27 June 2017

Spotlight on Cameroon’s war on worms

Kindly contributed by Louis-Albert Tchuem Tchuenté, Professor of Parasitology at the University of Yaoundé and Coordinator of the National Programme for the Control of Schistosomiasis and Intestinal Helminthiasis in Cameroon.

Taking advantage of renewed momentum for neglected tropical diseases, the Cameroon Ministry of Public Health has developed and adopted a strategic plan. In 2004 it officially launched the national program for the control of schistosomiasis and soil-transmitted helminthiasis (STH). Starting with a very limited budget, the control program gradually mobilized national and international partners, to enable a rapid scaling-up of activities that encompassed all endemic regions and health districts from 2007. Since then, national deworming campaigns are implemented annually, focusing mainly on the treatment of school-age children in high and moderate endemic health districts. The number of people treated for schistosomiasis each year has increased from 35,000 in 2006 up to 2.8 million today.

Prof. Louis-Albert Tchuem TchuentéProf. Louis-Albert
Tchuem Tchuenté

Positive impact

Several studies have clearly shown the positive impact of these annual deworming campaigns. In the capital Yaoundé, for example, the results showed significant declines of schistosomiasis prevalence between 2010 and 2016, from 41% to 0%, 25% to 2% and 20% to 0% in school-age children across various transmission sites. Similar decreases were observed in other parts of the country. Cases of interruption of schistosomiasis transmission were also observed in some foci. These results illustrate the progressive success of the national control program in Cameroon.

Political commitment

Campaign successes are primarily due to sustained political commitment from the government, which allowed the establishment of an innovative partnership between the Ministry of Public Health; the Ministry of Basic Education; the Ministry of Secondary Education; and the Union of Councils and Cities of Cameroon. This collaboration, together with domestic and international partners (such as Helen Keller International, Sightsavers, Perspective, International Eye Foundation, WHO and other UN agencies) has been the driving force to ensure regular deworming in Cameroon. Apart from political commitment, the conduct of a comprehensive mapping of schistosomiasis has been instrumental in the successful scale-up of treatment prevalence in 2010-2012 (the first update for 25 years!), as has the praziquantel donated by Merck through WHO for the treatment of school age children.

The picture shows the official launch of the 2010 national deworming campaign in Cameroon by the Minister of Public Health (man with yellow tie), the Minister of Basic Education (woman treating schoolchild), the WHO, UNICEF country representatives (behind the ministers), and other authorities.



From control to elimination

Looking forward to the 2020 WHO roadmap target, we are still far from achieving our goals, and several challenges remain – especially with the shift in our ambition from control to elimination of schistosomiasis. A readjustment of our main strategies is required, with more intensive and combined interventions. Today, it is obvious that treatment alone will not be sufficient to achieve the interruption of schistosomiasis transmission. In addition to treatment, the other major activities conducted in Cameroon are: (1) training of health and education personnel; (2) sensitization and education of communities about the disease, the risks of infection and measures for prevention; and (3) promotion of hygiene, safe water and sanitation systems in communities.

Additional needs

In order to closely review additional needs, for moving from control of schistosomiasis to elimination, we organized an international conference entitled ‘Towards Elimination of Schistosomiasis (TES): a paradigm shift’, held in Cameroon on March 22-23, 2017.  This conference was organized under the joint patronage of the Cameroonian Minister of Public Health and the Minister of Basic Education. The conference brought together scientists, experts, donors, policy makers, non-governmental development organizations, and students from all over the world. It provided a platform for accessing all that is new, evolving, challenging, successful and exciting in schistosomiasis control and elimination. The recommendations of the conference guided us when revising and improving our approach. So that we can achieve the interruption of schistosomiasis transmission, and elimination of the disease, the following are required:

  • An expansion in general access to treatment, achieved by extending mass drug administration to preschool-aged children and adults, and by increasing the availability of medicines in health centers throughout the year. Specific reference is made to the management of female genital schistosomiasis, encouraging gender equity.
  • Completion of precision mapping, providing high resolution information at the local level that can be used to better focus and tailor preventive chemotherapy. This applies to all demographic groups at risk (pre-school-aged children, school-aged children, and adults) in order to ensure a minimum level of annual treatment. Where deemed necessary, biannual (or more frequent) treatment should be implemented for the intensification of preventive chemotherapy.
  • Intensification of multi-sectoral actions to consolidate the elimination of schistosomiasis, and specifically up-scaling and fostering of the sustainability of integrated activities, including snail control, improvement of access to water, hygiene, and sanitation.
  • Strengthening of community ownership of the program, with appropriate communication and health education tools that nurture a closer partnership between local and national stakeholders engaged in cross-sectorial actions.

If you are interested in learning more about the Conference and its outcomes, please read the conference report (PDF).

Did you know that in Cameroon…

  • Schistosomiasis affects the lives of millions of impoverished people
  • It is estimated that more than 5 million people are at risk of infection, and 2 million are currently infected
  • Close to 50% of the 189 health districts have a moderate or high prevalence of schistosomiasis and are eligible for mass drug administration with praziquantel
  • The Ministry of Public developed and adopted a strategic plan and officially launched the national program for the control of schistosomiasis and soil-transmitted helminthiasis (STH) in 2004
  • People treated each year have increased from 35,000 in 2006 to 2.8 million today
  • Significant declines of schistosomiasis prevalence in school-age children were observed between 2010 and 2016
  • There are three species of schistosomes: one causes urogenital schistosomiasis (Schistosoma haematobium) and two cause intestinal schistosomiasis (Schistosoma mansoni and Schistosoma guineensis)