By Uchenna Igwe, Johnstone Kpilaakaa, and Justina Asishana
One morning in July 2022, Laraba Gana threw her household into a frenzy, screaming at the top of her voice. In a few minutes, some of her neighbours, attracted by the noise, gathered at her house to find her scolding and beating up her son, 14-year-old Ishiaku.
Days before, he had complained of pain while urinating, and that morning he found blood in his urine.
“I thought he had contracted gonorrhea or any of these rubbish diseases people contract from sex,” Laraba explained her position, which did not change until persistent calls by one of her neighbours, a nurse, who suggested it may not have been a sexually transmitted infection (STI).
After examining Ishiaku, the nurse gave him four tablets of praziquantel. Laraba said her son’s condition improved but revealed that she “had never heard about that kind of disease before that day.”
Like Laraba, many Nigerians are unaware of schistosomiasis despite its high prevalence, which increases the risk of infection. Ranked as one of Nigeria’s most prevalent neglected tropical diseases (NTDs), schistosomiasis (SCH) is a water-borne parasitic disease that is usually endemic in poor communities. These diseases are classified as “neglected” because they have received little or no attention in terms of prevention and control for several years.
Risk exposure to schistosomiasis, which is said to cause considerable morbidity and mortality, is prevalent among over 20.8 million Nigerians, especially school-aged children, who are most vulnerable to infection due to poor hygiene and certain play habits such as swimming or fishing in infested water.
Like Ishiaku, most children play and swim in the Wupa River, which also serves as a major water source for residents of Gosa and other surrounding communities in Kuje, who rely on it for their domestic needs.
“Most of us fetch the water from the river and use it for cooking, washing, and other things,” one of the residents said, who only identified himself as Musa.
With the prevalence of schistosomiasis in the federal capital territory (FCT) and risk exposure in communities like this, the Federal Capital Territory Administration (FCTA), in collaboration with partners, said it has embarked on interventions to curb the spread of the disease and other NTDs across the FCT.
“Schistosomiasis is endemic in all six area councils of the FCT. It’s one of the neglected tropical diseases we are managing. Basically, we are managing four of them, namely, schistosomiasis, or snail fever; onchocerciasis (river blindness); lymphatic filariasis (elephantiasis) and the last one, soil-transmitted hermit,” Dr Eunice Ogundipe, who coordinates the FCT’s NTDs Control programme said.
Image Credit: Social Voices
Dr Ogundipe said that the intervention, which has been active since 1995, was delivered through an annual mass administration of medicines (MAM), formerly mass drug administration (MDA), primarily targeted school-age children between five and fourteen years as well as unenrolled children, some of whom relocated to the FCT with their families due to the insurgency in the neighbouring states.
The FCT’s intervention follows a two-fold strategy encompassing mass medicine administration across schools and communities.
“For the school-based treatment, we have been collaborating actively with stakeholders within the education sector to ensure all-inclusive and effective treatment. We work with the National Association of Proprietors of Private Schools (NAPPS) and the Universal Basic Education Board (UBEB) for planning and the administration of treatments to both private and public school children,” she said, adding that teachers were trained and mobilized to administer the medicines to pupils to build trust and accessibility.
“We also involve the Parents Teachers Associations (PTA) to sensitize and obtain consent from parents before giving their children the treatment.”
For the community approach, Dr Ogundipe said working closely with traditional and community leaders helped drive the treatment effectively.
“We pay advocacy visits to them from time to time to create awareness, mobilize, and sensitize them. They nominate trusted members of their communities, whom we train for the community distribution of medicines. We call them community-directed distributors (CDDs). They move from house to house for the mass administration of medicines in their communities,” she said.
Treatment is carried out by administering Praziquantel – most of which was made available by Health and Development Support (HANDS) and the Christian Blind Mission (CBM).
Joseph Kumbo, CBM’s NTD Specialist, emphasized their commitment to eliminating schistosomiasis and other NTDs in the FCT and other coverage areas. He noted that schistosomiasis had far-reaching implications for children, education, and societal development.
