New campaign targets three million with bilharzia

Yemen's Ministry of Health and the World Health Organization (WHO) have begun a national campaign to combat bilharzia, which affects over three million of the country’s 21 million people, according to Abdullah Eshaish, head of the Combating Bilharzia Programme at the ministry. Yemen is the only country in the Middle East not to have eliminated the disease.

The campaign, the first of its kind in Yemen, will be implemented in four phases during 2008. The first stage, from 10-14 March, targets 858,236 children (aged 6-18) in six provinces - Taiz, Hajjah, al-Dhalei, Dhamar, al-Mahweet, and Abyan. Some 1,511 teachers and health workers will distribute anti-bilharzia drugs to children in 1,639 schools.

"Every year, around 2,000 people die [of bilharzia]. But this is not the exact figure as there are no reliable statistics in the country," Eshaish said.

Eshaish said the situation was worrying: "If a person with bilharzia does not take medicines to combat the disease, the disease would become dangerous and lead to urinary bladder cancer, cirrhosis, renal failure, and colon cancer," he said.

Four phases

Bilharzia facts
	Bilharzia is a human disease caused by parasitic worms called schistosomes, and is common in the tropics where ponds, streams and irrigation channels harbour bilharzia-transmitting snails.
	The disease also occurs in fresh water when intermediate snail hosts release infected forms of the parasite.
	People are infected by contact with water where infected snails live.
	Larval forms of the parasites (known as cercariae) released by the snails penetrate the skin of people in the water.
	The snails themselves become infected by another larval stage of the parasite, known as miracidium, which develops from eggs passed out in the urine or faeces of infected people.

The campaign's four phases will target 2,583,309 children - 69 percent at primary school, and 31 percent not enrolled, he said, adding that the second phase will start 24-27 March; the third 5-8 April, and the fourth 18-21 October.

The campaign is targeting 5,495 schools in 107 districts in 14 provinces. Targeted children will be given 6,225,775 Praziquantel pills (used for treating bilharzia) and 2,583,309 Albendazole pills (used for the treatment of a variety of worm infestations). Administering the drugs will be 4,426 trained teachers, and 3,034 health workers, together forming 1,633 teams.

Costs

The Praziquantel pills cost US$620,000, while the Albendazole pills cost $70,000. The overall cost of the campaign is $1.64 million of which $1.49 million is government-support and the WHO has paid $150,000.

The national campaign is part of the ministry's strategy to eliminate bilharzia and will continue over the next seven years.

Riadh Ben-Ismail, WHO's regional adviser, told IRIN there were two kinds of bilharzia in Yemen: urinary and intestinal. "Intestinal schistosomiasis (bilharzia) differs from that of the urinary variety: it might not fully respond to the drugs. Some animals (like monkeys) carry intestinal schistosomiasis and can bring it back to humans," he said.

He said 500,000-600,000 people infected with bilharzia had severe symptoms (like renal failure and bladder cancer).

Ben-Ismail said one way in which the disease spread was when children swam and urinated in ponds.

He also highlighted the problem of not catching those not in school: "If one child carrying the bilharzia parasite is not covered in the campaign, it means we have not done anything; he or she will spread the disease again," he said.

He said Yemen would need six years to be free from urinary schistosomiasis provided there was a major effort by the government and the community.

maj/ar/cb