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Described is the evolution of the schistosomiasis control programme in Burundi since 1985. A single round of selective population chemotherapy was carried out in the Rusizi Plain and the Bugesera focus from 1985 to 1990. The prevalences and intensities of infection as well as the number of symptomatic cases detected in general health services decreased considerably. Annual sample surveys in the treated areas showed, however, that these improvements were rapidly reversed by reinfection of the demographically changing population. Since repeated selective population chemotherapy was not sustainable in the long term, a primary health care approach was adopted. In areas with good access to basic health services, approximately 10% of all schistosomiasis cases now receive treatment annually through this approach. Yearly selective chemotherapy in primary schools in suburban Bujumbura reduced the prevalence of schistosomal infection among pupils from 23% to 9% over the period 1984-90, and this programme has now been extended to highly endemic areas in Imbo-Sud. Focal snail control produced disappointing results, and emphasis has therefore shifted towards health education and environmental control of transmission.The schistosomiasis control program, begun in Burundi in 1985, consisted of screening for Schistosoma mansoni eggs, treating people with at least 1 schistosome egg with 1 dose of praziquantel, spraying of a molluscide, and environmental control of transmission. In the Rusizi Plain, the number of S. mansoni infected cases fell considerably (from about 500 to 100 cases) after infected persons were treated with praziquantel. The mean participation rate was 80% (range, 67-97%). 2 years after treatment, however, schistosomiasis prevalence returned to 65%, 100%, and 85% of the initial level in Rugombo, Gihanga, and Buganda, respectively, all in the Rusizi Plain. In 1990, just 60% of the rural population participated in the chemotherapy campaigns conducted by mobile teams. The program adopted a primary health care (PHC) approach (selection based on symptoms and ability to keep up with demographic changes) by integrating chemotherapy into regional health services to improve morbidity control efforts, leading to the detection of 60% of cases. Thus, the PHC approach resulted in 10% of all schistosomiasis cases receiving praziquantel each year. Each year, health workers conducted selective chemotherapy in primary schools in suburban Bujumbura. This approach reduced prevalence of S. mansoni infection from 23% to 9% between 1984 and 1990. This success motivated program managers to expand the program to highly endemic areas in Imbo-Sud. Poor weed control, lack of maintenance, and the inability to cover entire water networks resulted in rapid recolonization of the snail population at treated sites. Thus, the program began emphasizing health education and environmental control of transmission (e.g., showers for field workers to clean themselves). |
