Control of schistosomiasis in sub-Saharan Africa: progress made, new opportunities and remaining challenges

SUMMARYSeveral other journal supplements have documented progress made in the control of schistosomiasis in Egypt, China and Brazil, however, with more than 97% of the schistosome infections now estimated to occur in Africa, the relevance of this special issue in Parasitology cannot be overemphasized. In total, 18 articles are presented, inclusive of a lead-editorial from the WHO highlighting a seminal resolution at the 54th World Health Assembly in 2001 that advocated de-worming. Facilitated by a US$ 30 million grant from the Bill and Melinda Gates Foundation in 2002, the Schistosomiasis Control Initiative subsequently fostered implementation of large-scale schistosomiasis (and soil-transmitted helminthiasis) control programmes in six selected African countries. From 2005, CONTRAST, a European union-funded consortium, was formed to conduct multi-disciplinary research pertaining to optimisation of schistosomiasis control. Progress made in schistosomiasis control across sub-Saharan Africa since the turn of the new millennium is reviewed, shedding light on the latest findings stemming from clinical, epidemiological, molecular and social sciences research, inclusive of public health interventions with monitoring and evaluation activities. New opportunities for integrating the control of schistosomiasis and other so-called neglected tropical diseases are highlighted, but more importantly, several opportune questions that arise from it frame the remaining challenges ahead for an enduring solution.

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Rethinking the Top-Down Approach to Schistosomiasis Control and Elimination in Sub-Saharan Africa

Frontiers in Public Health ◽

10.3389/fpubh.2021.622809 ◽

2021 ◽

Vol 9 ◽

Author(s):

Adeola Onasanya ◽

Michel Bengtson ◽

Oladimeji Oladepo ◽

Jo Van Engelen ◽

Jan Carel Diehl

Keyword(s):

Integrated Approach ◽

Sub Saharan Africa ◽

World Health ◽

Intersectoral Collaboration ◽

Top Down ◽

African Countries ◽

Schistosomiasis Control ◽

Active Approach ◽

Sub Saharan ◽

Health Organization

The control and elimination of schistosomiasis have over the last two decades involved several strategies, with the current strategy by the World Health Organization (WHO) focusing mainly on treatment with praziquantel during mass drug administration (MDA). However, the disease context is complex with an interplay of social, economic, political, and cultural factors that may affect achieving the goals of the Neglected Tropical Disease (NTD) 2021-2030 Roadmap. There is a need to revisit the current top-down and reactive approach to schistosomiasis control among sub-Saharan African countries and advocate for a dynamic and diversified approach. This paper highlights the challenges of praziquantel-focused policy for schistosomiasis control and new ways to move from schistosomiasis control to elimination in sub-Saharan Africa. We will also discuss an alternative and diversified approach that consists of a Systems Thinking Framework that embraces intersectoral collaboration fully and includes co-creating locally relevant strategies with affected communities. We propose that achieving the goals for control and elimination of schistosomiasis requires a bottom-up and pro-active approach involving multiple stakeholders. Such a pro-active integrated approach will pave the way for achieving the goals of the NTD 2021-2030 roadmap for schistosomiasis, and ultimately improve the wellbeing of those living in endemic areas.

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The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002–2008

Parasitology ◽

10.1017/s0031182009990400 ◽

2009 ◽

Vol 136 (13) ◽

pp. 1719-1730 ◽

Cited By ~ 208

Author(s):

A. FENWICK ◽

J. P. WEBSTER ◽

E. BOSQUE-OLIVA ◽

L. BLAIR ◽

F. M. FLEMING ◽

...

Keyword(s):

Neglected Tropical Diseases ◽

Integrated Control ◽

Monitoring And Evaluation ◽

Sub Saharan Africa ◽

Preventive Chemotherapy ◽

Schistosomiasis Control ◽

Control Programmes ◽

Sub Saharan ◽

Management Approaches ◽

Control Initiative

SUMMARYSchistosomiasis remains one of the most prevalent parasitic diseases in developing countries. After malaria, schistosomiasis is the most important tropical disease in terms of human morbidity with significant economic and public health consequences. Although schistosomiasis has recently attracted increased focus and funding for control, it has been estimated that less than 20% of the funding needed to control the disease in Africa is currently available. In this article the following issues are discussed: the rationale, development and objectives of the Schistosomiasis Control Initiative (SCI)-supported programmes; the management approaches followed to achieve implementation by each country; mapping, monitoring and evaluation activities with quantifiable impact of control programmes; monitoring for any potential drug resistance; and finally exit strategies within each country. The results have demonstrated that morbidity due to schistosomiasis has been reduced by the control programmes. While challenges remain, the case for the control of schistosomiasis has been strengthened by research by SCI teams and the principle that a national programme using ‘preventive chemotherapy’ can be successfully implemented in sub-Saharan Africa, whenever the resources are available. SCI and partners are now actively striving to raise further funds to expand the coverage of integrated control of neglected tropical diseases (NTDs) in sub-Saharan Africa.

