A nationwide campaign in Burkina Faso aimed to treat all school-age children for schistosomiasis and soil-transmitted helminthiasis. How effective is this approach? Research shows that a combined school- and community-based strategy can produce high coverage, but sustainability will be a challenge for the future.

Schistosomiasis (bilharzia) is widespread across Burkina Faso. Following World Health Organisation recommendations, the Ministry of Health, supported by the Bill and Melinda Gates Foundation through the Schistosomiasis Control Initiative, offers all children free praziquantel treatment. Several pockets of soil-transmitted helminthiasis (intestinal worms) transmission are spread across the country, so albendazole is also part of the treatment package.

Looking at the successes and costs of the campaign, research led by Imperial College London found that:

• In total, 1,027,007 children received treatment during the first phase of the campaign in 2004 and 2,295,557 in 2005. The total coverage was 3,322,564 children: 90.8 percent of the estimated school-age population.
• Almost 40 percent received treatment from their school teachers. The remaining 60 percent did not attend school and were reached instead by community drug distributors.
• Treatment costs per child treated were US$ 0.098 (US$ 0.084 through schools; US$ 0.107 in the community). Total costs per child, including drugs, were US$ 0.32 (US$ 0.308 through schools; US$ 0.33 in the community).

The study shows that drug distribution through schools and in the community can achieve high coverage rates among school-age children in countries where school enrolment is low and the number or size of primary schools is too small to justify solely school-based distribution. The researchers recommend using both channels to reach the maximum number of children at the lowest cost.

Decentralised decision-making aided the campaign’s success. Only 22.8 percent of the non-drug budget was spent at the national coordination level, while 69.6 percent was allocated to the two lowest implementation levels (district and dispensaries), which were left to decide how to make best use of their funds.

Control of schistosomiasis in Burkina Faso will need ongoing financial support due to wide geographical spread and high rates of transmission. However, the research highlighted several positive signs for future sustainability of these disease control activities, including:

• The treatment campaign was implemented by national staff using local expertise and existing infrastructure. There was huge support from government staff and community members in terms of commitment, dedication and social mobilisation.
• The campaigns built local capacity in disease control. Re-treating children should cost less as only refresher training and top-up supplies of equipment (dose poles, buckets, cups) will be needed.
• Drugs are the biggest budget line. Regular donation of praziquantel by manufacturers to endemic countries would greatly boost sustainability.
• The campaign approach actively delivers drugs to those in need. Full sustainability will involve integration of regular parasite treatment into routine healthcare services.

Source(s):
‘A Combined School- and Community-Based Campaign Targeting All School-age Children of Burkina Faso Against Schistosomiasis and Soil-transmitted Helminthiasis: Performance, Financial Costs and Implications for Sustainability’, Acta Tropica 99 (2-3), pages 234-242, by Albis-Francesco Gabrielli, Seydou Touré, Bertrand Sellin, Elisabeth Sellin, Césaire Ky, Hamado Ouedraogo, Malachie Yaogho, Michael D Wilson, Howard Thompson, Souleymane Sanou and Alan Fenwick, 2006

id21 Research Highlight: 18 December 2007

Further Information:
Albis-Francesco Gabrielli
Preventive Chemotherapy and Transmission Control
Department of Control of Neglected Tropical Diseases
World Health Organisation
20 Avenue Appia
CH-1211 Geneva 27
Switzerland

Tel: +41 22 79 11876
Fax: +41 22 79 14869
Contact the contributor: gabriellia@who.int

World Health Organisation

Other related links:
'Mass worm control in Uganda'

Symptoms and dollar signs? Cost-effective schistosomiasis treatment in Burundi

Do worm-free children grow bigger and brighter?

Self-diagnosis of schistosomiasis by Tanzanian schoolchildren

The Schistosomiasis Control Initiative