
CC3: HEALTH PROGRAMS & PROBLEMS

MPH-HSDC 2019/2020

INSTITUTE OF TROPICAL MEDICINE, ANTWERP

Epidemiological Burden

Species
Intestinal Schistosoma
mansonii
Schistosoma
japonicum
Schistosoma
mekongi
Schistosoma
intercalatum

Urogenital Schistosoma
haematobium2
Global Spatial Heterogeneity of Schistosomiasis
Endemic in 74 countries
>780 million are at risk
>200 million infected worldwide (2017)
>280,000 deaths annually (2017)

90% of infected people

85% of Populations at Risk

Adapted from Gryseels B et al. Human Schistosomiasis. Lancet2006; 1106-18 3

Status of Schistosomiasis Prevalence-Kenya -2017
• Approx. 15M at risk
• Approx. 6M infected
• Prevalent species: S Mansonii and S Haematobium

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Disability-adjusted life years (DALYs) due to Schistosomiasis 1990-2017
Global

DALYs due to schistosomiasis

 Global - 1,431,447 (IHME

2017)
 Kenya - 58,707 (IHME 2017)
Kenya

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 Economic Burden of Schistosomiasis
Direct Costs Proportion of Years of Life Lost(YLL) & Years Lived with Disability (YLD) for
Disability-adjusted life years (DALYs) of the majors Neglected Tropical Diseases
• Intervention costs-drugs, delivery
costs, personnel, snail control
chemical
• Medical costs- stool sample
investigations, hospitalization costs
Indirect Health Costs
• Caregiver costs
• Transportation costs
Indirect Non-Health cost
• Loss of wages due to illness &
hospitalization – DALYs, YLD
• Loss of wages due to premature
mortality – DALY, YLL

PLOS Neglected Tropical Diseases:2014-Vol 8. Issue 7 6

Conceptual Framework of Social Determinants
of Schistosomiasis
General Social Determinants of
Relevance
Gender Occupation Politics
Culture Age
Intervention Elements
Health Systems Community Involvement
Education Economy
Water & Health
Migration Sanitation Education
Biomedical Aspects
Environment
Ethnicity Diagnosis Prevention
Treatment

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Credit: Bruun B and Aagaard-Hansen. Social Science Perspectives on Schistosomiasis. 2008.
Factors influencing Schistosomiasis Infection & Disease

Credit: Stephanie J Krauth et al. A Call to systems epidemiology to tackle the complexity of schistosomiasis. Trop. Med. Infect. Dis, 2019 8
 Perception of Schistosomiasis & Impact
on Health Seeking Behaviour (HSB)
Perceptions on the Perceptions of modern Financial considerations of Aspects of the local
Biomedical Knowledge of Stigma of schistosomiasis
symptoms of treatments and health treatment for environment and the
Schistosomiasis infection
schistosomiasis services for schistosomiasis schistosomiasis community

Lack of knowledge on the Treatment regarded as Unaffordability of modern

infection’s signs and futile treatment and health Difficulty in accessing
symptoms -> poor HSB services-> poor HSB health services resulted in
some participants not
seeking treatment
Infection regarded as for schistosomiasis
untreatable due to its
endemicity Those in higher socio-
Perceived lack of severity Shameful to be infected
Supernatural Beliefs -> economic groups were
for schistosomiasis or to have an infected
traditional healers more likely to seek
symptoms -> poor HSB Perceived inadequacy of family member .
treatment
health services deter Social pressure from
people from obtaining neighbours and relatives
treatment was commonly placed on
People with at least high Someone else paying for mothers to take their
school education more health services positively children, with
knowledgeable of the Unavailability of influenced whether
medications from health severe symptoms, to the
disease than those modern treatment was health services
with lower education services-> poor HSB sought

Sacolo H et al. Knowledge, attitudes and practices on Schistosomiasis in sub-Saharan Africa. BMC Infect Dis. 2018 Jan 18;18(1):46.