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Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

BMC Public Health ◽

10.1186/s12889-021-11635-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Edward Kwabena Ameyaw

Keyword(s):

Pregnant Women ◽

Sub Saharan Africa ◽

World Health ◽

Health Concern ◽

Maternal And Newborn Health ◽

African Countries ◽

The World ◽

Itn Use ◽

Multi Level ◽

Sub Saharan

Abstract Background Malaria in pregnancy is a crucial public health concern due to the enormous risk it poses to maternal and newborn health. The World Health Organisation therefore recommends insecticide-treated net (ITN) for pregnant women. The world over, sub-Saharan Africa bears the highest prevalence of malaria and its associated complications. This study investigated the individual, community and society level factors associated with ITN use among pregnant women in sub-Saharan Africa. Methods The study was conducted with Demographic and Health Survey data of 21 sub-Saharan African countries. A total of 17,731 pregnant women who possessed ITN participated in the study. Descriptive computation of ITN use by survey country and socio-demographic characteristics was conducted. Further, five multi-level binary logistic regression models were fitted with MLwiN 3.05 package in STATA. The Markov Chain Monte Carlo (MCMC) estimation procedure was used in estimating the parameters whilst the Bayesian Deviance Information Criterion was used for the model fitness test. Results On average, 74.2% pregnant women in SSA used ITN. The highest prevalence of ITN use occurred in Mali (83.7%) whilst the least usage occurred in Namibia (7%). Women aged 30–34 were more likely to use ITN compared with those aged 45–49 [aOR = 1.14; Crl = 1.07–1.50]. Poorest women were less probable to use ITN relative to richest women [aOR = 0.79; Crl = 0.70–0.89]. Compared to women who did not want their pregnancies at all, women who wanted their pregnancies [aOR = 1.06; Crl = 1.04–1.19] were more probable to use ITN. Women in male-headed households had higher likelihood of ITN use compared to those from female-headed households [aOR = 1.28; Crl = 1.19–1.39]. On the whole, 38.1% variation in ITN use was attributable to societal level factors whilst 20.9% variation was attributable to community level factors. Conclusion The study has revealed that in addition to individual level factors, community and society level factors affect ITN use in SSA. In as much as the study points towards the need to incorporate community and societal variations in ITN interventions, active involvement of men can yield better outcome for ITN utilisation interventions in SSA.

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The seasonality of cholera in sub-Saharan Africa

10.1101/2021.11.23.21265642 ◽

2021 ◽

Author(s):

Javier Perez-Saez ◽

Justin Lessler ◽

Elizabeth C. Lee ◽

Francisco J. Luquero ◽

Espoir B. Malembaka ◽

...

Keyword(s):

Large Scale ◽

Task Force ◽

Case Fatality ◽

Sub Saharan Africa ◽

Health Concern ◽

National Differences ◽

Sub Saharan ◽

Eastern And Southern Africa ◽

Positive Correlations ◽

Gates Foundation

Background Cholera remains a major threat in Sub-Saharan Africa (SSA) where some of the highest case fatality risks are reported. Knowing in what months and where cholera tends to occur across the continent can aid in improving efforts to eliminate cholera as a public health concern; though largely due to lack of unified large-scale datasets, no continent-wide estimates exist. In this study we aim to estimate cholera seasonality across SSA. Methods We leverage the Global Task Force on Cholera Control (GTFCC) global cholera database with statistical models to synthesize data across spatial and temporal scale in order to infer the seasonality of excess suspected cholera occurrence in SSA. We developed a Bayesian statistical model to infer the monthly risk of excess cholera at the first and/or second administrative levels. Seasonality patterns were then grouped into spatial clusters. Finally, we studied the association between seasonality estimates and hydro-climatic variables. Findings The majority of studied countries (24/34) have seasonal patterns in excess cholera, corresponding to approximately 85% of the SSA population. Most countries (19/24) also had sub-national differences in seasonality patterns, with strong differences in seasonality strength between regions. Seasonality patterns clustered into two macro-regions (West Africa and the Sahel vs. Eastern and Southern Africa), which were composed of sub-regional clusters with varying degrees of seasonality. Exploratory association analysis found most consistent and positive correlations between cholera seasonality and precipitation, and to a lesser extent with temperature and flooding. Interpretation Widespread cholera seasonality in SSA offers opportunities for intervention planning. Further studies are needed to study the association between cholera and climate. Funding The NASA Applied Sciences Program and the Bill and Melinda Gates Foundation.

