More information:
Published: November 2012
The Schistosomiasis Control Initiative (SCI) assists African governments with treatment of neglected tropical diseases and runs a number of smaller-scale projects (more).
SCI is a recommended organization because of its:
Our full review, below, discusses our full assessment of SCI, including what we see as its strengths and weaknesses as well as issues we have yet to resolve.
We began reviewing SCI in 2009. Our review has consisted of:
Previous reports on Schistosomiasis Control Initiative: April 2011 review and November 2011 review.
SCI works with governments in sub-Saharan Africa to create or scale up mass drug administration programs for neglected tropical diseases (NTD), particularly schistosomiasis and soil-transmitted helminths (STHs), in school-aged children and other groups determined to be at high risk.1 SCI's role has primarily been to solicit grants from large funders, identify country recipients, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs.
SCI does not report a comprehensive budget of all of its expenditures. It reports spending for each of its "accounts." It has accounts for each of the grants it has received, as well as accounts for unrestricted donations. We have seen spending details for some of these accounts, including all of the accounts containing unrestricted funds.
SCI's work has been driven by a number of large grants, each with somewhat varied program designs and geographic coverage:
SCI's role in mass drug administrations in general is to:10
Prior to 2011, unrestricted funds accounted for a very small portion of SCI's total funding.11 SCI told us that this funding was primarily used to fund treatments in regions of Cote d'Ivoire and Mozambique.12
In part due to GiveWell's recommendation, between November 2011 and October 2012, SCI received about $2 million. Over the same period it spent about $637,000 and made spending commitments totaling $1.37 million (details in our November 2012 update). SCI told us that it has spent (and plans to spend) these funds in three main categories:13
In addition, SCI has received some smaller grants for a variety of projects, including:
We have seen a number of spending breakdowns from SCI, which vary in the amount of detail, the categories used, and the funding sources or years covered. We do not feel that any one source gives a comprehensive picture of how SCI has spent its money, so we present a few different breakdowns of SCI's expenditures:
SCI's mass drug administration programs are focused on delivering treatments that have been both (a) independently studied in rigorous trials and found to be effective, and (b) found to be effective in three national programs aided by SCI.
We have remaining concerns about whether the results found in SCI-aided programs are:
We also have remaining questions about how many treatments are needed to have lasting impact, and how many treatments each individual receives in SCI's programs (more).
SCI's primary program is mass deworming, which we discuss extensively on another page. There is a very strong case that mass deworming is effective in reducing infections. The evidence on the connection to positive quality-of-life impacts is less clear, but there is a possibility that deworming is strongly beneficial.
We have seen detailed technical reports for four countries: Burkina Faso, Niger, Uganda, and Burundi. The first three countries accounted for about 74% of SCI funding as of April 2010 (the most recent report we've seen that breaks down overall spending by country),23 though the data below covers only the first year or two of these programs, which started in 2003-2004 and have continued until at least 2010. We also include Burundi for which we have seen a technical report that appears to cover the full time period of SCI's work in the country. Burundi is the only country for which we have seen data on a program that was not funded by SCI's first Gates Foundation grant. Note that the data from Burundi is from two studies: (a) 2007-2011 results from schools included in a pilot program in three provinces; and (b) 2008, 2009, and 2011 results from schools in the other districts.
We focus on these countries because (a) these countries account for the bulk of SCI's spending prior to April 2010 (and evaluations from more recently-funded countries are not yet available) and (b) we have the most in-depth information on them.
