Schistosomiasis: challenges for control, treatment and drug resistance.
OBJECTIVE
Schistosomiasis is a parasitic disease that has recently attracted increased focus and funding for control. Despite shifts in global health policy towards the implementation of mass chemotherapeutic control programmes at the national scale in sub-Saharan Africa, however, many challenges still exist.


RESULTS
Publications reviewed for this article cover: the development of treatment strategies; the planning, implementation and impact of control programmes; the re-evaluation of the burden of schistosomiasis; improved tools for control; new drugs; the safety of treatment during pregnancy; and the development of resistance against praziquantel.


CONCLUSIONS
The morbidity due to schistosomiasis has been shown to be greater than was previously thought. The reduction in morbidity of schistosomiasis by control programmes has been demonstrated, while new tools include a validated dose pole for delivering the correct treatment, geographical information systems mapping for determining high-risk areas, and Lot Quality Assurance Sampling for determining treatment strategies at the local level. Sustainability and future funding are issues to be addressed. Despite some positive results, myrrh is apparently ineffective against schistosomiasis, but fortunately no resistance to praziquantel has developed. We predict the impact of schistosomiasis control will be a healthier generation of children within 5 years.
Fenwick
Alan
A
Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, UK. a.fenwick@imperial.ac.uk
Webster
Joanne P
JP
D000328:Adult; D000818:Animals; D002648:Child; D003140:Communicable Disease Control / Q000379:methods; D004351:Drug Resistance; D006801:Humans; D011223:Praziquantel / Q000494:pharmacology / Q000627:therapeutic use*; D011785:Quality Assurance, Health Care; D012494:Sampling Studies; D012547:Schistosoma / Q000187:drug effects*; D012552:Schistosomiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D012556:Schistosomicides / Q000494:pharmacology / Q000627:therapeutic use*
D012556:Schistosomicides; D011223:Praziquantel