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Our study rationale was to establish contemporary epidemiological data on malaria and schistosomiasis among school-going children in Chikwawa District before future environmental changes associated with the Shire Valley Transformation Programme occurred. Our cross-sectional surveys tested 1134 children from 21 government-owned primary schools (approximately 50 children per school); rapid diagnostic tests for malaria (Humasis Pf/PAN) and intestinal schistosomiasis (urine-Circulating Cathodic Antigen) were used, with urine reagents strips and egg-filtration with microscopy for urogenital schistosomiasis. All infected children were treated with an appropriate dose of Lonart® (for malaria) and/or Cesol® (for schistosomiasis). Across 21 schools the overall prevalence was 9.7% (95% CI: 8.8–10.6%) for malaria, 1.9% (95% CI: 1.4–2.3%) for intestinal schistosomiasis, and 35.0% (95% CI: 33.6–36.5%) for egg-patent urogenital schistosomiasis. The prevalence of co-infection of malaria with urogenital schistosomiasis was 5.5% (95% CI: 4.8–6.2%). In a third of the schools, the prevalence of malaria and urogenital schistosomiasis was above national averages of 10.5% and 40–50%, respectively, with two schools having maxima of 36.8% and 84.5%, respectively. Set against a background of ongoing control, our study has revealed an alarming burden of malaria and schistosomiasis in southern Malawi. These findings call for an immediate mitigating response that significantly bolsters current control interventions to better safeguard children's future health.

Infectious diseases are emerging at an unprecedented rate while food production intensifies to keep pace with population growth. Large-scale irrigation schemes have the potential to permanently transform the landscape with health, nutritional and socio-economic benefits; yet, this also leads to a shift in land-use patterns that can promote endemic and invasive insect vectors and pathogens. The balance between ensuring food security and preventing emerging infectious disease is a necessity; yet the impact of irrigation on vector-borne diseases at the epidemiological, entomological and economic level is uncertain and depends on the geographical and climatological context. Here, we highlight the risk factors and challenges facing vector-borne disease surveillance and control in an emerging agricultural ecosystem in the lower Shire Valley region of southern Malawi. A phased large scale irrigation programme (The Shire Valley Transformation Project, SVTP) promises to transform over 40,000 ha into viable and resilient farmland, yet the valley is endemic for malaria and schistosomiasis and experiences frequent extreme flooding events following tropical cyclones. The latter exacerbate vector-borne disease risk while simultaneously making any empirical assessment of that risk a significant hurdle. We propose that the SVTP provides a unique opportunity to take a One Health approach at mitigating vector-borne disease risk while maintaining agricultural output. A long-term and multi-disciplinary approach with buy-in from multiple stakeholders will be needed to achieve this goal.