All of the following data is from uncontrolled panel studies, i.e. the same individuals were examined before and after treatment and the changes in their disease status reported as the effect of the treatment. Cross-sectional studies of children in the same schools as the cohort children and selected to match, in age and sex, the cohort group were also conducted in Burkina Faso with roughly similar results.24 In the four countries, significant decreases in parasite prevalence and intensity, anemia, and some disease manifestations were observed. All of the changes reported in the below table are statistically significant at p<0.05.25
Schistosoma haematobium | Schistosoma mansoni | Hookworm | ||||
---|---|---|---|---|---|---|
Country | Changes in prevalence | Changes in intensity | Changes in prevalence | Changes in intensity | Changes in prevalence | Changes in intensity |
Burkina Faso | 59.1% at baseline to 7.7% at two years | 94.2 eggs/10ml urine at baseline to 6.8 at two years | 2.8% at baseline to 0.3% at two years | 4.6 eggs per gram of feces at baseline to 0.6 at two years | Not reported | Not reported |
Niger | 75.3% at baseline to 28% at one year | 22.8% prevalence of heavy-intensity infections at baseline to 4.6% at one year | Not reported | Not reported | Not reported | Not reported |
Uganda | Not reported (SCI reports very low baseline prevalence26) | N/A | 42.4% at baseline to 17.9% at two years | 219.6 eggs per gram of feces at baseline to 37.4 at two years | 50.9% at baseline to 10.7% at two years | 309.4 eggs per gram of feces at baseline to 21.9 at two years |
Burundi (pilot) | Not reported (SCI reports very low baseline prevalence27) | N/A | 12.7% at baseline to 1.7% at four years | Not reported | 17.8% at baseline to 2.7% at four years | Not reported |
Burundi (other schools) | Not reported (SCI reports very low baseline prevalence28) | N/A | 6.2% at baseline to 0.7% at three years | Not reported | 15.1% at baseline to 5.4% at three years | Not reported |
For the other two prominent soil-transmitted helminths, ascaris and trichuris, very low prevalence of ascaris was reported in the Niger and Burkina Faso studies,29 and low baseline levels with modest decreases at two years were reported for both ascaris and trichuris in Uganda. In Burundi, effects on ascaris and trichuris appear inconsistent; prevalence both rose and fell by statistically significant amounts over the five years of the study (with the exception of trichuris, where the rise in prevalence was not statistically significant). Data from Uganda and Burundi are given in the footnote.30
Country | Anemia | Mean hemoglobin concentration31 | Blood in urine32 | Ultrasound abnormalities of the urinary tract prevalence | Ultrasound abnormalities of the bladder | Thinness or wasting | Shortness or stunting | Firm or hard liver | Firm or hard spleen |
---|---|---|---|---|---|---|---|---|---|
Burkina Faso | 65.75% at baseline to 61.59% at one year | 10.97 g/dL at baseline to 11.25 g/dL at one year | Micro: 49.56% at baseline to 10.50% at one year | Not reported | Not reported | Not statistically significant | Not statistically significant | Not reported | Not reported |
Niger | 61.9% at baseline to 50.4% at one year | 11.0 g/dL at baseline to 11.4 g/dL at one year | Gross: 7.1% at baseline to 0.4% at one year; Micro: 53.5% at baseline to 6.0% at one year | 45.6% at baseline to 15.2% at one year | 41.6% at baseline to 14.7% at one year | Not reported | Not reported | Not reported | Not reported |
Uganda | 51.6% at baseline to 36.2% at two years | 11.4 g/dL at baseline to 12.0 g/dL at two years | Not reported | Not reported | Not reported | Not reported | Not reported | 63.3% at baseline to 0.8% at two years | 61.6% at basline to 14.1% at one year |
Burundi (pilot) | 25.4% at baseline to 8.3% at four years | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Burundi (other schools) | 26.0% at baseline to 16.3% at three years | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
Due to the way in which they were carried out, these studies may overestimate SCI's impact. Potential sources of bias include:
The baseline characteristics measured in the studies did differ in some ways between those children who were found on follow up and those who were not; however the differences do not exhibit consistent patterns across the three studies (not reported for Burundi).41
We have limited information on whether the results presented above from Burkina Faso, Niger, Uganda, and Burundi can be generalized to other countries in which SCI has run programs (see footnote for details of where SCI has worked over what years and what results we have seen42). In addition to the published studies discussed above, we requested monitoring reports from Tanzania, which we did not receive.