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HIV/AIDS

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0098 ◽

2020 ◽

pp. 901-933

Author(s):

Sarah Fidler ◽

Timothy E.A. Peto ◽

Philip Goulder ◽

Christopher P. Conlon

Keyword(s):

Large Scale ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

African Countries ◽

Global Pandemic ◽

The People ◽

Reduce Life Expectancy ◽

Sub Saharan ◽

Living With Hiv ◽

The Impact

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).

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A Systematic Review of the Incremental Costs of Implementing a New Vaccine in the Expanded Program of Immunization in Sub-Saharan Africa

MDM Policy & Practice ◽

10.1177/2381468319894546 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831989454

Author(s):

Joe Brew ◽

Christophe Sauboin

Keyword(s):

Systematic Review ◽

Data Collection ◽

Interquartile Range ◽

Sub Saharan Africa ◽

World Health ◽

African Countries ◽

Vaccine Type ◽

Sub Saharan ◽

Health Organization ◽

The Cost

Background. The World Health Organization is planning a pilot introduction of a new malaria vaccine in three sub-Saharan African countries. To inform considerations about including a new vaccine in the vaccination program of those and other countries, estimates from the scientific literature of the incremental costs of doing so are important. Methods. A systematic review of scientific studies reporting the costs of recent vaccine programs in sub-Saharan countries was performed. The focus was to obtain from each study an estimate of the cost per dose of vaccine administered excluding the acquisition cost of the vaccine and wastage. Studies published between 2000 and 2018 and indexed on PubMed could be included and results were standardized to 2015 US dollars (US$). Results. After successive screening of 2119 titles, and 941 abstracts, 58 studies with 80 data points (combinations of country, vaccine type, and vaccination approach–routine v. campaign) were retained. Most studies used the so-called ingredients approach as costing method combining field data collection with documented unit prices per cost item. The categorization of cost items and the extent of detailed reporting varied widely. Across the studies, the mean and median cost per dose administered was US$1.68 and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routine vaccination was more costly than campaigns, with mean cost per dose of US$1.99 and US$0.88, respectively. Conclusion. Across the studies, there was huge variation in the cost per dose delivered, between and within countries, even in studies using consistent data collection tools and analysis methods, and including many health facilities. For planning purposes, the interquartile range of US$0.54 to US$2.31 may be a sufficiently precise estimate.

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When Should the Emphasis on Schistosomiasis Control Move to Elimination?

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed3030085 ◽

2018 ◽

Vol 3 (3) ◽

pp. 85 ◽

Cited By ~ 12

Author(s):

W. Secor ◽

Daniel Colley

Keyword(s):

South America ◽

Operational Research ◽

Sub Saharan Africa ◽

World Health ◽

Evidence Based ◽

Clean Water ◽

Schistosomiasis Control ◽

The World ◽

The Caribbean ◽

Sub Saharan

The stated goal of the World Health Organization’s program on schistosomiasis is paraphrased as follows: to control morbidity and eliminate transmission where feasible. Switching from a goal of controlling morbidity to interrupting transmission may well be currently feasible in some countries in the Caribbean, some areas in South America, northern Africa, and selected endemic areas in sub-Saharan Africa where there have been improvements in sanitation and access to clean water. However, in most of sub-Saharan Africa, where programmatic interventions still consist solely of annual mass drug administration, such a switch in strategies remains premature. There is a continued need for operational research on how best to reduce transmission to a point where interruption of transmission may be achievable. The level of infection at which it is feasible to transition from control to elimination must also be defined. In parallel, there is also a need to develop and evaluate approaches for achieving and validating elimination. There are currently neither evidence-based methods nor tools for breaking transmission or verifying that it has been accomplished. The basis for these statements stems from numerous studies that will be reviewed and summarized in this article; many, but not all of which were undertaken as part of SCORE, the Schistosomiasis Consortium for Operational Research and Evaluation.

