Experience has shown that predatory snails and fishes are successful only in very specific habitats and biological control is not a practical option at present.

Prevention of human contact with infected water

This requires the provision of alternative supplies of safe water, coupled with health education. Where contact with infected water is unavoidable, protective clothing such as rubber boots sMtpi be worn; this may prove impraoricjjtl for peasant fanners or subsistence fishermen. I lias recently been shown that artemether can be used pre-phylactically to prevent the develcpirent of infection.

Health education

Human attitudes towards water and water-borne disease transmission frequently need to be modified, particularly in areas with endemic schistosomiasis.

Health education should be the responsibility of all health workers and should be based on a clear understanding of the people's perception of disease and its relation to the environment. Efforts should be directed towards those groups that are at greatest risk and most involved in transmission -usually young children. It is recommended that, whenever possible, efforts be positive rather than negative in orientation. In other words, it is better to encourage children to refrain from initially polluting water sources than to try to prevent water contact. Infection is likely to be associated with certain types of water-contact behaviour, which will vary in different transmission situations. If a link is established between specific activities and schistosomiasis transmission, then these activities should be discouraged.

An effective health-education programme should promote active community participation (see below). Such participation may range from a community installing its own water supply to a community simply co-operating with the health authorities in reducing contact with unsafe water bodies.

Community participation

Community participation must be considered as an essential element of any schistosomiasis control programme.

National interest should be promoted once the schistosomiasis problem is considered to be a serious public health problem. Governments or communities implementing schistosomiasis control programmes have the responsibility of organizing national or local efforts through mechanisms acceptable to the communities concerned.

Recognition of the problem by the local population and its awareness of the risks and possible consequences of infection must be the basis of its co-operation. To this end the advice should be prepared in a clear, simple and convincing form, and presented in the most suitable style. Simple, inexpensive and appropriate technology must be carefully selected and transmitted to those members of the community most involved in schistosomiasis control.

Community participation must be organized as an integral part of the basic health-care activities and the primary health workers must be prepared to assume their responsibilities at the local level.

References and further reading

Genta R.M. (1987) Strongyloidiasis. In: Pawloski Z. (Ed.) Intestinal Helminthic Infections. Bailliere Tindall, London, pp. 645-667.

Lucas A., et al. (1966) Radiological changes after medical treatment of vesical schistosomiasis. Lancet 1: 631-634.

Niamey Working Group (1999) Ultrasound in schistosom-iasis. WHO document. TDR/Sch/Ultrason/99.

Pawlowski Z.S., Schad GA. & Stott G.J. (1991) Hookworm Infection and Anaemia. WHO, Geneva.

Sleight A.C. and Mott K.E. (1986) Schistosomiasis. In: Gilles H.M. (Ed.) Epidemiology and Control of Tropical Diseases. W.B. Saunders, Philadelphia, pp. 643-670.

Srini Vasan H. (1993) Prevention of Disabilities in Patients with Leprosy; A Practical Guide. WHO, Geneva.

UNDP/World Bank/WHO (1998) TDR's contribution to the development of multidrug therapy for leprosy. TDR/ER/RD/98.4.

UNDP/World Bank/WHO (1995) The Schistosomiasis Manual. TDR/SER/MSR/95.2.

WHO (1977) Social and Health Aspects of Sexually Transmitted Diseases. Public Health Papers No. 65. WHO, Geneva.

WHO (1978) 7th WHO Expert Committee on Leprosy. Technical Report Series No. 874. WHO, Geneva.

WHO (1980) Epidemiology and Control of Schistosomiasis. Technical Report Series No. 643. WHO, Geneva.

WHO (1982) Chemotherapy of Leprosy for Control Programmes. Technical Report Series No. 675. WHO, Geneva.

WHO (1984) Expert Committee on Rabies, Seventh. Report. Technical Report Series No. 709. WHO, Geneva.

WHO (1985) Epidemiology of Leprosy in Relation to Control. Technical Report Series N< . 716. WHO, Geneva.

WHO (1985) The Control of Schistosomiasis. Technical Report Series No. 728. WHO, Geneva.

WHO (1985) Vital Haemotrhagic Fevers. Technical Report Series No. 721. WHO,

WHO (1986) WHO Expert Committee on Sexually Transmitted Diseases and Treponematoses. Technical Report Series No. 736. WHO, Geneva.

WHO (1987) Community-Based Education for Health Personnel. Technical Report Series No. 746. WHO, Geneva.

WHO (1987) Prevention and Control of Intestinal Parasitic Infections. Technical Report Series No. 749. WHO, Geneva.

WHO (1992) Epidemiological Modelling for Schistosomiasis Control. TDR/IDE/Sch-Mod/92.1.

WHO (1992) WHO Expert Committee on Rabies. Technical Report Series No. 824. WHO, Geneva.

WHO (1993) The Control of Schistosomiasis. Technical Report Series No. 830. WHO, Geneva.

WHO (1996) Report of the WHO informal consultation on hookworm infection and anaemia in girls and women. WHO/CTD/SIP/06.1. WHO, Geneva.

WHO (1998) Guidelines for the Evaluation of Soil Transmitted Helminthiasis and Schistosomiasis at Community Le\>el. WHO/CDS/SIP/98.1. WHO, Geneva.

WHO (1998) WHO Expert Committee on Leprosy. Technical Report Series No. 874. WHO, Geneva.

WHO (1999) Report of the WHO informal consultation on monitoring the drug efficacy in the control of schistosomiasis and intestinal nematodes. WHO, Geneva.


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