For its first year or two of work in Mali and Tanzania, SCI posts results, but not details of how the data was collected, on its website. While reported results show positive effects, results are not reported for many indicators and we do not know if the methods used to collect this data were highly rigorous.43
SCI notes that in Zambia, which received support under SCI's initial Gates Foundation grant, implementation was poor and results below expectations.44
We have not seen evaluations of SCI's work on diseases other than schistosomiasis and soil-transmitted helminths and our understanding from conversations with SCI is that it does not monitor these programs. We have not seen evaluations of SCI's work with populations other than schoolchildren. Adults also receive treatment in some SCI-funded programs.45
We have seen limited information on the success of activities SCI has funded with unrestricted funds:
As of this writing in November 2012, we do not yet expect monitoring from countries where SCI is working to start new national deworming programs (Ethiopia, Zimbabwe and Mauritania) with unrestricted funds, as treatments have not yet started in those countries.49
We remain unsure about how many treatments are needed to impact health. SCI told us that its views on what groups should be treated and how often "is largely based on intuition and common sense, though it usually works and SCI collects sufficient data to know when it isn't working. In general, in high endemicity areas re-infection is a major issue; in lower endemicity areas, a single treatment can be sufficient."53 One example of the variation in treatment patterns is what SCI told us about its program in Yemen:
The details of our calculation of SCI's full cost per treatment are in this spreadsheet. In short, using data on the value of SCI's grants from 2002-2010, the number of schistosomiasis and STH treatments it reports delivering during that period, and conversations with SCI about how the grants were used, we estimate:
Note that SCI's USAID grants involved some treatments for diseases other than schistosomiasis and STHs; we do not include these on either side of the calculation, i.e., we do not include the treatments in the denominator of "cost per treatment" or the value of donated drugs in the numerator of "cost per treatment."
We discuss how the above figures relate to how much it costs to improve a child's health and development at our report on mass treatment programs for schistosomiasis and STHs.
As of November 2012, SCI held about $840,000 in unallocated funds. SCI is considering using this funding and additional funds it raises on some combination of the following. We note that SCI's plans have been somewhat fluid to date. We do not consider this a bad thing and have encouraged unrestricted funding to allow SCI flexibility.
We believe the Schistosomiasis Control Initiative to be a strong and effective organization overall.
More on how we think about evaluating organizations at our 2012 blog post.
We discuss SCI's financials above.
While we believe that SCI is an outstanding organization, we list some unresolved issues below:
"Objectives of SCI
Fenwick et al. 2009, Pg 3.
"The move towards national control programmes in sub-Saharan Africa was facilitated by an award from the Bill and Melinda Gates Foundation (BMGF; http://www.gatesfoundation.org) Global Health Program in 2002, to the SCI for the implementation and evaluation of control of schistosomiasis." Fenwick et al. 2009, Pg 2.
Amount at Gates Foundation, "Imperial College London (June 2002)."
"Six countries were selected by October 2003 for full support: Burkina Faso, Mali, Niger, Uganda, Tanzania and Zambia. The countries each proposed a different implementation approach and management structure for their large-scale schistosomiasis control. This was readily accepted because the BMGF required SCI to test the ‘proof-of-principle’ of national scale, Ministry of Health (MoH)-led schistosomiasis control programmes. SCI is based in Imperial College London and operated with the principle that all programmes were country owned and run, with SCI staff offering technical and other assistance, but not as expatriates living in-country. Programmes were based in the MoH in the respective country, and SCI offered support to improve the national health system." Fenwick et al. 2009, Pg 2.
Between 2003 and 2008, SCI provided treatment for schistosomiasis and soil-transmitted helminths to the following number of people (Fenwick, et al. 2009, Pg 3, Table 1).
Year | Uganda | Burkina Faso | Niger | Mali | Tanzania | Zambia |
---|---|---|---|---|---|---|
2003 | 0.43 | - | - | - | 0.10 | - |
2004 | 1.23 | 1.03 | 0.67 | - | 0.44 | - |
2005 | 2.99 | 2.30 | 2.01 | 2.60 | 2.95 | - |
2006 | 1.51 | 2.82 | 1.56 | 2.18 | 0.38 | 0.56 |
2007 | 1.81 | 0.75 | 2.07 | 0.65 | 2.65 | 0.25 |
2008 | 1.50 | 2.70 | 5.28 | - | 1.24 | - |
"Current and future rounds of treatment in all six countries are being delivered in an integrated manner to include schistosomiasis, STH, lymphatic filariasis, onchocerciasis and trachoma." Fenwick et al. 2009, Pg 10. The "six countries" refers to the six countries funded by SCI's first Gates Foundation grant.
