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Deol AK, Fleming FM, Calvo-Urbano B, Walker M, Bucumi V, Gnandou I, Tukahebwa EM, Jemu S, Mwingira UJ, Alkohlani A, Traoré M, Ruberanziza E, Touré S, Basáñez MG, French MD, Webster JP. Schistosomiasis - Assessing Progress toward the 2020 and 2025 Global Goals. N Engl J Med 2019; 381:2519-2528. [PMID: 31881138 PMCID: PMC6785807 DOI: 10.1056/nejmoa1812165] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND With the vision of "a world free of schistosomiasis," the World Health Organization (WHO) set ambitious goals of control of this debilitating disease and its elimination as a public health problem by 2020 and 2025, respectively. As these milestones become imminent, and if programs are to succeed, it is important to evaluate the WHO programmatic guidelines empirically. METHODS We collated and analyzed multiyear cross-sectional data from nine national schistosomiasis control programs (in eight countries in sub-Saharan Africa and in Yemen). Data were analyzed according to schistosome species (Schistosoma mansoni or S. haematobium), number of treatment rounds, overall prevalence, and prevalence of heavy-intensity infection. Disease control was defined as a prevalence of heavy-intensity infection of less than 5% aggregated across sentinel sites, and the elimination target was defined as a prevalence of heavy-intensity infection of less than 1% in all sentinel sites. Heavy-intensity infection was defined as at least 400 eggs per gram of feces for S. mansoni infection or as more than 50 eggs per 10 ml of urine for S. haematobium infection. RESULTS All but one country program (Niger) reached the disease-control target by two treatment rounds or less, which is earlier than projected by current WHO guidelines (5 to 10 years). Programs in areas with low endemicity levels at baseline were more likely to reach both the control and elimination targets than were programs in areas with moderate and high endemicity levels at baseline, although the elimination target was reached only for S. mansoni infection (in Burkina Faso, Burundi, and Rwanda within three treatment rounds). Intracountry variation was evident in the relationships between overall prevalence and heavy-intensity infection (stratified according to treatment rounds), a finding that highlights the challenges of using one metric to define control or elimination across all epidemiologic settings. CONCLUSIONS These data suggest the need to reevaluate progress and treatment strategies in national schistosomiasis control programs more frequently, with local epidemiologic data taken into consideration, in order to determine the treatment effect and appropriate resource allocations and move closer to achieving the global goals. (Funded by the Children's Investment Fund Foundation and others.).
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Affiliation(s)
- Arminder K Deol
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Fiona M Fleming
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Beatriz Calvo-Urbano
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Martin Walker
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Victor Bucumi
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Issah Gnandou
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Edridah M Tukahebwa
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Samuel Jemu
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Upendo J Mwingira
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Abdulhakeem Alkohlani
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Mahamadou Traoré
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Eugene Ruberanziza
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Seydou Touré
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Maria-Gloria Basáñez
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Michael D French
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
| | - Joanne P Webster
- From the Schistosomiasis Control Initiative (A.K.D., F.M.F., B.C.-U.), the London Centre for Neglected Tropical Disease Research (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), the Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London (A.K.D., F.M.F., M.W., M.-G.B., J.P.W.), and the Royal Veterinary College, the Department of Pathobiology and Population Sciences, University of London (M.W., J.P.W.) - all in London; the Ministry of Health Burundi, Bujumbura (V.B.); the Ministry of Health Niger, Niamey (I.G.); the Ministry of Health Uganda, Vector Control Division, Kampala (E.M.T.); the Ministry of Health Malawi, Lilongwe (S.J.); the Ministry of Health Tanzania and the National Institute for Medical Research, Dar es Salaam (U.J.M.); the Ministry of Health Yemen, Sana'a (A.A.); the Ministry of Public Health and Hygiene Mali, Bamako (M.T.); the Neglected Tropical Diseases Unit, Malaria and Other Parasitic Diseases Division, Institute of HIV-AIDS, Disease Prevention, and Control, Rwanda Biomedical Center, Ministry of Health, Kigali (E.R.); the National Schistosomiasis Program, Ministry of Health, Ouagadougou, Burkina Faso (S.T.); and RTI International, Washington, DC (M.D.F.)
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