Burkina Faso Restructures National Schistosomiasis Treatment Strategy Using Recommendations from Experts Meeting

April 11th, 2014

In late November 2013, Burkina Faso’s National Program for the Control of Schistosomiasis and Soil-transmitted Helminthiasis (PNLSc) revised its national treatment strategy for schistosomiasis (SCH), in part to better align its program with treatment recommendations released by the World Health Organization (WHO) in 2012.

Rivers contaminated with infected snails can transmit schistosomiasis to children and adults
Photo © HKI

The revised strategy is the product of a meeting of 25 experts from Burkina Faso’s Ministry of Health (MOH), including Neglected Tropical Disease Program (NTDP) staff as well as regional and district MOH staff; the University of Burkina Faso; and the END in Africa project, including experts from project lead FHI360 and sub-grantee Helen Keller International (HKI), held in Ouagadougou on November 28-29, 2013.

According to baseline studies conducted before the country started treating citizens for the disease in 2004, all 63 of Burkina Faso’s health districts (HDs) are endemic for schistosomiasis.

Under the country’s previous SCH treatment strategy, residents of all 63 HDs were given praziquantel, the drug that cures SCH, once every two years, irrespective of the level of infection in each district. However, even after receiving 5 rounds of praziquantel treatments between 2004-2012, survey data from 2013 showed that more than 50% of the population in one region of Burkina Faso still suffered from SCH infections. In addition, although SCH prevalence had declined in the 12 other regions of the country, it still affected more than 10% of the population in a number of health districts.

Meanwhile in 2012, the WHO released new treatment guidelines on schistosomiasis control and passed a resolution calling on countries to work towards elimination of schistosomiasis and to completely stop local disease transmission. Among the recommendations contained in these new guidelines is taking each district’s level of infection into account when determining treatment frequency.

To bring the country’s SCH treatment strategy into alignment with these new guidelines, Burkina Faso’s health authorities invited 25 SCH experts to gather in Ouagadougou on November 28-29, 2013, to discuss the 2013 impact assessment survey data and determine next steps. At that meeting, the experts categorized each of Burkina Faso’s 63 HDs into one of three groups according to infection level: districts with SCH prevalence below 10%; districts with prevalence of 10-49.9%; and districts with prevalence of 50% or more.

Group of experts presents recommendations on schistosomiasis treatment strategy to Burkina Faso’s national NTD program
Photo: J.Koroma, FHI360

While treatment impact will continue to be monitored similarly in all health districts, the PNLSc will follow the treatment regimes outlined in the new WHO treatment guidelines, which differ according to prevalence level. Districts in the below 10% prevalence group will continue providing praziquantel to residents once every two years; districts with 10-49.9% prevalence will provide praziquantel annually; and districts with prevalence of 50% or more will treat residents twice a year.

Although the 2013 survey data showed that three regions had zero prevalence of SCH, the experts recommended continuing treatments in those regions until snail control and other environmental factors are addressed, since it is necessary to control vector and environmental issues in order to stop disease transmission permanently. Thus, those three regions will continue to treat residents for schistosomiasis with praziquantel once every 2 years.

The experts also recommended conducting operational research to determine why SCH prevalence had increased to over 50% in one region, while the other 12 regions showed reduced prevalence. In addition, they suggested that the national NTD program use the 2013 schistosomiasis survey data to produce several publications.

Finally, the experts recommended that the national NTD program undertake the following activities in order to move toward SCH elimination:

• Prepare a plan for stopping local disease transmission and eliminating schistosomiasis based on findings of the November 2013 meeting;
• Set up an elimination committee for schistosomiasis and other NTDs;
• Strengthen collaboration with the departments of education, environment and agriculture in Burkina Faso; and
• Capture and include the recommendations from the November 2013 meeting in the country’s FY2015 NTD program work plan.

These recommendations will serve to guide the PNLSc in implementing more effective treatment strategies and monitoring and evaluation activities, with the ultimate aim of SCH control. In addition, including all the recommendations in the FY2015 work plan and budget will ensure that PNLSc receives the support it needs to move forward in its SCH control efforts.