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Schistosomiasis and soil-transmitted helminthiasis are the most prevalent neglected tropical diseases (NTDs) in sub-Saharan Africa. According to research by The Economist Intelligence Unit, commissioned by the END Fund, NTDs cause an annual loss of 17 million healthy life years globally, with 40% of these lost in sub-Saharan Africa.
Schistosomiasis, a disease caused by parasitic flatworms, is endemic in Ethiopia with an estimated 35 million people at risk of infection.
Infection occurs when the parasite’s larvae penetrate a person’s skin during contact with water infested by snails that act as the intermediary host of the parasite, often through fishing, swimming, bathing and washing clothes. Once the worms mature inside the body, they release eggs that can cause permanent organ damage and even death.
Alia and her children. Credit: SCI Foundation/ I. Getachew
Alia Jamal, a 27-year-old mother of two who lives near the shores of Lake Hawassa in southern Ethiopia, has high hopes for her children.
“I want my children to be educated. I would like for one of them to be a doctor and the other a health officer.”
Being healthy is not something Alia takes for granted. Debilitating diseases like malaria commonly occur in her community. Schistosomiasis is less known, but arguably more insidious because of how it is transmitted and the slow onset of symptoms.
Alia, who has had several bouts of schistosomiasis, said:
“The disease gives you stomach pains and diarrhoea. I have had it in the past. This time I was very ill for four days. It is very difficult and scary, especially for someone who is not familiar with it.”
The manmade dam in Keranso, Shone Woreda, traps water from the previous rainy season which the local community uses for washing clothes, bathing, swimming, taking home for household chores, and providing water for their cattle. Credit SCI Foundation/I.Getachew
Children are at high risk of schistosomiasis due to their frequent exposure to infested water, especially with activities such as swimming. In children, the disease can cause anaemia and stunted growth, and can affect their ability to learn. This, in turn, impacts their future prospects. Many infected adults are unable to work or be fully productive due to fatigue and weakness, leading to economic hardship.
SCI Foundation has been working with the Ministry of Health in Ethiopia since 2013 to implement national plans for eliminating parasitic worm diseases like schistosomiasis, supporting the delivery of treatment where the disease is most prevalent, and mapping the disease to better identify the worst-affected areas.
Health workers who are assigned to health posts serving rural communities like Alia’s are on the frontlines of this effort, providing critical preventative advice and services, as well as referring patients to health centers that can offer both diagnosis and treatment.
Almaz Atiya is a health worker providing advice for families on how to prevent and treat schistosomiasis and other diseases. Credit: SCI Foundation/I.Getachew
Almaz Atiya is one of two health extension workers assigned to the health post in Tullo, near where Alia lives.
“Children as well as adults bathe in that water. And the women go into the water barefoot to fetch water. They get exposed to bilharzia and get sick. I ask them how they are feeling and if they indicate these symptoms and that they have had them for three, four days – some say they see blood in their stool – I immediately refer them to a health center that has laboratory services. They have their stool examined at the lab and they are given medication. I follow up with them after that.”
“I had very painful stomach aches and diarrhoea,” said Alia. “I went to the health post when I got sick and they referred me to the health centre and after being examined, they gave me medicine, and that is how I got better.”
In addition to referring patients for further assessment, frontline health workers like Almaz advise villagers on how to prevent infection.
“The health extension workers visit us and give advice about our latrines and hygiene,” said Alia. “They advise us to use soap and wash our hands properly. We wash in the lake water, and they have told me that was the source of my illness. After learning that, I have stopped going into the lake barefoot and washing in it. I now stand at the water edge without entering to get water and we buy piped water for drinking.”
The recent World Health Organization road map for neglected tropical diseases has set targets for the elimination of these infections as public health problems by 2030. Achieving these targets will require concerted action, including better data, context-specific approaches, integration with wider public health efforts, and programmes to improve access to water and sanitation services.
SCI Foundation works closely with the Ethiopian Ministry of Health to conduct mass drug administration campaigns as part of efforts to control and eliminate parasitic worm diseases.
The economic impact is undeniable. If parasitic worm diseases like these are eliminated by 2040, Ethiopia could gain 3.2 billion US dollars, according to the Economist Intelligence Unit.
“We have given medicines for bilharzia through a campaign where we went from house to house in the villages,” said Almaz. “We did this twice – last year and the year before that. The results were good, and it made a big difference. If we are able to continue providing these medications, then I think we will achieve even better results.”
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Bereket Takele, 18, fills 25 litre jerrycans with water from a river, for use at home and for his neighbours who pay him five birr (local currency) per jerrycan. The water is infested with schistosoma putting him at risk of schistosomiasis. Credit: SCI Foundation/ I. Getachew