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Zanzibar is an archipelago in the Indian Ocean just off the African coast, with the two largest islands known as Unguja and Pemba. Although part of the United Republic of Tanzania, it has an autonomous Government and Ministry of Health (MoH). It is well known for its pristine white sandy beaches, abundant sunshine, Swahili dishes, hospitable people and luxury tourist resorts. Zanzibar is often referred to as ’Spice Island’ due to its cloves, nutmeg, cinnamon, and black pepper.
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%.
Biannual preventive chemotherapy (PC) together with additional interventions such as health education, community sensitisation and improved access to clean water and adequate sanitation have successfully alleviated much of the disease burden. However, persistently high prevalence is found in certain areas. These persistent hot-spots of transmission and reinfection are linked to risk factors such as living in close proximity to a freshwater body containing intermediate host snail species, frequent and intense contact of the population with infested water sources, lack of safe water supplies and poor sanitation.
Elimination of SCH transmission is a priority for Zanzibar and the MoH was one of the first in Africa to adopt an elimination strategy, implementing their Zanzibar Elimination of Schistosomiasis Transmission (ZEST) project from 2011 – 2017. The mainstay of the MoH approach is to treat all children between the age of 3-5 years old, all school-aged children (SAC) (5-14 years) and all adults in endemic areas, twice a year for both SCH and STH.
The treatment strategy includes both school and community-based distribution. In the community this focuses on a door-to-door approach with community drug distributors (CDDs) visiting each household and providing treatment for SCH, STH and lymphatic filariasis at the same time. Zanzibar was the first place to trial this triple drug co-administration approach in 2006. For school-based delivery, trained teachers provide de-worming treatment to pupils. Every year, CDDs and teachers are selected and trained on the importance of treatment and health education, making the de-worming campaign efficient and cost-effective.
Urogenital SCH has been eliminated as a public health problem in many areas on both Pemba and Unguja islands, but transmission remains an issue.
New challenges have also arisen, including uncertain future funding to sustain regular treatment and new irrigation schemes that have the potential to undo the significant gains made in reducing infection. SCH contributes to an ongoing cycle of poverty and stigma that leaves people unable to work, go to school or participate fully in family and community life. The disease continues to affect populations who are exposed to contaminated water due to activities such as fishing, farming and recreation. All of these challenges threaten Zanzibar’s goal of elimination.
“We are in the last mile of achieving our dream of eliminating this debilitating disease.”
Dr Fatma Kabole – Head of the NTD Unit at the Ministry of Health in Zanzibar talks about the impact of SCH in Zanzibar, and the urgent need to eliminate this disease from the islands.
As a top rated international development nonprofit, we support deworming programmes across sub-Saharan Africa in the following countries:
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
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
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
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
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, 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.
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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.
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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.
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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
Parasitic worm infections often trap people in a cycle of poverty, and almost a quarter of the population in Uganda is living below the poverty line. We’re supporting the local government to eliminate these infections, including schistosomiasis.
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View our work in Zanzibar
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.
View our work in Malawi