Schistosomiasis in Malawi

All 29 of Malawi’s health districts are endemic for schistosomiasis, with both urogenital and intestinal schistosomiasis present within the country. Disease levels in Malawi range from 1.3% to 25.4%, which are classified as low to moderate prevalence, according to the World Health Organization’s (WHO) endemicity categories.

Malawi

The Republic of Malawi, also known as ‘the warm heart of Africa’, is a landlocked country in Southeastern Africa and its economy is heavily based on agriculture.

Prevalence of schistosomiasis

SCI Foundation-supported NTD programmes

With support from SCI Foundation (SCIF), the Ministry of Health (MoH) in Malawi has been providing treatment to people residing in all areas in which schistosomiasis and soil-transmitted helminthiasis (STH) occur. SCIF provides technical and financial support for Malawi’s schistosomiasis control programme, with a focus on treatment through mass drug administration (MDA) and associated surveys.

NTD programme in Malawi

To date, the programme has predominantly focused on reduction of prevalence and severity of infections but is now looking to transition towards elimination as a public health problem.

Five Facts

Population: 19.6 million (2021)
National-scale annual treatment for schistosomiasis and soil-transmitted helminthiasis since 2012, providing a total of 76,823,483 treatments
During the 2021-22 fiscal year, SCI Foundation supported the delivery of 2,725,558 and 154,679 treatments for schistosomiasis and soil-transmitted helminthiasis respectively
SCI Foundation’s support to Malawi is currently enabled by general donated funds
SCI Foundation works in partnership with the Ministry of Health and the Centre for Health, Agriculture and Development Research & Consulting (CHAD)

How treatments are delivered

Malawi usually implements a combination of school and community-based MDA. In schools, treatments are delivered by Health Surveillance Assistants (HSAs, a cadre of community health workers in Malawi) with support from teachers. Community-based MDA is carried out by HSAs with support from community volunteers.

SCIF supports treatment for both schistosomiasis and STH to be delivered in all districts with medications donated by pharmaceutical manufacturers through the WHO, according to the frequency guidance provided by WHO.

To date, treatment has targeted all school-aged children within the country, as well as adults considered to be at high-risk. However, target populations are likely to change moving forward following the completion of nationwide reassessment mapping and transition to sub-district MDA implementation.

The WHO recommends that reassessment mapping should be carried out to determine if prevalence has changed after 5-6 rounds of treatment. In Malawi, this was undertaken in three phases, with surveys taking place in 2017, 2018 and 2019. Reassessing prevalence in this way is important to determine which areas still require treatment and at what frequency (based on prevalence) and to refocus resources to ensure the programme is continuing to have maximum impact on infection after multiple rounds of treatment.

A map of Malawi showing a snapshot of the results derived from the 2017-19 reassessment mapping surveys. It displays the percentage of people likely to be infected (prevalence) by either Shistosoma haematobium or Shistosoma mansoni in each district, coloured according to the WHO recommended prevalence thresholds for treatment frequency. The dots represent each school surveyed, and the size and colour of the dots indicate the percentage of sampled students found to be positive for either disease.

Challenges specific to Malawi

A fifth of the country is occupied by Lake Malawi; therefore, certain areas can only be reached by boat, which can be challenging for treatment and surveys. More generally, movement within the country can be difficult during the rainy season. There have also been some programme challenges related to community perceptions, for example fear of ‘bloodsuckers’ in certain areas of Malawi.

An additional challenge more recently was that community-based health activities were impacted by the public’s fear and misconception that they were to be offered COVID-19 vaccinations.

What does the future look like?

SCIF continues to work closely with the Ministry of Health to reach their goals and objectives, as outlined in their national strategic plans.

Where We Work

As a top rated international development nonprofit, we support deworming programmes across sub-Saharan Africa in the following countries:

Burundi

Burundi is one of the smallest countries in Africa, and its more than 11 million inhabitants make it one of the most population dense countries on the continent. The country is endemic for parasitic worm infections including schistosomiasis, and following several years of treatment, we’re supporting the local government to eliminate these diseases for good.

View our work in Burundi

Côte d’Ivoire

Parasitic worm infections are debilitating and disproportionately affect the poor and vulnerable, particularly children. While lack of awareness and limited access to clean water and sanitation continue to present challenges, Côte d’Ivoire’s national programme is committed to achieving the elimination of schistosomiasis. By supporting the Ministry of Health, we’re continuing to fight these diseases using sustainable interventions.

View our work in Côte d’Ivoire

Uganda

Parasitic worm infections are debilitating and disproportionately affect the poor and vulnerable, particularly children. While lack of awareness and limited access to clean water and sanitation continue to present challenges, Uganda’s national programme is committed to achieving the elimination of schistosomiasis. By supporting the Ministry of Health, we’re continuing to fight these diseases using sustainable interventions.

View our work in Uganda

Ethiopia

Ethiopia, in the horn of Africa, is the most populous land-locked country in the world. It bears a significant burden of parasitic worm infections, including schistosomiasis, but we’re supporting the Ministry of Health to implement a multi-year national programme for the control and elimination of these diseases.

View our work in Ethiopia

DRC

Parasitic worm infections (such as schistosomiasis) often trap people in a cycle of poverty, and almost half of the population of the Democratic Republic of the Congo (DRC) is living below the national poverty line. We’re supporting the local government to eliminate these infections.

View our work in DRC

Liberia

Around 40% of Liberia’s population is affected by parasitic worm infections (such as schistosomiasis), but we’ve successfully worked with its government to reach all at-risk school age children with treatment.

View our work in Liberia

Madagascar

Madagascar, one of the largest islands in the world, is a low-income country that has suffered from several years of reduced international aid. In most endemic areas in the country, people have gone untreated for many years. We’re supporting the Ministry of Public Health and Education to reach the largest possible number of people affected by schistosomiasis.

View our work in Madagascar

Niger

A majority of Niger’s population lives in rural areas and almost half of Nigerians live below the poverty line. Access to clean water and sanitation is a daily challenge, but by supporting the Ministry of Health we’ve helped to deliver over 10 million treatments for schistosomiasis and soil-transmitted helminths, and have reached all at-risk school-age children.

View our work in Niger

Sudan

With over half of Sudan’s population unable to use improved water and sanitation, over 20 million people need treatment for parasitic worm infections and schistosomiasis. We’re supporting the country’s government to help maintain an elimination programme with national reach.

View our work in Sudan

Tanzania

Despite the country’s control programme reaching national coverage, the size of population at risk is still significant. We support the Ministry of Health and Pemba’s Public Health Laboratory-Ivo de Carneri to deliver treatments against parasitic worm infections, including schistosomiasis.

View our work in Tanzania

Zanzibar

All 11 districts across both islands in Zanzibar are endemic for soil-transmitted helminthiasis (STH) and all but one on Unguja are endemic for urogenital schistosomiasis (SCH) with prevalence ranging from 0.4 – 4.8%.

View our work in Zanzibar