The majority of counties in Sub-Saharan Africa and parts of Asia and South America are burdened by parasitic diseases referred to as neglected tropical diseases (NTDs) because, despite causing a significant burden to about two billion people, NTDs do not attract much attention in terms of funding.

NTDs include diseases such as schistosomaisis (schisto), soil-transmitted helminthes (STHs; helminthes are parasitic worms), dracunculiasis (Guinea) worm, and many others. They affect huge numbers of people, and can cause serious disabilities and even death.

For example, it is estimated that 200 million people are infected with schistosomaisis worldwide, with 85% of the disease burden in Sub-Saharan Africa. Schisto is a water-born worm infection which can lead to diseases such as bladder cancer in urinary schisto, and severe liver complications in intestinal schisto.

As for soil-transmitted helminthes (round worm, whipworm, and hookworms), more than 2 billion people worldwide are suffering from chronic debilitating morbidity which results in impaired growth and cognitive development in children and severely affects work output in adults.

Data from the ministry of health and the Sanitary Information System reveals that causes of schisto have been detected in the country, but the public health burden of the disease is not established.

Based on health district records, however, STHs are known to be distributed all over Rwanda, and the World Health Organization reports that there were 400,000 Rwandese infected with schisto in 2001.

Moreover, findings of the Sanitary Information System (SIS) of Minsante indicate that schisto is found in the Northern Province, around Bulera and Ruhondo Lakes; in the Western Province, around Bugarama plain; in the Southern Province (Huye) and in Kigali (Kinamba). However, no large-scale study has ever been carried out.

Maps of predicted risk

Denise Mupfasoni, the country coordinator coordinator of NTD/Access Project in Rwanda, said that the effective control of intestinal worm infections requires identifying their prevalence and the local contributing factors, particularly for the high-risk groups.

NTD/Access was first launched in Bugesera district last July 11 in Mayance B primary school, where 1000 school children were dewormed.

The goal of this program is to reduce morbidity due to schisto, STH, trachoma etc. to the levels where the diseases are not of public health significance.

Denise Mupfasoni further on said that a study involving 3360 school children from eight districts had been conducted between September and October in order to obtain an accurate estimate of the prevalence of schisto and STHs.

She added that these estimates will be used to produce maps of predicted risk for each of these infections. These maps will then allow for treatment both in schools and communities, and to develop a long-term monitoring and evaluation strategy at the national level.

The results of this first phase show that intestinal schisto exists in many districts, with prevalence in the surveyed schools of between 0 and 44%. The highest prevalence was found around the shores of Lakes Ruhondo and Burera.

The same survey showed that the soil-transmitted worm infections were highly endemic with overall prevalence of 64.55%. No case of urinary schisto was found.

Denise Mupfasoni also highlighted some of NTD/Access's achievements, which include trainings in 8 districts; 219 teachers, 83 health workers, 1860 community workers, 27 local authorities, and 18 journalists.

The country coordinator also pointed out that even if sanitation and personal hygiene are the most adequate ways to prevent worm infections, sometimes broad de-worming and medication campaigns are necessary.

"The quality of life for millions of people will be improved, and it will give children a healthy start to life, improving their nutritional status and ability to attend and perform well in school," said Mupfasoni.

She went on to say that since helminthiasis control in sub-Saharan Africa still entirely depends on donor funding, which is not sustainable, integrating de-worming into already existing and successful disease control campaigns such as the Child Days, HIV-AIDS and immunization or malaria control programs may be the only way to support the programs, and Rwanda will endeavor to do that.