Search

An estimated 4.5 million South Africans, mainly in settings of rural poverty, are in need of treatment for urogenital schistosomiasis. In spite of severe morbidity and mortality, schistosomiasis remains a neglected disease with an important gender impact. The World Health Organization recommends regular mass treatment of all school-aged children. In areas endemic for schistosomiasis children are treated with a single dose of praziquantel, used for almost 30 years as the drug of choice. If administered in childhood, praziquantel has been proven to effectively prevent schistosomiasis-related morbidity, as well as reduce the socio-economic impact of the disease. Moreover, preventing urogenital schistosomiasis may also reduce HIV transmission in sexually active females. In this paper we examine the impact of the disease, the use of generic praziquantel and the need for a change in health and drug policy in order to make generic praziquantel available for mass treatment campaigns in South Africa. Generic praziquantel has been on the market for almost 30 years. Although elsewhere available free of charge, or at low cost, affordable generic versions of praziquantel are not obtainable in South Africa.

There is increasing evidence of an association between female genital Schistosoma haematobium infection and HIV. In KwaZulu-Natal, we aimed to explore girls' water contact practice and to determine whether a study exclusively on girls would be manageable and welcomed. Three primary schools that had participated in a parasite control programme eight years prior were approached. Subject to consent, girls aged 9 to 12 years were interviewed on water-body contact, symptoms and household composition. Urine samples were analysed for S. haematobium infection eggs. Good dialogue was achieved in all schools and 95% consented to participation; 43% had an S. haematobium infection, geometric mean intensity 10.5 ova per 10 ml urine. Only 12% had ever been treated for S. haematobium. Water-body contact was signifcantly associated with S. haematobium (OR 2.8, 95% CI 1.3-5.9, p= 0.008); however, S. haematobium was also found in 20% of girls who claimed to never have had water-body contact. Sixty-four percent thought they had no choice but to use unprotected water; 21% had no mother in the household, and being an orphan increased the risk of having S. haematobium. The community welcomed the study. Prevalence levels in South Africa are so high that some communities are eligible for WHO-recommended regular mass treatment.