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Schistosomiasis: Poor WASH system fueling disease in Nigeria

By Ijeoma UKAZU

Schistosomiasis, a Neglected Tropical Disease, NTD, is an infection that is prevalent in tropical and sub-tropical areas as well as in poor communities without potable water and adequate sanitation.

Expert’s points that most of the NTDs are fueled by poor Water Sanitation and Hygiene, WASH system, stating that promoting adequate water and sanitation would likely contribute a great deal to the elimination of most NTDs.

According to the World Health Organization, WHO 2017 report, over 200 million people globally are infected with Schistosomiasis with over 700 million people living are at risk of the infection and over 90 per cent of infected people live in sub-Saharan Africa.

In Nigeria, the 2017 National baseline mapping reports that 139,645,032 people live in schistosomiasis at-risk areas. The report further showed that 41,033,925 school-aged children and 1,396,203 adults require mass treatment.

Public health experts say, Schistosomiasis causes chronic infections in affected individuals, adding that infants and children are prone to the infections due to their less developed immune systems.

Explaining further, the Deputy Director and Programme Manager, National Schistosomiasis/ Soil-Transmitted Helminthiasis Elimination Programme, Mrs Obiageli Nebe states that “Schistosomiasis is also known as Bilharzia or snail fever. It is a parasitic disease caused by tiny blood-dwelling worms. The infection occurs when individuals particularly children come into contact with contaminated water.”

She said the risk factors include walking barefoot (hookworm), ingestion of eggs in contaminated food or from contaminated hands, poor sanitary infrastructure and inadequate water supply.

While reeling out the symptoms of these worm infections, Nebe said, they include diarrhoea, bloody stool, anaemia, stunted growth, enlarged liver, and spleen, severe damage to the liver leading to liver fibrosis, portal hypertension amongst others.

Nebe, who spoke during a workshop organised by the United Nations Children’s Fund, UNICEF, added that schistosomiasis is a disease of low socio-economic status affecting the poorest communities and most neglected vulnerable people.

Reasons why infants and children are especially prone to the infection, the Programme Manager, National Schistosomiasis, said it is due to their less developed immune system that makes it easy for worm infestation to occur in them through contaminated food and water or soil.

On prevention, she said this could be achieved by wearing shoes, washing hands thoroughly with soap and water after using the latrine and before eating, proper food preparation and storage, filtering or treating contaminated drinking water, and keeping schools and households’ feces-free

Explaining further, “These parasites are known to have a detrimental impact on child health as they deplete nutrients in children and adversely affect physical and cognitive development, causing symptoms such as abdominal pain, anaemia, bladder, liver diseases and other health problems which impair growth, reduced school attendance with the poor learning outcome.”

With Nigeria having the highest burden of tropical diseases in Africa, Nebe said massive deworming exercise has been initiated in the country, stressing the importance of the exercise, she said worms are harmful to children’s health, education, growth, and development, stating that deworming can improve children’s school participation, growth, and nutritional intake.

“Deworming tablets improve health, appetite, and energy levels, reduce school absenteeism, and improve the learning ability of children,” while calling on the government, noting that the government have made a lot of effort toward the elimination of the disease.

On WASH/NTDs integration, the WASH Specialist, UNICEF Nigeria, Bioye Ogunjobi said the UN Agency has been supporting NTDs control programme in Nigeria in 12 states and in recent times, we have included a programme called; “WASH NTDs Integration” because it discovered the strong linkage of WASH to the elimination of NTDs in the country.

Ogunjobi added that these interventions are a community-led total sanitation approach that allows communities to link their health status to their defecation practice and this has happened in a number of communities. “We hope to continue to do this and we have also asked that WASH be integrated into health as a whole as this would help a lot,” he said.

Ogunjobi said WASH should be integrated into the health care system to end NTDs by 2030 in Nigeria urging the government to fund NTDs elimination programme, adding that, “The government needs to be adequately involved in investing in this programme as, without that, NTDs will linger in the country and would hinder the targeted elimination plan. Targeting these policymakers is key.

“Governments -federal, state and local government as well as various partners -international non-governmental organizations, development partners need to put money on the table if we want to be able to achieve our set goal.”

He urged the media to use their reports to create more awareness on the main needs of NTDs to enlighten key policymakers who may be unaware, stressing that policymakers need to know what should be done to achieve this goal in terms of NTDs control, treatment as well as the continuous investment of the programmes.

Reports say Nigeria is currently battling with the management of 15 out of the 20 NTDs identified by WHO amid poor awareness that has remained a barrier to early treatment.

These NTDs include trachoma – (Granular Conjunctivitis), Onchocerciasis – (River blindness) Lymphatic Filariasis, – (Elephantiasis) Soil-Transmitted Helminthiasis, Schistosomiasis, (parasitic worms) and Leprosy, Snakebites, Yaws Rabies, Buruli ulcer, Leishmaniasis, Human African Trypanosomiasis, HAT, among others.

Unfortunately, more than half of Nigerians, an estimated two out of every three persons are at risk of one or more of NTDs, according to statistics.

A group of experts from the United Kingdom, Michael Templeton, David Croll and Jack Grimes has reviewed the impact of upgraded access to safe water, adequate sanitation and good hygiene on schistosome transmission.

In their recently completed systematic review and meta-analysis pertaining to water sanitation and hygiene, and schistosomiasis. They found that people with safe water and adequate sanitation have significantly lower odds of a schistosoma infection.

They said, importantly though, the transmission of schistosomiasis is deeply entrenched in social-ecological systems and hence is governed by setting-specific cultural and environmental factors that determine human behaviour and snail populations.

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