Countries and dates from Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)."
Schistosomiasis Control Initiative, "Burundi: Strategy."
Schistosomiasis Control Initiative, "Rwanda: Strategy."
Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)."
Schistosomiasis Control Initiative, "Account Summary (May 2011)."
"A team from Imperial College London has been awarded 25 million funding from the UK Government to continue its fight against neglected tropical diseases, it was announced this week. The money will enable the Schistosomiasis Control Initiative (SCI) to provide 75 million treatments to protect some of the world’s poorest children against schistosomiasis – an illness caused by parasitic worms – and soil-transmitted helminths (STH). £15 million of the funding will be spent directly on procuring drug treatments, through an organisation called Crown Agents. The rest will be administered by SCI." Schistosomiasis Control Initiative, "Imperial Initiative to Protect Children from Tropical Disease Awarded £25m Government Backing."
Alan Fenwick, conversation with GiveWell, October 17, 2011.
"SCI will be assisted in their drug delivery by the Centre for Neglected Tropical Diseases at Liverpool School of Tropical Medicine via a sub contract through LATH (Liverpool Associates in Tropical Health). In six countries, this will lead to treatment for lymphatic filariasis – another worm disease – becoming integrated with schistosomiasis and STH treatment." Schistosomiasis Control Initiative, "Imperial Initiative to Protect Children from Tropical Disease Awarded £25m Government Backing."
As of July 2011, it had received about $580,000 in unrestricted funding (Schistosomiasis Control Initiative, "IC Trust Summary (September 2011)") and $108 million overall (Schistosomiasis Control Initiative, "Gates Foundation Final Report (January 2011)," Pg 20).
"For the smaller donor, we have two or three projects, which we have been supporting and which will hopefully lead to pilot project in their respective countries.
Alan Fenwick, phone conversation with GiveWell, February 16, 2011.
See our November 2012 update on SCI.
SCI's summary of active accounts as of May 2011 lists five research grants totaling £1.9 million, or about $3 million. Schistosomiasis Control Initiative, "Account Summary (May 2011)."
"Once we have people that want to give at least $100,000, we talk to them directly. Two examples:
Alan Fenwick, phone conversation with GiveWell, February 16, 2011.
Funds committed for future use listed in Schistosomiasis Control Initiative, "IC Trust Summary (September 2011)":
Alan Fenwick, conversation with GiveWell, September 15, 2011. Note: "SCI generally doesn't do water and sanitation programs because of the expense. In Burundi they're doing water and sanitation programming because they have been successful there with running a program and treating schistosomiasis, but soil-transmitted helminth infections remain persistent." Alan Fenwick, conversation with GiveWell, October 17, 2011.
Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)."
"When SCI claims back from USAID, a small % -- about 6% -- is an overhead charge that goes to Imperial College. SCI is not a registered charity but a part of Imperial College." Alan Fenwick, phone conversation with GiveWell, February 16, 2011.
The line item is "external consultants." SCI told us, "The line 'external consultants' which seems a high personnel cost in some sub awards is in fact a transfer to the Countries - which for the sake of Imperial accounting are classed as 'external consultants' because Imperial College accounting system has no line for field work in Africa." Alan Fenwick, email to GiveWell, February 1, 2011.
Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)."
