This study gives information on prevalence of Bilharzia in Zomba District of Southern Malawi. Study was lead by Deepa Pullanikkatil from Leadership for Environment and Development Southern and Eastern Africa, Malawi.

1. Schistosomiasis prevalence
in Zomba, Southern Malawi
Deepa Pullanikkatil
Leadership for Environment and Development Southern and Eastern
Africa
Malawi

2. Introduction
• A large proportion of Malawi’s more than 13 million people live in
rural areas where major livelihood activities include subsistence
farming, irrigation and fishing.
• Therefore the villagers have contact with water, which exposes them
to schistosomes.
• In this case study, surveys and parasitological investigations were
conducted to determine the prevalence of schistosomiasis and to
explore the relationship between disease prevalence and selected
qualitative variables in five villages located in Zomba District in Lake
Chilwa Basin.

3. What is Bilharzia?
• Schistosomiasis (Bilharzia) is
caused by flatworms of the
genus Schistosoma.
• In Africa six species- medical
concern
• Schistosoma mansoni
• S. haematobium

4. Signs & Symptoms
• Pain on passing urine
• Haematuria (blood in urine)
• Persistent Abdominal pain
• Blood stained stool
• Mild anaemia and malnutrition
• Cough
• Diarrhoea
• Eosinophilia — extremely high white blood cell count.
• Fever
• Fatigue
• Hepatosplenomegaly — the enlargement of both the liver
and the spleen

5. Hematuria

6. Countries affected
Species Geographical distribution
Intestinal schistosomiasis Schistosoma mansoni
Africa, the Middle East, the
Caribbean, Brazil,
Venezuela, Suriname
Schistosoma japonicum
China, Indonesia, the
Philippines
Schistosoma mekongi
Several districts of
Cambodia and the Lao
People’s Democratic
Republic
Schistosoma guineensis
and related S. intercalatum
Rain forest areas of central
Africa
Urogenital schistosomiasis Schistosoma haematobium Africa, the Middle East
Table: Parasite species and geographical distribution of schistosomiasis (WHO
Factsheet 115, Jan 2012)

7. Some statistics
• At least 230 million people require treatment every
year. Schistosomiasis transmission has been
documented in 77 countries. However those at most
risk of infection are in 52 countries.
• Schistosomiais is prevalent in tropical and sub-tropical
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.
• Source: WHO Factsheet 115, Jan 2012.

8. Transmission
Through contact
with schistosome
infested water
Carrier- Water
snails

9. Source: FAO

10. Prevention & Control
• Proper use of latrine
• Wearing protective gear- boots
• Avoiding swimming in infected waters, near habitat of
snails (reeds)
• Provision of safe water (boreholes with washing slabs)
• Information, Education and Communication
• Mass Treatment in endemic areas

11. Our
Study
Area

12. Methodology
• Through the Lake Chilwa Basin Climate Change Adaptation
Programme, 65 villages and 29 schools were identified as S.
haematobium hotspot areas.
• Random number tables were used to carry out basic simple random
sampling of five villages (Mukhweya, Machemba, Masala, Lamusi I
and Maluwa) and five primary schools (Mitole, Mikundi, Khuluvi,
Nazitimbe and Muluma) from the hotspot areas.
• The surveys were conducted over a three-month period from
September to November 2011, resulting in the participation of all 483
respondents from the selected villages and primary schools.
• Simple random sampling was applied in this study mainly because of
its low cost of application, and due to little available advance
knowledge of the population.

13. • Data from simple random sampling tends to be free of classification
errors, in addition to producing results that are simple to interpret
under different study conditions.
• Prevalence of each group was calculated as the proportion of the sum
of moderately and severely infected people to the total number of
participants representing that group, and overall prevalence was
computed by comparing total number of infected participants to the
total sample size for this study.
• Prevalence values obtained in this study are only estimates of the
true population parameters derived from data collected from
samples. Therefore confidence intervals (CIs) at the 95% confidence
level were calculated to show how bilharzia prevalence estimates
from the samples compared with the true population prevalence.

14. Methodology

15. Results

17. Washing, bathing and swimming in
possibly infected waters
Children lining up for treatment.
Heights being measured to
determine dosages.

19. Conclusion and Recommendations
• Schistosomiasis can be cheaply treated with a single dose of the drug
Praziquantel.
• Despite the relatively low treatment costs, experiences in this
endemic study region show that the re-infection rate is high, requiring
two repeated treatments, or as frequent as every six months to lower
the prevalence of the disease (Clerinx & Van Gompel, 2011).
• Funding limitations continue to hamper treatment efforts in Malawi,
and more concerted efforts are required from all sectors to mobilise
financial resources for combating the disease.

20. • Evidence from this study has demonstrated that targeted treatment
interventions are urgently required, focussing on complete villages
and highly vulnerable groups such as school- going children, and
occupations associated with long hours of water contact in endemic
regions.
• Such targeted measures should be part of a holistic package of
prevalence reducing measures, including the continued exploration of
potentially important options involving biological controls of
intermediate host snails

21. Publication
• This study was published in the African Geographical Review
Pullanikkatil,D., Mubako,S., Phalira,W., Chiotha,S and Luhanga,M.
(2013). ‘Schistosomiasis prevalence in Zomba, Malawi’, African
Geographical Review. Routledge Vol 33; Issue I.

22. Study benefits
• 9005 people from targeted villages were treated for Bilharzia
• Ministry of Health now allows rural villagers to access drugs through
the schools where targeted drug administration is done. This was as a
result of this study findings. Previously rural people and out of school
youth in rural areas were left out from the targeted drug
administration done in primary schools.

23. Thank you