title: Study and implementation of urogenital schistosomiasis elimination in Zanzibar (Unguja and Pemba islands) using an integrated multidisciplinary approach.
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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ISRCTN48837681.
authors.affiliation: Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, UK.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Knopp
authors.forename: Khalfan A
authors.initials: KA
authors.lastname: Mohammed
authors.forename: Said M
authors.initials: SM
authors.lastname: Ali
authors.forename: I Simba
authors.initials: IS
authors.lastname: Khamis
authors.forename: Shaali M
authors.initials: SM
authors.lastname: Ame
authors.forename: Marco
authors.initials: M
authors.lastname: Albonico
authors.forename: Anouk
authors.initials: A
authors.lastname: Gouvras
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Savioli
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Colley
authors.forename: Jürg
authors.initials: J
authors.lastname: Utzinger
authors.forename: Bobbie
authors.initials: B
authors.lastname: Person
authors.forename: David
authors.initials: D
authors.lastname: Rollinson
mesh_terms: D000328:Adult; D000818:Animals; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration*; D004199:Disease Vectors; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007391:International Cooperation; D009313:National Health Programs; D009937:Organizational Objectives; D011159:Population Surveillance; D011223:Praziquantel / Q000008:administration & dosage* / Q000627:therapeutic use; D036301:Qualitative Research; D012548:Schistosoma haematobium / Q000302:isolation & purification*; D012553:Schistosomiasis haematobia / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D013636:Tanzania; D013997:Time Factors
chemical_list: D011223:Praziquantel