Note that a source covering slightly different dates and grants reported a slightly different breakdown. Aggregating spending data from the Gates Foundation (2006-2011) and USAID (2006-2009) integrated control grants, we estimate that SCI spent about 38% of this funding on "field work expenses," 25% on drugs, 21% on staff, and 17% on various other expenses. We are unclear what "field work expenses" signifies. For the one country for which we have more detail, Burkina Faso, "field work expenses" were grants to the organization RISEAL, which is described on its website as "a federation of associations operating in West Africa, Madagascar, and in Europe" to "promote the control of Neglected Tropical Diseases" (RISEAL, "Homepage."). However, it is our understanding from conversations with SCI that much of its funding is often channelled via governments. Data from Schistosomiasis Control Initiative, "Gates2 Y1 to Y5 Accounts" and Schistosomiasis Control Initiative, "USAID RTI Y1 to Y3 Accounts."
Schistosomiasis Control Intiative, "Gates2 Burkina Faso Spending Report."
Schistosomiasis Control Initiative, "Gates Foundation Final Report (January 2011)," Pg 20.
Schistosomiasis Control Initiative, "IC Trust Summary (September 2011)."
Data on spending by country is from Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)," Pg 1. Funding, as of April 2010, was concentrated in Burkina Faso (34% of country-specific funding), Niger (33%), Uganda (10%), Burundi and Rwanda (10%; we don't have data for these countries independently), and Tanzania (7%).
"In addition to the cohort follow-up, a cross-sectional survey was conducted during the second follow-up (2 years post-treatment), in which a group of children (7–14 years old) outside the original cohort were randomly selected and examined in the sentinel schools. The number, age and sex structures were matched to those in the cohort who were present at the second follow-up in each school. Infection status in these children should represent the quality of treatment in children outside cohorts in schools, to confirm and validate the cohort data, i.e. no preferred treatment was given to cohort children…As in the cohort data, the proportion of heavy [S. haematobium infections was reduced from 25% to just 3.2% (Fig. 2). However, these children outside the cohort did show a slightly higher prevalence and intensity of S. haematobium infection than those in the cohort as in Table 1 (P<0.01) at 2 years post-treatment…In baseline children (7–14 years old) in the original cohort in this region, prevalence of S. mansoni infection was 14.2% (95% CI: 10.8–17.6; n = 408) [13.6% in the cohort baseline] and intensity of infection was 23.0 epg (95% CI: 11.8–34.2; n = 408) [22.4 epg in cohort] before treatment. Two years after treatment, S. mansoni prevalence in this region was 7.6% (95% CI: 4.4–11.0; n = 248) [1.5%in cohort] and intensity of infection was 16.5 epg (95% CI: 1.9–31.0; n = 248) [2.9 epg in cohort] (both P>0.05)." Touré et al. 2008, Pg 781-783.
Sources for the data in the tables:
Results from Kabatereine et al 2007, Pg 93, Table 2 (see source for 95% confidence intervals) and Schistosomiasis Control Initiative, "Monitoring and Evaluation Report for Burundi" (see source for statistical significance). We report "as measured results" for Burundi; SCI also reports model results.
Baseline | Year 1 | Year 2 | Year 3 | Year 4 | |
---|---|---|---|---|---|
Ascaris in Uganda | 2.8% | 1.6% | 0.6% | - | - |
Trichuris in Uganda | 2.2% | 2.5% | 1.6% | - | - |
Ascaris in Burundi (pilot) | 14.9% | 12.9% | 20.1% | 10.6% | 10.1% |
Trichuris in Burundi (pilot) | 3.2% | 1.8% | 3.9% | 1.5% | 2.4% |
Ascaris in Burundi (other schools) | 21.6% | 11.7% | - | 9.1% | - |
Trichuris in Burundi (other schools) | 10.4% | 10.0% | - | 4.3% | - |
"The SCI-supported schistosomiasis control program was implemented during 2004 and had treated 3,322,564 school-aged children in the 13 regions of the country through October 2006...For the present study, parasitological and morbidity data were collected from a cohort of 1727 Burkinabé children 6–14 years old, randomly sampled from 16 schools before and 1 year after chemotherapy (2004 and 2005, respectively). The schools included in these surveys were randomly selected from all schools in 4 Regional Health Directorates known a priori to be places where schistosomiasis is highly endemic." Koukounari et al. 2007. Pg 660.
