Schistosomiasis Control Initiative
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Schistosomiasis Control Initiative

The Schistosomiasis Control Initiative works with Ministries of Health and Education in sub-Saharan African countries to support programs controlling and eliminating two types of parasitic worm infections: schistosomiasis and soil-transmitted helminthiasis. The majority of programs treat school-aged children, but can also include at-risk adults.

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Founded
2002
300M
treatments delivered
US$0.43
average cost per annual treatment

The problem: intestinal worms and parasites

Schistosomiasis (shis-toe-so-my-a-sis) and soil-transmitted helminthiasis (STH) are both what the World Health Organization calls “neglected tropical diseases,” which affect the poorest and most marginalized communities in the world. Schistosomiasis is carried by freshwater snails and transmitted through contaminated water during everyday activities, such as bathing, fishing, and washing clothes in lakes, rivers, or ponds. STH is caused by a group of intestinal parasites, and is transmitted through soil contaminated with human feces.

The World Health Organization estimates that 206 million people are affected by schistosomiasis and 1.5 billion are infected with STH [1] [2]. Infection with these parasites can result in anemia, blood in urine, abdominal pain, and genital discomfort. These symptoms can lead to impaired cognitive development and reduced school attendance; longer-term effects include stunted growth, internal organ damage (such as liver fibrosis), increased risk of HIV infection, and bladder cancer.

The World Health Organization estimates that 206 million people are affected by schistosomiasis and 1.5 billion are infected with STH.

The solution: cost-effective school deworming programs

Mass deworming programs — typically run by national governments — provide those living in at-risk communities the medication needed to treat STH and schistosomiasis infections. These programs have a strong track record of success and are highly cost-effective, generally at around 43 cents per child per year. The estimated long-run social financial rate of return is around 65% per year. [3]

“Among interventions that have been rigorously tested by randomized evaluations, school-based deworming is one of the most cost-effective means of increasing school attendance.”
—Innovations for Poverty Action [4]

How the Schistosomiasis Control Initiative works

SCI does not have country offices or local staff. Rather, they work directly with government programs to help deliver services through existing health care systems. By providing technical support, SCI can remain agile and responsive, and focus on building capacity and maximizing efficiency. Plus, working in partnership increases their organizational cost effectiveness, while reducing duplicative efforts.

What makes the Schistosomiasis Control Initiative so effective


Cost-effectiveness

Pharmaceutical companies donate the majority of treatment medicines. The average cost per treatment is only US$0.43. 

Designed for scale

SCI has supported the delivery of over 300 million treatments for schistosomiasis and STH since it was founded in 2002.

Compounding impact

Treating schistosomiasis and STH can increase school attendance by up to 25%, as well as lead to improved academic performance. [5] Deworming has also been shown long-term to lead to better health, better jobs, and 21–29% increased earning. [6] It has a high annualized financial internal rate of return of 32%. [7]

Schistosomiasis Control Initiative’s accountability

SCI is a model of nonprofit transparency, publishing information and reports about their support of treatment programs.

They combine the best of public and private healthcare, partnering with pharmaceutical companies, national governments, and local health authorities to support the design and implementation of treatment programs. They are recommended as a top charity by rigorous charity evaluator GiveWell, and have received an A or A+ rating from the UK government’s Department for International Development (DFID) for the past 5 years. [8]

Frequently Asked Questions

How will SCI use my donation?

Individual donations to SCI fund all aspects of treatment delivery including training, logistics, advocacy, social mobilization, and monitoring and evaluating activities. Donations are not used to procure treatment medicines — the majority are donated by pharmaceutical companies. 

SCI does not have local offices in target countries and therefore does not have additional overhead costs. When SCI was still housed within Imperial College, overheads/management fees were approximately 15%.  As a stand-alone entity, SCI Foundation is aiming to streamline its operations.

How many people does SCI help?

Since its foundation in 2002, SCI has supported delivery of over 300 million treatments for schistosomiasis and STH. Each year, SCI facilitates delivery of approximately 50 million treatments to those at risk and aims to support countries reach all  communities in need of treatment.

Which diseases do SCI’s treatment target?

Treatment programs target schistosomiasis and STH. In certain countries where programs are integrated to control and eliminate all neglected tropical diseases, SCI also supports treatment of onchocerciasis, lymphatic filariasis and trachoma.