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 Chemotherapy
Schistosomiasis
Transmission Cycle
&
WASH
Intervention Points Interventions

A - Reduce the prevalence & intensity Vector Control:

of infection within the population
Biological/Moluscicides

B - Improve environmental conditions

Engineering
C - Vector Control Controls

D – Reduce contact with infected

water

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CREDIT: SUSANNE SOKOLOW & CHELSEA WOOD ET AL., VIA A CREATIVE COMMONS LICENSE
 Analysis of Interventions for Schistosomiasis
Control*
Interventions Efficacy Operational Efficiency Relative Cost Acceptability

1. Mass Drug Administration Moderate High ++ Moderate

2. Symptomatic Treatment High Low + High

3. Snail Control High Moderate +++ Moderate

4. WASH High High ++++ Moderate

5. Engineering Controls Moderate Low +++++ High

*-Lo NC, Bogoch II, Blackburn BG, et al. Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: A cost-
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effectiveness modelling study. Lancet Glob Heal. 2015
 Chemotherapy Based
Schistosomiasis Control
Praziquantel (PZQ) – Recommended Drug for Schistosomiasis
treatment & control
Modalities of Mass Drug Administration (MDA)

• Community-Wide Treatment of High-Risk Adults – If prevalence >50%

• Age-Targeted Drug Delivery – 10% <Prevalence> 49.9%

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 Main Processes of a School-Based
Schistosomiasis MDA Programme in
Kenya

Advocacy & Local training of

Medicines
Stakeholder first line health &
school facilities Distribution
Forums

Initial
Single- National
Community
engagement &
Treatment
delivery &
Trainings
Year mobilization supervision

Activities

Prevalence Data Collection Programme

Surveys & Planning evaluation

Annual Programme Activities 13

 1. Inadequate targeting –Other high risk groups
(farmers, fishermen, vehicle washers)
Operational untreated
Challenges for 2. Logistical challenges- Distribution of
medicines, poles, IEC materials
School Based 3. Treatment fatigue -> Reduced adherence
MDA for over time
4. Poor coverage for children not in school
Schistosomiasis
5. Funding uncertainty
6. Low political commitment

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 1. Assembly WH, States M. Weekly epidemiological record Relevé épidémiologique hebdomadaire. 2019;(50):601-612.

2. Bruun B, Aagaard-Hansen J, Watts S. The social context of schistosomiasis and its control An introduction and annotated bibliography. Strategies.
2008:227. doi:10.2471/TDR.08.978924159718 0

3. Bundy DAP, Guyatt HL, Road C. Cost analysis of schistosomiasis. 1992:1989-1991.

4. Mbah MLN, Kjetland EF, Atkins KE, et al. Cost-effectiveness of a community-based intervention for reducing the transmission of Schistosoma
haematobium and HIV in Africa. Proc Natl Acad Sci U S A. 2013;110(19):7952-7957. doi:10.1073/pnas.1221396110

5. Cronin T, Sheppard J, de Wildt G. Health-seeking behaviour for schistosomiasis: A systematic review of qualitative and quantitative
literature. Pan Afr Med J. 2013;16:1-9. doi:10.11604/pamj.2013.16.130.3078

6. Bergquist R, Gray D. Prospects for Schistosomiasis Elimination.; 2019. doi:10.3390/books978-3-03921-358-0

References 7. Krauth S, Balen J, Gobert G, Lamberton P. A Call for Systems Epidemiology to Tackle the Complexity of Schistosomiasis, Its Control, and Its
Elimination. Trop Med Infect Dis. 2019;4(1):21. doi:10.3390/tropicalmed4010021

8. Hotez PJ, Alvarado M, Basáñez MG, et al. The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical
Diseases. PLoS Negl Trop Dis. 2014;8(7). doi:10.1371/journal.pntd.0002865

9. Lo NC, Bogoch II, Blackburn BG, et al. Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and
soil-transmitted helminthiasis: A cost-effectiveness modelling study. Lancet Glob Heal. 2015;3(10):e629-e638. doi:10.1016/S2214-109X(15)00047-9

10. Sokolow SH, Wood CL, Jones IJ, et al. Global Assessment of Schistosomiasis Control Over the Past Century Shows Targeting the Snail
Intermediate Host Works Best. PLoS Negl Trop Dis. 2016;10(7). doi:10.1371/journal.pntd.0004794

11. Leslie J, Garba A, Oliva EB, et al. Schistosomiais and Soil-Transmitted helminth control in Niger: Cost effectiveness of school based and
community distributed mass drug administration. PLoS Negl Trop Dis. 2011;5(10). doi:10.1371/journal.pntd.0001326

12. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet. 2006;368(9541):1106-1118. doi:10.1016/S0140-6736(06)69440-3

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