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Open Access Study protocol

Study and implementation of urogenital schistosomiasis elimination in Zanzibar (Unguja and Pemba islands) using an integrated multidisciplinary approach

Stefanie Knopp123, Khalfan A Mohammed4, Said M Ali5, I Simba Khamis4, Shaali M Ame5, Marco Albonico6, Anouk Gouvras3, Alan Fenwick7, Lorenzo Savioli8, Daniel G Colley9, Jürg Utzinger12, Bobbie Person10 and David Rollinson3*

Author Affiliations

1 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box,, CH–4002, Basel, Switzerland

2 University of Basel, P.O. Box,, CH–4003, Basel, Switzerland

3 Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK

4 Helminth Control Laboratory Unguja, Ministry of Health, P.O. Box 236, Zanzibar, United Republic of Tanzania

5 Public Health Laboratory - Ivo de Carneri, Ministry of Health, P.O. Box 122, Chake-Chake, Pemba, United Republic of Tanzania

6 Ivo de Carneri Foundation, Viale Monza 44, 20127, Milan, Italy

7 Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Faculty of Medicine, VB1 Norfolk Place, St. Mary's Campus, London, UK

8 Department of Control of Neglected Tropical Diseases, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27, Switzerland

9 Department of Microbiology and Center for Tropical and Emerging Global Diseases, University of Georgia, 330B Coverdell Building, Athens, GA, 30602, USA

10 National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop C-14, Atlanta, GA, 30333, USA

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BMC Public Health 2012, 12:930  doi:10.1186/1471-2458-12-930

Published: 30 October 2012

Abstract

Background

Schistosomiasis is a parasitic infection that continues to be a major public health problem in many developing countries being responsible for an estimated burden of at least 1.4 million disability-adjusted life years (DALYs) in Africa alone. Importantly, morbidity due to schistosomiasis has been greatly reduced in some parts of the world, including Zanzibar. The Zanzibar government is now committed to eliminate urogenital schistosomiasis. Over the next 3–5 years, the whole at-risk population will be administered praziquantel (40 mg/kg) biannually. Additionally, snail control and behaviour change interventions will be implemented in selected communities and the outcomes and impact measured in a randomized intervention trial.

Methods/Design

In this 5-year research study, on both Unguja and Pemba islands, urogenital schistosomiasis will be assessed in 45 communities with urine filtration and reagent strips in 4,500 schoolchildren aged 9–12 years annually, and in 4,500 first-year schoolchildren and 2,250 adults in years 1 and 5. Additionally, from first-year schoolchildren, a finger-prick blood sample will be collected and examined for Schistosoma haematobium infection biomarkers. Changes in prevalence and infection intensity will be assessed annually. Among the 45 communities, 15 were randomized for biannual snail control with niclosamide, in concordance with preventive chemotherapy campaigns. The reduction of Bulinus globosus snail populations and S. haematobium-infected snails will be investigated. In 15 other communities, interventions triggering behaviour change have been designed and will be implemented in collaboration with the community. A change in knowledge, attitudes and practices will be assessed annually through focus group discussions and in-depth interviews with schoolchildren, teachers, parents and community leaders. In all 45 communities, changes in the health system, water and sanitation infrastructure will be annually tracked by standardized questionnaire-interviews with community leaders. Additional issues potentially impacting on study outcomes and all incurring costs will be recordedand monitored longitudinally.

Discussion

Elimination of schistosomiasis has become a priority on the agenda of the Zanzibar government and the international community. Our study will contribute to identifying what, in addition to preventive chemotherapy, needs to be done to prevent, control, and ultimately eliminate schistosomiasis, and to draw lessons for current and future schistosomiasis elimination programmes in Africa and elsewhere.

Trial registration

ISRCTN48837681

Keywords:
Urogenital schistosomiasis; Schistosoma haematobium; Preventive chemotherapy; Snail control intervention; Bulinus globosus; Behaviour change intervention; Morbidity control; Transmission control; Elimination; Zanzibar; Tanzania