“One of the major impacts of this [disease] is that it increases absenteeism, affecting the educational development of students. Because as they continue to stay away from school, it affects their access to opportunities. Research has also shown that children with a heavy infection with this worm suffer irreversible retardation in brain development. The priority has been to prevent the disease burden on these children, which is what we have been doing over the past 28 years,” he said.
The last MAM was held between June and July 2022, and in the faraway Takushara community in the Kabusa area, 17-year-old Muhammed Adamu was a beneficiary. He had suffered a recurring stomach upset for weeks, even after ingesting painkillers. He only improved after receiving a dose of Praziquantel from one of the community-directed distributors (CDD) in his area.
“All the pain in my stomach stopped after I took the drug they gave me. They said it was a worm medicine,” Muhammed recalled. There are many other testimonies from residents who received the drugs in the community.
Daunting challenges stall efforts
While there is progress with the treatment, certain pitfalls still plague the exercise. Dr Ogundipe agrees but hopes the challenges can be addressed quickly to sustain progress.
She described inadequate funding as a big challenge plaguing the exercise and urged the government to improve funding for the programme.
“Most times, they will allocate funds, but they are not accessible. How will you do the work? How will you cover logistics to reach the schools? How will you cover communities? You have to pay the CDDs stipends. If the government can be faithful in releasing counterpart funding, it will go a long way,” she said. She, however, commended the contributions of partners like HANDS and CBM, without whom she said, “the treatment would have stopped.”
Dr Ogundipe also noted that urbanization, high literacy level, and socioeconomic status had contributed to stalling penetration and success of the exercise, especially in urban areas.
“We don’t get maximum support in the urban areas like AMAC where we have eminent people, the shakers and movers of society. They have high fences, and most times they don’t even open their gates, unlike in rural communities where information is shared communally and access is easier,” she said.
Despite these challenges, Dr Ogundipe says all hopes are not lost. She advocated for providing clean water in the communities and promoting good environmental hygiene practices to curb the spread of schistosomiasis and other NTDs.
“Providing social amenities will go a long way to curb NTDs. If these communities can get clean potable water, the risks and spread of schistosomiasis and waterborne diseases will be reduced. The people themselves need to improve personal and environmental hygiene,” she said.
She also emphasized the need to increase health education and promote awareness of NTDs in communities. “Many people don’t know much about them. It will also help to get the involvement of the media. You will notice that when they talk about NTDs, they mostly focus more on the big three; Tuberculosis (TB), malaria, and HIV.”
Plateau and Nasarawa, relentless in schistosomiasis control efforts
Four years after the FCT started intervention to curb schistosomiasis (SCH), Plateau and Nasarawa states started an SCH control program focusing on urinary SCH. Due to the unavailability of funds, only about 200,000 children were able to be administered Praziquantel every year from 1999 through 2007; that is about 1.15 million doses, which were either administered through stand-alone treatment or integrated into the MDAs of onchocerciasis and/or lymphatic filariasis programs.
However, the control program in both states recorded increased reach in 2008 when E-Merck, a German multinational science and technology company, through the World Health Organisation, donated Praziquantel to be administered in both states, increasing treatment from 200,000 to over 1.1 million.
Image Credit: Social Voices
“We observed a significant reduction in the prevalence and intensity of SCH in school-aged children after three to five years of interventions in Nasarawa and Plateau states,” according to a team of researchers from the American Journal of Tropical Medicine and Hygiene.
Since SCH is water-borne, the lack of adequate water and sanitation facilities in both states was identified as a major reason for the prevalence, especially in school-aged children. “The majority of the population of these states did not have access to improved sanitation in 2013, but the proportions having access nearly doubled by 2018 from 35.8% to 65.7% in Nasarawa and 18.8% to 35.6% in Plateau,” the researchers said.
