For more information on research and collaboration related to this topic in Uganda, please contact the officer responsible at;
Dr. Edridah Muheki Tukahebwa,
Vector Control Division (MoH),
Plot 15 Bombo Road,
P.O Box 1661, Kampala, Uganda
MINISTRY OF HEALTH
Press Statement on National Bilharziasis and Worm Control Programme in Uganda (BWCP).
Intestinal schistosomiasis, also called Bilharzia, is one of the leading causes of morbidity and disability in many fishing communities lying along large water bodies in Uganda, such as Lakes Albert, Victoria, Kyoga and along the Albert Nile, as well as in rice paddy fields in Eastern Uganda. It is estimated that over 60% of the people in these communities have the disease; with Schistosoma mansoni infections recorded in 73 out of 112 districts of Uganda. By contrast, urinary schistosomiasis, caused by S.haematobium, exists in only a few districts near Lake Kyoga and is much rarer.
In Uganda, the main intermediate host snails include B. stanleyi, B. pfeifferi, B. choanomphala and B. sudanica. Transmission of intestinal schistosomiasis, which is the main type of the disease in Uganda, is mainly favored by the presence of these suitable intermediate hosts as well as intensive water contact activities, especially fishing.
Nation-wide schistosomiasis control in Uganda was initiated in 2003 under the auspices of the Schistosomiasis Control Initiative (SCI) with funding from the Bill & Melinda Gates Foundation. The objective was to control morbidity through regular chemotherapy of at-risk communities as identified based on the World Health Organization (WHO) mapping protocol which uses the single Kato-Katz thick smear method for diagnosis. Studies carried out between 1988 and 2013, by the Vector Control Division, Ministry of Health revealed that Schistosoma mansoni (intestinal Bilharziasis) is prevalent in 75 and S.haematobium (urinary Bilharziasis) in just 3 out of the 112 districts in the country.
It is estimated that 5.4 million people are infected while 13.9 million people are at risk of Schistosomiasis infection. With the recent WHO resolution and the 65th World Health Assembly of 2012 with a call on schistosomiasis elimination by the year 2020, the country has made some tremendous progress with the implementation of Mass treatment of communities and schools which was launched in 2003 in high endemic districts. Currently there are 73 endemic districts of which 43 are high to moderate while 30 are low endemic. All high to moderate endemic districts benefit from mass treatments with Praziquantel (PZQ). Morbidity due to schistosomiasis has been greatly reduced by MDA.
Map of Uganda Showing Current Status of Schistosomiasis Program Implementation
SOIL TRANSMITTED HELMINTHIASIS (STH):
In Uganda there are four nematode species of public health importance: Ascaris lumbricoides (roundworm), Trichuris trichiura (whipworm), Ancylostoma duodenale and Necator americanus (hookworms). Their eggs are released through the faeces of infected individuals into the environment, hence the collective name of Soil Transmitted Helminths (STH). Both A.lumbricoides and T.trichiura eggs are then ingested by humans through contaminated hands or food. Hookworm infections, however, are the result of human skin penetration by larvae that develop in the soil. The overall effects of STHs are detrimental to health, growth, and the development of children including cognitive development. Among the STH, hookworm infection is the most widespread. It is homogenously distributed in the country exceeding 60% prevalence in 85% of the schools surveyed. In contrast, Ascaris lumbricoides and Trichuris trichiura are concentrated in south-western Uganda where the prevalence is as high as 89% in some places. The spatial distribution of the STH in Uganda is heavily influenced by climatic conditions, especially temperature and rainfall.
Map of Uganda showing the current status of STH Program Implementation.
The major goal of Bilharzia and Worm Control program is reduction of morbidity to levels where the disease is no longer of public health importance in Uganda through conducting epidemiological mapping in all districts to determine level of infections, carryout implementation of school-based/community-based Mass Drug Administration (MDA) in all endemic districts and ensuring that MDA treatments in all endemic districts achieves coverage of more than 75%.
This greatest achievement to Bilharzia and Worm Control program is epidemiological mapping of the distribution of Bilharzia and STH done, currently 73 endemic districts out of 112 are implementing PZQ MDA for Bilharzia and all the 112 are implementing deworming during MDA for STHs, Country-wide training of all Village Health Teams (VHTs) and Teachers to implement MDAs, PZQ and dewormers have been made available in all the Health Centres and programme implementing districts in Uganda. Community Sensitizations and Health Education programmes have been launched and brought closer to at risk populations in Uganda.
The greatest challenge to control of Bilharzia in Uganda is poor sanitation in terms of latrine coverage and usage, as a result, after successful treatment; the majority of the people quickly get re-infected, thus compromising the impact of MDAs. It is therefore vital to undertake sanitation improvement, behaviour change among communities and snail control all of which are currently not being given adequate attention due to limited funding. Construction of pit latrines especially in public places such as canoe landing sites, schools, health facilities, worshiping places and markets should be seriously considered by MoH. Production of adequate and appropriate IEC materials is needed for promoting hygiene education. Furthermore, it might be helpful for MoH to establish inter-sectoral collaboration with ministry of education and Schistosomiasis to be included in the school curriculum. In collaboration with the Ministry of Local Government and other relevant partners, provision of safe water sources for domestic use should be promoted. The increased dependence on VHTs/CMDs by every community-based health initiative takes much of their time without paying for it, thus increasing their opportunity cost for the programme.
This success story has been through the effort of the Ministry of Health’s Bilharzia and Worm Control Programme with support of the implementing partners including: Schistosomiasis Control Initiative (SCI) with funding from the Bill & Melinda Gates Foundation, The WHO, Children without worms and RTI/ENVISION. We also acknowledge the support of the District Local Governments; the district NTD Focal Persons and Village Health Teams (VHT)/Community medicine distributors (CMDs); and the communities for their support and cooperation that allowed this to be achieved.
For more information contact:
The Director General Health Services,
Ministry of Health,
P.O. Box 7272,
Telephone: +256-414-340874, +256-414-231584 | Fax: 256-414-414 340877, +256-414-231 584
E-mail: email@example.com | Website: www.health.go.ug