A comprehensive guide to the technical and practical factors that need to be considered when designing and implementing programmes for the control of schistosomiasis. Noting the success of strategies focused on morbidity control, the report shows how the spectrum of programme goals can now be broadened to include reductions in the prevalence and intensity of established infections and decreases in the intensity of transmission. Throughout, emphasis is placed on knowledge and experiences that can help programme managers establish feasible goals and then select control options in line with the form of infection, its public health importance, the degree and type of morbidity, available resources, and integration into the primary health care system. Information is specific to the different types of schistosomiasis and the distinctive epidemiological features, clinical manifestations, and response to treatment of each. The report has three main parts. The first, which is devoted to strategies for control, gives programme managers a concise, yet complete review of all factors that need to be considered when establishing priorities and deciding on the most appropriate options for control. Emphasis is placed on the many recent advances, including experiences with praziquantel, that have strengthened the tools available for prevention, diagnosis, treatment, and cure. While noting the severe financial constraints faced in many endemic countries, the report cites recent findings and experiences that make it possible for each endemic country to take action against schistosomiasis, even when resources are scarce and health services limited. The second part gives specialists a detailed state-of-the-art review of all technical developments relevant to control. Separate sections describe the distinctive patterns of morbidity and mortality seen in each form of infection, update knowledge about the parasite and its mammalian hosts, and summarize what is known about the snail intermediate host and its susceptibility to control by molluscicides, biological agents, and environmental management. Other sections describe a range of advances in diagnostic tools, from hospital-based radiological investigations to the use of portable ultrasound equipment at the village level, and issue advice on treatmet and retreatment schedules for chemotherapy with praziquantel, metrifonate, and oxamniquine. The final part uses profiles of control programmes in 23 countries to document the feasibility of control and illustrate the diversity of approaches that can be applied according to different national conditions, forms and prevalence of infection, health care systems, and available resources.

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WHODOC

WHO monograph

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