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What sub-Saharan African countries can learn from malaria elimination in China

Tropical Medicine and Health ◽

10.1186/s41182-021-00379-z ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Abubakar Olaitan Badmos ◽

Aishat Jumoke Alaran ◽

Yusuff Adebayo Adebisi ◽

Oumnia Bouaddi ◽

Zainab Onibon ◽

...

Keyword(s):

Significant Proportion ◽

Sub Saharan Africa ◽

World Health ◽

Western Pacific Region ◽

African Region ◽

African Countries ◽

African Context ◽

Sub Saharan ◽

Health Organization ◽

Global Reduction

AbstractMalaria is one of the most devastating diseases plaguing the sub-Saharan African region since time immemorial. In spite of a global reduction in mortality rates, a significant proportion of deaths due to malaria is still accounted for in the region. China recently joined the 40 countries declared malaria free by the World Health Organization and became the first country in the WHO Western Pacific Region to be awarded the certification. We commented on the strategies employed by China to eliminate malaria, address challenges facing malaria control in sub-Saharan Africa, and derive lessons that could be learned in the sub-Saharan African context.

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Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0249853 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249853

Author(s):

Ugochinyere Ijeoma Nwagbara ◽

Emmanuella Chinonso Osual ◽

Rumbidzai Chireshe ◽

Obasanjo Afolabi Bolarinwa ◽

Balsam Qubais Saeed ◽

...

Keyword(s):

Scoping Review ◽

Positive Attitude ◽

Grey Literature ◽

Further Education ◽

Sub Saharan Africa ◽

World Health ◽

African Countries ◽

Preventive Practices ◽

Adequate Knowledge ◽

Sub Saharan

Background Knowledge, attitudes, perception, and preventative practices regarding coronavirus- 2019 (COVID-19) are crucial in its prevention and control. Several studies have noted that the majority of people in sub-Saharan African are noncompliant with proposed health and safety measures recommended by the World Health Organization (WHO) and respective country health departments. In most sub-Saharan African countries, noncompliance is attributable to ignorance and misinformation, thereby raising questions about people’s knowledge, attitudes, perception, and practices towards COVID-19 in these settings. This situation is particularly of concern for governments and public health experts. Thus, this scoping review is aimed at mapping evidence on the knowledge, attitudes, perceptions, and preventive practices (KAP) towards COVID-19 in sub-Saharan Africa (SSA). Methods Systematic searches of relevant articles were performed using databases such as the EBSCOhost, PubMed, Science Direct, Google Scholar, the WHO library and grey literature. Arksey and O’Malley’s framework guided the study. The risk of bias for included primary studies was assessed using the Mixed Method Appraisal Tool (MMAT). NVIVO version 10 was used to analyse the data and a thematic content analysis was used to present the review’s narrative account. Results A total of 3037 eligible studies were identified after the database search. Only 28 studies met the inclusion criteria after full article screening and were included for data extraction. Studies included populations from the following SSA countries: Ethiopia, Nigeria, Cameroon, Uganda, Rwanda, Ghana, Democratic Republic of Congo, Sudan, and Sierra Leone. All the included studies showed evidence of knowledge related to COVID-19. Eleven studies showed that participants had a positive attitude towards COVID-19, and fifteen studies showed that participants had good practices towards COVID-19. Conclusions Most of the participants had adequate knowledge related to COVID-19. Despite adequate knowledge, the attitude was not always positive, thereby necessitating further education to convey the importance of forming a positive attitude and continuous preventive practice towards reducing contraction and transmission of COVID‐19.

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Preparedness and Response Efforts to Fight against COVID-19 in Sub-Saharan Africa: Challenges and Opportunities

Journal of Pediatrics & Neonatal Biology ◽

10.33140/jpnb.05.02.07 ◽

2020 ◽

Vol 5 (2) ◽

Keyword(s):

Sub Saharan Africa ◽

World Health ◽

African Countries ◽

Global Pandemic ◽

Laboratory Facility ◽

The World ◽

Challenges And Opportunities ◽

Sub Saharan ◽

The Moment ◽

Health Organization

In late December the World Health Organization declared COVID-19 as global pandemic and needs international concern. As the novel corona virus rages through the world and spreads rapidly Africa is the least-affected continent at the moment. Sub-Saharan Africa is the home of more than one billion populations with fragile health system which is prone for the epidemic to occur. But Ebola experience left many African countries better prepared. We were searching all sources of the website related to preparation and prevention of COVID-19 in sub-Sahara Africa countries. Most African countries have established laboratory facility and implement the recommendations that terminate the outbreak COVID-19.

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