Further information about SCI

Schistosomiasis before and after SCI support. (2003 to 2010) in Uganda

By Narcis. B. Kabatereine.

Schistosomiasis (also knows as bilharzia, bilharziosis or snail fever) had long been known as a serious public health problem in Uganda according to Nelson (1958). High transmission was known along large water bodies, especially along the lakes Albert, Victoria, Kyoga and the Albert Nile. Very heavy S. mansoni egg loads had been reported among people living in West Nile in extreme north west Uganda, many of them with over 1000 eggs per gram of faeces, implying transmission was incredibly intense. Severe morbidity rates were common in the affected communities as reported by Ongom and Bradly (1972).

At Butiaba, the village of the current concern along Lake Albert, people experienced many advanced symptoms of the disease before the SCI support; with persistent diarrhoea often accompanied by bouts of blood and others passed out faeces also stained with blood. Most of them had severe liver and spleen (hepatosplenic) disease, accompanied by blocked liver vessels (portal hypertension) and a generally rotting liver (liver fibrosis). This led to enlargement of splenic and aesophageal varices which at times burst, leading to profuse bleeding through the mouth and nose (haematemesis) and subsequent death. Ascites (glossily enlarged stomach) was common mainly due to the hypertension.

In West Nile about 150 kilometers north west of Butiaba, schistosomiasis was the second cause of hospital admissions in the 1960s and in the 1970s, and a leading cause of hospital death especially in adult males according to Williams and others in 1987. This situation was unchanged in the affected communities until 2003, when SCI and other partners provided the needed support for control of this scourge.

What SCI did and how:

In 2003, SCI provided drugs and logistics for mass treatment campaign among all communities at risk of schistosomiasis throughout the country. In addition, SCI supported intensive health education in schools and communities. These interventions were uninterrupted up to 2007 and were resumed again from 2010 to date. In addition, SCI supported research to evaluate the impact of the interventions. A cohort of 462 adult males living in Butiaba were among those involved in the monitoring and evaluation impact studies. These people were regularly examined using a portable ultra sound machine to detect schistosomiasis morbidity. In 2010, after 8 years of intervention, 111 people out of the original 462 people were re-examined to document the impact of the interventions.

Results

• Although many of the 462 people had grade C+ fibrosis (damaged livers) in 2003, only 3 individuals still presented with damaged livers in 2010.
• There was a marked improvement in individuals who originally had grade D damage, and none still had grade D liver damage in 2010.
• No one with originally normal liver had damaged liver in 2010.
• Several members originally with grace C+ damage had regressed to normal status and were living a productive life.
• Although people still got exposed to infection in the lake, there was a reduction in both incidence and severity of the liver disease (Schistosomiasis).
• Improvement of condition was influenced by age being lower, stressing the importance of early schistosomiasis treatment.

Conclusion

Although people continue to have low income, live under unsanitary conditions and continue to get in contact with schistosomiasis infested waters as they go on fishing, serious schistosomiasis morbidity was eliminated in Uganda during this period.

• Where schistosomiasis transmission occurs on small water bodies, the disease prevalence has been reduced from about 100% in 2003 to less than 10% in 2010 according to the most recent survey results.
• SCI support is greatly appreciated by the government of Uganda and the affected communities.