According to recent findings, the blood in school-aged children’s urine — a telltale sign of schistosomiasis infection — has been reduced by about 50% in Plateau and Nasarawa states.
A visit to Seri Village, a rural community, in May 2023 showed that several Water Sanitation and Hygiene projects had been implemented to enable access to quality water. Just next to the local primary school in Seri is a solar-powered borehole built by the Federal Ministry of Water Resources through its Partnership for Expanded Water Supply, Sanitation, and Hygiene(PEWASH) Programme.
“Until this borehole was provided, we largely depended on the river—which is often dry during dry seasons—and wells, which are very few in the community,” said Amos Bitrus, Seri community leader.
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“Provision of clean drinking water and sanitation infrastructure has been shown to reduce infection,” according to Emily Griswold, an Associate Director at The Carter Center, a US-based nongovernmental organization that has significantly contributed to the prevention of diseases, especially NTDs, in Nigeria.
Despite these efforts, schistosomiasis remains a health challenge in Plateau and Nasarawa states. “Research into MDA coverage, targeting, and frequency, as well as efforts to improve water safety and sanitation, are needed to control these diseases further and thereby improve the health of these children and their communities,” Griswold said.
Currently, the Carter Center is working with the Federal Ministry of Health to provide health education and praziquantel to treat schistosomiasis in nine states where the disease burden is reportedly higher, including Nasarawa and Plateau.
In Niger, efforts at eliminating schistosomiasis intensify
In Niger state, the persistent challenge of schistosomiasis has found a breeding ground in its 25 local government areas, with particular prevalence in rice farming communities.
To transform this landscape, a 2012 investigation led by “M. Abdullahi TB Saidu” delved into the depths of Wushishi and Zungeru, two localities within the Wushishi government area. Collecting urine samples from 100 school children in each community, the researchers employed standard filtration techniques to detect Schistosoma haematobium eggs, shedding light on the scope of the issue.
The findings unveiled a distressing reality: 40% of the inhabitants were infected, with males experiencing a higher infection rate than females. The most vulnerable, children aged 10-15, bore the brunt of the disease with a staggering 48.75% infection rate.
Building on this insight, another research conducted by Mohammed Idris and Aliyu Usman Isah in Borgu local government areas honed in on the prevalence among male farmers. Unveiling a 36% infection rate compared to the 8% among their female counterparts, it became clear that action was crucial.
In May 2023, a visit to Limawa A ward in Chachanga local government area drew attention to the human face of this issue. Umar Mohammed’s harrowing experience of urinating blood for a week brought to life the suffering endured and the transformative relief that came from Praziquantel’s treatment.
Fueled by grassroots efforts, Luqman Musa, a Community Directed Volunteer (CDV), unveiled the vital role of open drainages in the problem’s perpetuation. The community’s proactive approach, driven by the dedication of these volunteers, witnessed a tangible reduction in schistosomiasis prevalence.
Over the past five years, the Niger state government has intensified mass drug administrations and bolstered the number of volunteers. Simultaneously, the state Environmental Protection Agency heightened awareness campaigns for proper drainage maintenance.
Ummulkha Nauzo, the Niger state Coordinator for NTDs elimination, highlighted the tireless support of Donor Partners like Mithosath, contributing medicine to treat schistosomiasis for over two decades. Amidst the challenges, Nauzo emphasized the diminishing burden of the disease, marking progress in the right direction.
Looking ahead, Niger State is embracing the Federal government’s National Schistosomiasis Elimination Programme (NSCHEP), priming itself for a fresh round of treatment. With data collection on the horizon, the state aims to chart its trajectory toward further improvement.
At the forefront of change stands the Mission to Save the Helpless (MITOSATH), a stalwart force against schistosomiasis in Niger state. With eight years of dedicated intervention, MITOSATH’s multi-pronged approach encompasses school sensitization programs, training for Community Directed Distributors, and campaigns promoting hygiene practices and the perils of open defecation.
**This article was originally published by Social voices