What are neglected tropical diseases (NTDs)?

These are a diverse group of treatable and preventable infectious diseases. They affect the poorest and most marginalized communities in the world, placing a heavy burden on over 1 billion people. NTDs impact life expectancy, education, and economic opportunities, costing developing economies billions of dollars each year. Although they are biologically diverse, the World Health Organization have grouped these diseases together to underscore the importance of their impact of health and development of the most disadvantaged populations. [9]

Can schistosomiasis and STH be eliminated?

In 2012, the World Health Assembly affirmed the feasibility of eliminating schistosomiasis, and urged endemic countries to intensify control programs and initiate elimination campaigns where appropriate through preventive chemotherapy, strengthened health systems, provision of water and sanitation, as well as hygiene and snail control. In the same year, the WHO published guidance on eliminating STH as a public health problem in children.

SCI is committed to supporting the delivery of treatment as one of the key strategies for elimination of SCH and STH. SCI is also working in partnership with other sectors that are important in disrupting the life cycle of these parasites, such as Water, Sanitation and Hygiene, to leverage resources to high risk areas.

How often is treatment given?

Every country program is tailored to meet the specific population needs. How often treatment is given is based on the proportion of the population infected, which is determined through existing information and data, as well as through mapping surveys. Where disease prevalence is high, treatment is recommended to be given to all at-risk populations annually for schistosomiasis and twice yearly for STH. [10]

How much confidence do you have in SCI’s work given the recent debate over the benefits of deworming?

In July of 2015, a re-analysis of an influential study on deworming was released, kicking off an ongoing debate about the benefits of mass deworming. Generally speaking, there appears to be a division between the health community, which is more skeptical about the benefits of mass deworming, and the development economics community, which is more enthusiastic. Each community has its own standard analytical methodology, and these different methodologies lead to different interpretations of the data. [11] [12] [13]

In addition to following the public discussion, we’ve had conversations with various experts on deworming to improve our understanding of this issue. A common thread in these talks is the important differences between schistosomiasis and other intestinal worms. Simply put, schistosomiasis causes particularly severe health issues. Unlike soil-transmitted intestinal worms, schistosomiasis worms live a long time (up to 20 years) and the eggs they lay build up in an infected person’s organs. As a result, prolonged schistosomiasis infections can lead to fibrosis of the liver and bladder, and even death due to burst varices (dilated blood vessels). Recent data has also suggested a link between schistosomiasis and an increased risk of HIV infection. [14]

In light of these differences, we believe there is a stronger case for eliminating schistosomiasis than STH. SCI concentrates primarily on schistosomiasis (though they will also provide medicine for other types of worms as a synergistic health intervention), and going forward SCI expects the bulk of its budget to be spent on schistosomiasis control and elimination. We are confident that SCI will conduct these efforts in a cost-effective manner, having received donations of hundreds of millions of tablets of praziquantel, an anti-schistosomiasis medicine. [15] We continue to rate SCI as one of our recommended charities.

 

Why does The Life You Can Save recommend Schistosomiasis Control Initiative?

We recommend SCI because they have been named a Top Charity by GiveWell, one of our charity evaluators.

Is my donation tax-deductible?

Sources

All photos and videos courtesy of the Schistosomiasis Control Initiative

[1] World Health Organization, 10 facts about schistosomiasis

[2] World Health Organization, Soil-transmitted helminth infections fact sheet

[3] Trends in Parasitology, Worms, wisdom, and wealth: why
deworming can make economic sense

[4–5] Innovations for Poverty Action, School-Based Deworming

[6] Worms at Work: Long-run Impacts of Child Health Gains, 2011

[7] Worms at Work: Long-run Impacts of a Child Health Investment, 2016

[8] GiveWell’s review of SCI Foundation

[9] World Health Organization, Neglected tropical diseases

[10] SCO Foundation, WHO Treatment Guidelines

[11] Giving Evidence, Deworming: problems under re-analysis

[12] Columbia University, What Has Been Learned from the Deworming Replications: A Nonpartisan View

[13] GiveWell, New deworming reanalyses and Cochrane review

[14] PLOS Neglected Tropical Diseases, Schistosomiasis is associated with incident HIV transmission and death in Zambia

[15] The Life You Can Save, SCI Delivers Over 100 Million Deworming Treatments—with Plans to Deliver More