Strategies Against Schistosomiasis

Although schistosomiasis is not eradicable, the disease can be prevented and transmission controlled with a single, annual dose of praziquantel. Community health workers conduct rapid assessments to determine the prevalence of schistosomiasis in a given village.

A dipstick is used to detect the presence of blood in the urine of children and the proportion of infected children in a village determines the treatment plan for that community.

Nigeria's Schistosomiasis Control Program, in partnership with The Carter Center, began in 1999 in two Nigeria states, Nasarawa and Plateau, expanding to Delta state in 2004. Since 1999, more than 70,000 treatments have been distributed to nearly 400 villages in the three states. Although this success is remarkable, more than 6 million praziquantel tablets are still needed every year to treat those in just two of the states; the need for Delta state is unknown as the area is still being evaluated. Unlike Mectizan, used to fight river blindness, and albendazole, one of two drugs used to fight lymphatic filariasis, no company donates praziquantel, so the Center's distribution is limited to the drugs it can afford to purchase.

Furthermore, there is a limited supply of praziquantel; only 89 million tablets are made when there is a need of 423 million. Nigeria needs more than any other country; approximately 43 million tablets. Not everyone who needs the drug can get it, which is yet another harsh reality for some of the most poverty stricken areas of the world. To ration the limited supply, the program follows the WHO distribution guidelines:

• When a village reports more than 50 percent of children have blood in their urine, only then does everyone get treatment.

• When 20-50 percent of children have bloody urine, only the children get treated.

• When less than 20 percent of children have symptoms, no one in the village gets pills.

This is a tragic situation, but there is hope. Studies of those treated show that, within six months of receiving praziquantel, up to 90 percent of the damage due to infection can be reversed. In the past, praziquantel has been used successfully to treat millions of people at risk for or infected with schistosomiasis in Brazil, Egypt, and China.

With success in these two Nigerian states, when sufficient funds are secured, the next step is to help extend the Schistosomiasis Control Program to all of Nigeria. The Carter Center hopes the hard work and success of its partners in Nigeria will kick start a nation-wide initiative to address the quiet plague of schistosomiasis.