FROM TESTING TO TREATMENT

Accelerating the elimination of schistosomiasis in preschool-aged children in Tanzania

February 7, 2025

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“When it rains, water collects in the rice fields, and children love playing in it,” explains Angel Michael, a mother from Kabale, Itilima district in Tanzania. “I wish we could stop children from contracting kichocho. It’s such a dangerous disease.”

Schistosomiasis, locally known as kichocho, is an acute and chronic neglected tropical disease (NTD) caused by parasitic worms. In Tanzania, where communities frequently interact with freshwater sources, the disease remains a significant health challenge. With nearly 20 percent of global cases affecting those under five years of age, efforts to address the disease are more crucial than ever.

“I have four children – the first is a girl, and the other three are boys,” shares Limi Masunga from Mwaswale, also from Itilima. “When we heard there was testing for kichocho, we were grateful and we decided to participate so we could understand our children’s health status.”

A young man assists two women at a table with packages in a bright room.

A woman in a blue dress stands confidently on a path, surrounded by greenery.

Angel’s and Limi’s families were among over 1,000 participants in a baseline parasitological assessment study conducted in January 2025 in Itilima, Sengerema and Kigoma districts. Communities near bodies of water, where schistosomiasis is prevalent, are the focus.

The study aims to deepen understanding of the burden of schistosomiasis among preschool-aged children (aged two to five years), and marks a significant step towards the upcoming rollout of a new paediatric treatment. It is part of the National Institute for Medical Research (NIMR)’s Strengthening Capacity for Delivery and Uptake of Paediatric Praziquantel Formulation for Schistosomiasis (STEPPS) project, supported by the UNDP-led Access and Delivery Partnership (ADP), the Special Programme for Research and Training in Tropical Diseases (TDR), and the Government of Japan.

A child pumps water from a well while three others wait with yellow jerry cans nearby.

A woman and a child stand in shallow water, smiling against a bright blue sky.

ADDRESSING A CRITICAL GAP IN TREATMENT

In young children, schistosomiais can lead to anemia, stunted growth and impaired cognitive development – effects that often persist into adulthood, contributing to long-term health issues and imposing significant social and economic burdens on affected communities.

While the drug praziquantel, a proven treatment for schistosomiasis, has long been available for older children and adults, no suitable formulation existed for children under five – until now. The lack of an appropriate treatment for schistosomiasis in preschool-aged children has perpetuated a glaring health inequity, leaving this vulnerable group disproportionately affected and unable to benefit from the advancements in care available to older age groups.

The ADP project is working closely with NIMR and the Ministry of Health in preparing for the rollout of arpraziquantel, the new paediatric formulation of praziquantel that recently gained endorsement from the World Health Organization. This medicine was developed by the Pediatric Praziquentel Consortium, a global public-private partnership supported by the European and Developing Countries Clinical Trials Partnership, the Global Health Innovative Technology Fund and Merck.

Five women in colorful clothing engaged in conversation outdoors.

A woman and a child walk past a clinic building with a sign, surrounded by grassy areas.

A woman interacts with a child while a man sits at a table in a classroom setting.

“Neglected tropical diseases like schistosomiasis are diseases of poverty, with devastating, long-term impacts,” says Dr. Paul Erasto Kazyoba, Chief Research Scientist at NIMR and lead of the STEPPS project. “We have to ensure that interventions are delivered as early as possible before these children grow older. This will improve their quality of life and the community’s involvement in socio-economic activities.”

“This baseline study is going to help us make informed decisions on how to provide access to this important drug to the under-five children,” he adds.

Two individuals in traditional attire engage with a man at a desk in an indoor setting.

Laboratory technician handling test tubes on a table covered with a red cloth.

COLLABORATING FOR BETTER HEALTH OUTCOMES

The baseline study is a collaborative effort involving NIMR researchers, district health officers and local healthcare workers.

“Previously, we tested children aged seven and above. However, we realized that younger children also needed testing,” explains Boaz Mnyeshi Petro, a laboratory technician. “This study is critical for understanding their condition.”

A man in a striped shirt examining a specimen under a microscope at a wooden table. — Boaz Mnyeshi Petro uses a microscope to examine samples for schistosomiasis.

The study aims to map areas most affected by the disease using Geographic Information Systems. By collecting stool and urine samples from children, and plotting their geographic coordinates, researchers can then identify the prevalence and intensity of infections.

Community engagement plays a central role in this initiative. Community health workers visit households, educating families about schistosomiasis prevention and treatment, addressing cultural myths and encouraging participation. Testing kits are provided to the families, who drop off their samples the following day at the local commumity health care facility.

The efforts in mapping of disease occurrences and engaging with endemic communities are critical for informing future treatment strategies for schistosomiasis in preschool-aged children.

"This baseline survey is a great opportunity to engage the community and can help policymakers understand the disease burden in young children," says Dr. Corinne Merle, a scientist at TDR.

A woman and a girl sit conversing outside, surrounded by greenery and colorful walls. — A mother with her children sit outside the community health centre, where the baseline parasitological assessment study was being conducted.

“Changes will come when people boil drinking water, and if children stop playing in contaminated waters, they will be healthy and remain free from kichocho,” notes Angel Michael, sharing some of what she learned from her conversation with the community health care worker who visited her home.

“The collaboration is excellent. We distributed containers for collecting samples, and the people responded very well, returning them,” says Jeremiah Nyanda, a community health worker and local resident. “The community is very pleased with the initiative. They all wanted their children to be tested.”

A man walks along a dusty road between homes under a bright blue sky with fluffy clouds.

A man and woman sit on blue plastic chairs, engaged in conversation in a rural setting.

PAVING THE WAY FOR A HEALTHIER FUTURE

The forthcoming rollout of the new pediatric treatment offers hope to families like Angel’s and Limi’s.

“What excites me about this medication for children is its potential to reduce – and eventually eradicate – kichocho infections in children,” says Ngw’ashi Dotto Haga, a healthcare worker in Kabale.

For communities, the benefits extend beyond health. “When a person is sick, it disrupts daily activities, especially economic ones,” notes Julius Johakim Tambirija, the chairman of Mlaga village in Sengerema. “Instead of going to the farms to plant crops for production, they spend their time seeking treatment or caring for sick children.”

By combining innovative health technologies, community involvement and strengthened health systems, Tanzania is setting an example for tackling neglected tropical diseases. The success of this collaborative initiative demonstrates how focused interventions can transform health outcomes for vulnerable populations while addressing long-standing health inequities. This effort underscores the critical role of partnerships between national institutions and global development partners in driving sustainable change, paving the way for a healthier and more equitable future for generations to come.