It’s an early Monday morning, and Portia Guta (35), from Chibondo Village in Shamva District, Mashonaland Central Province, has just learned that she tested positive for Schistosomiasis or Bilharzia. Schistosomiasis, also known as snail fever, is an infection of the urinary tract or bowels, caused by Schistosoma (blood fluke), a flatworm parasite.
By Michael Gwrisa in Shamva District
Portia was among the participants who got screened for Schistosomiasis during a Pilot Study that was conducted to ascertain the magnitude of Schistosomiasis in the Shamva District. The Pilot project also assessed the diagnostic tools, molluscicidal chemicals, and health education and conducted house-to-house screening of Bilharzia/Schistosomiasis. The study was conducted over a two months period by the National Institute for Health Research (NIPR), a department in the Ministry of Health and Child Care (MoHCC) in conjunction with the China National Institute of Parasitic Diseases (NIPD).
Portia is married and has four children. Her village is among the 14 Villages under the Chevakadzi ward, where 30 households were chosen through random selection for Schistosomiasis screening.
I am one of the people who got tested recently and it turns out I am Bilharzia positive. The five of us got screened, however, I was the only one who tested positive for Bilharzia in my family,” said Portia.
Even though she is very much aware of the risk factors of Bilharzia which include getting into contact with water harboring snails ferrying the intermediate host of Bilharzia, the shortage of safe water points in her community exposes Portia and several villagers in Shamva to the risk of contracting Schistosomiasis.
“I know the disease can be transmitted mainly through contact with water that carries snails that carries the diseases causing worms. I do my laundry in the river every time and I suspect that is how I contracted the disease. I also know that you can even get the disease by consuming undercooked vegetables. However, there are no boreholes in the area so the river is the best option for us when it comes to doing laundry,” she said.
Portia, together with several people who tested positive for Bilharzia, has come to Chevakadzi Clinic in Shmva to receive their doses of Praziquantel drugs, which treat Bilharzia. However, one cannot help but notice the glaring disparities in the proportion of women to men who have come through for Bilharzia treatment. Women outnumber the men and one wonders why?
According to findings from the Pilot study that was counted in the Chevakadzi ward in Shamva District, a high prevalence of Schistosomiasis was recorded in females compared to men.
Professor Nicholas Midzi, the Director for the National Institute for Health Research in Zimbabwe said while children were the biggest high-risk group targeted by annual Mass Drug Administration programs, recent data from their Pilot Study shows that women were also a high-risk group.
“In Chevakadzi, overally, the ward had a prevalence of 15.6 percent of Schistosomiasis or Bilharzia. Afterwards, we then stratified the disease by gender and we found that males had 14.30 percent prevalence and for women, it was 16.67 percent. This is largely to do with the exposure women have to water containing the snails as they spend time in the rivers or water sources doing laundry among other business,” said Professor Midzi.
He added that women living in areas where Bilharzia is endemic are at a greater risk of female genital Schistosomiasis and HIV.
“We have been able to show and demonstrate that when young women are living in an endemic community for Schistosomiasis or Bilharzia, 75 percent of them suffer from what is referred to as Female Genital Schistosomiasis. This is the presence of schistosomiasis ova in the reproductive organs of the females.
“These may lead to abortions (miscarriages), ectopic pregnancies, and much more to it, the lesions that are formed within the vagina result in exchanging blood in males and females, and that increases the transmission of HIV. We have also been able to demonstrate that females who have Female Schistososimais are three times most likely to contract HIV,” said Professor Midzi.
He, however, said even though the prevalence of Schistosomiasis is lower in males compared to women, men who have Urinary Schistosomiasis exhibit high HIV viral load levels compared to those without schistosomiasis.
According to the study, the two major intermediate hosts for Schistosomiasis in Zimbabwe are Bulinus Globosus and Biomhpalaria Pfeifferi. However, a novel variant of snails also responsible for both Urinary and Intestinal Bilharzia, the Blinus trunctus has also been discovered in some water sources in Shamva.
At the national level, according to a 2010 Baseline study, Shamva District had the highest Schistosomiasis prevalence in the Mashonaland Central Province.
A Geospatial Survey that was conducted by the Ministry of Health through financial support from the Higherlife Foundation, The End Fund Initiative, and the World Health Organisation (WHO) recently revealed that all 29 districts in Shamva require National Mass Drug Administration for Schistosomiasis.
Meanwhile, Mashonaland Central Provincial Medical Director, Dr. Clement Chuma said since 2010, his province has been recording outbreaks of Schistosomiasis outside Shamva district in districts such as Mbire and Rushinga, with schoolchildren being the most affected population.
“Shamva District was selected for the implementation of the comprehensive schistosomiasis elimination strategies including treatment of affected people, provision of sanitation, safe water, health education, and snail control because of the demonstrated huge burden in the district.
“In Zimbabwe, the first National Baseline Survey on schistosomiasis was conducted in 2010 by the Ministry of Health and Child Care (MoHCC). The survey showed that Mashonaland Central was among the provinces highly affected by the diseases. Shamva has the highest prevalence of schistosomiasis in the province and all 63 districts in the country,” said Dr Chuma.
According to the World Health Organisation, any prevalence that is greater or equal to 10 percent calls for the implementation of annual mass drug administration reaching greater or equal to 75 percent coverage.
Schistosomiasis/Bilharzia is one of 28 Neglected Tropical Diseases (NTDs) that have been listed or identified by the World Health Organisation (WHO) and is an acute disease that is formed by the immune response to the Schstosomis or Bilharzia worms in the body tissues that brings the reactions, lesions or other effects.
NTDs such as Schistosomiasis largely affected impoverished communities such as Shamva and other parts of the country where the disease is endemic. The diseases cause devastating health consequences. According to WHO 2021 global estimates, 251.04 million people are at risk of
Schistosomiasis is prevalent in tropical and subtropical areas, especially in poor communities without access to safe drinking water and adequate sanitation. It is estimated that at least 90% of those requiring treatment for schistosomiasis live in Africa. There are 2 major forms of schistosomiasis – intestinal and urogenital – caused by 5 main species of blood fluke.
Schistosomiasis mostly affects poor and rural communities, particularly agricultural and fishing populations. According to the World Health Organisation, women doing domestic chores in infested water, such as washing clothes, are also at risk and can develop female genital schistosomiasis. Inadequate hygiene and contact with infected water make children especially vulnerable to infection.
Working with partners and the private sector, WHO has advocated for increased access to praziquantel and resources for implementation. A significant amount of praziquantel – enough to treat more than 100 million children of school age per year – has been pledged by the private sector and development partners.
