Act now to stop bilharzia in young children

Professor Francisca Mutapi

On Tuesday, the world will come together to raise awareness on a group of 21 illnesses known as Neglected Tropical Diseases.

Several of these diseases are common in Zimbabwe, with bilharzia the most prevalent.

Bilharzia is caused by parasitic worms.

It is contracted when a person comes into contact with the larval of the worms in freshwater bodies such as rivers and dams.

This means all Zimbabweans who come into contact with freshwater bodies, for example, for recreational activities or domestic use are at risk of contracting the disease.

About 100 million people in Africa are affected by bilharzia and in Zimbabwe the prevalence rate is 5 percent.

This means that one out of every 20 people in Zimbabwe has bilharzia.

However, the disease is not equally distributed across all age groups.

It occurs more frequently in children than in adults, and mostly those living in rural and peri-urban areas.

In Zimbabwe, young children are at risk of infection because they play in the water.

The disease is a serious threat to young children as it compromises normal growth and development.

This leads to stunting, poor memory and consequently poor school performance.

If it is not treated, the disease can progress to the bladder, liver and can cause urogenital tract damage.

The latter is important for sexual and reproductive health in adults since the damage to the urogenital tract puts people at risk of sexually transmitted diseases such as HIV.

The health damage caused by the parasitic worms begins as soon as a person contracts the infection.

It is important to note that this damage can be reversed by treatment using a drug called Praziquantel.

However, treatment needs to be administered early.

The longer infected people are left untreated, the worse the disease becomes and the less likely that the damage can be reversed.

This means that it is critical to diagnose and treat the infection as soon as possible.

Since 2012, the Ministry of Health and Child Care has run a national school-based programme offering free bilharzia treatment every year targeting learners from Grade One.

Children aged five years and below are not included in this programme since they are not yet enrolled in school.

This means these children can only be treated at the clinic when they are infected.

However, very few of these children are treated at clinics or other health centres.

Research has demonstrated the urgent need for these young children to be diagnosed and treated for bilharzia and to do so regularly.

There are three reasons why all people caring for young children especially in rural and peri-urban areas must have their children checked and treated for bilharzia and to do so urgently.

Firstly, children as young as six months can be infected by bilharzia.

Secondly, it has been proven that the disease can damage the health of children within three months of infection.

Thirdly, and fortunately, we have also shown that when treated early, the damage can be reversed and children can develop and grow normally.

This means it is critical for caregivers and community members especially community health workers to be vigilant in both looking out for symptoms of bilharzia in young children and in getting very young children tested and treated for bilharzia.

One of the easiest ways of getting young children treated for bilharzia is to ask for the children to be checked for bilharzia when they take them to the clinic for the monthly baby growth monitoring and vaccination (kuenda ku scale).

Staff at the health centres and clinics are familiar with the symptoms for bilharzia and can detect bilharzia from these various signs.

For young children aged five years and below, when parents or carers see blood in urine, they should immediately take the children for treatment.

In terms of the national control of bilharzia, integrating the recording of bilharzia on the baby cards will drive awareness among caregivers and ensure that it is integrated in the child health and growth monitoring services provided at health centres.

It might be argued that routine checks and treatment would be expensive.

The benefits of this approach far outweighs the health and economic costs of delaying treatment until the children are in school as is currently the default practice. The advantages of systematically getting the children treated early is that it prevents the development of the more serious forms of the diseases.

In this case, prevention of serious disease is better and cheaper than cure.

The bilharzia tablets cost between US0,50 cents and US$1.

More complicated forms of the disease such as liver and kidney damage are more difficult and more expensive to treat as this involves surgery.

Therefore, it makes health and economic sense to catch and treat the disease early.

Zimbabweans can make a significant contribution to World NTD Day by undertaking to take their young children aged five years and below to the clinic or health centre to be checked and treated for bilharzia.

The nurses delivering treatment for bilharzia can ensure they record this on the baby’s health card.

Meanwhile, health policy makers can work towards getting de-worming for bilharzia added as a scheduled item on the baby health card alongside childhood vaccination and Vitamin A supplementation.

Everyone in the childcare chain from parents, careers, community health workers, primary health care workers and policy makers can unite and act together to eliminate bilharzia in Zimbabwe.

Professor Fransisca Mutapi is co-director at Global Health Academy