"Eight villages located in schistosomiasis endemic regions were randomly selected to represent the two main transmission patterns in Niger: six villages located near permanent (Tabalak, Kokorou) or semi-permanent (Kaou, Mozague, Rouafi, and Sabon Birni) ponds and two (Saga Fondo, Sanguile) located along the Niger River. The villages represented the south-western region (Tillabe´ry) and the central-northern region (Tahoua) of the country, with four villages from each region. One village is located in the Sudanian climatic zone and the seven others are in the Sahelian climatic zone." Tohon et al. 2008, Pg 2.
Anna Phillips, email to GiveWell, October 13, 2011.
Kabatereine et al. 2007, Pg 92.
Schistosomiasis Control Initiative, "Monitoring and Evaluation Report for Burundi," Pg 1.
Schistosomiasis Control Initiative, "Monitoring and Evaluation Report for Burundi," Pg 13.
Benjamin Styles, phone conversation with GiveWell, August 12, 2011.
Funding sources in table below are compiled from:
Schistosomiasis Control Initiative, "Summary Sheet of Treatments Instigated and Overseen by SCI."
Alan Fenwick, phone conversation with GiveWell, June 17, 2010.
Schistosomiasis Control Initiative, "Board Management Accounts (April 2010)."
2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | |
---|---|---|---|---|---|---|---|---|---|---|
Burkina Faso | - | Gates | Results with details | Gates | Results with details | Gates/ USAID | Results with details | Gates/ USAID | Results without details | Gates/ USAID | No results | Gates / USAID | No results | Gates / USAID | No results | Gates / USAID | No results | (Taken over by HKI) |
Burundi | - | - | - | - | GNNTDC | Results with details | GNNTDC | Results with details | GNNTDC | Results with details | GNNTDC | Results with details | Individual | Results with details | Individual | Results expected later |
Cote D'Ivoire | - | - | - | - | - | - | - | - | DFID | No results yet | |
Liberia | - | - | - | - | - | - | - | - | DFID | No results yet | DFID | No results yet |
Malawi | - | - | - | - | - | - | - | - | DFID | No results yet | DFID | No results yet |
Mali | - | Gates | Results without details | Gates | Results without details | Gates/ USAID | Results without details | USAID | No results | USAID | No results | USAID | No results | (Taken over by HKI) | (Taken over by HKI) | |
Mozambique | - | - | - | - | - | - | - | - | DFID | No results yet | DFID | No results yet |
Niger | - | Gates | Results with details | Gates | Results with details | Gates/ USAID | Results without details | Gates/ USAID | No results | Gates/ USAID | No results | Gates/ USAID | No results | Gates/ USAID | No results | DFID | No results yet | DFID | No results yet |
Rwanda | - | - | - | - | GNNTDC | No results | GNNTDC | No results | GNNTDC | No results | GNNTDC | No results | ? | End Fund | No results yet |
Tanzania | Gates | Results without details | Gates | Results without details | Gates | No results | Gates | No results | Gates | No results | Gates | No results | Gates | No results | Gates | No results | DFID | No results yet | DFID | No results yet |
Uganda | Gates | Results with details | Gates | Results with details | Gates | Results with details | Gates/ USAID | Results without details | Gates/ USAID | No results | Gates/ USAID | No results | Gates/ USAID | No results | Gates/ USAID | No results | DFID | No results yet | DFID | No results yet |
Yemen | - | - | - | - | - | - | - | - | Unrestricted SCI funds | No results yet | World Bank | No results yet |
Zambia | - | Gates | Known failure | Gates | Known failure | Gates | Known failure | Gates | Known failure | - | - | - | DFID | No results yet | DFID | No results yet |
Schistosomiasis Control Initiative, "Mali: Impact."
Schistosomiasis Control Initiative, "Tanzania: Impact."
Schistosoma haematobium | Schistosoma mansoni | Hookworm | Anemia | ||||||
---|---|---|---|---|---|---|---|---|---|
Country | Follow up rate | Changes in prevalence | Changes in intensity | Changes in prevalence | Changes in intensity | Changes in prevalence | Changes in intensity | Changes in prevalence | Changes in mean haemoglobinemia |
Mali | 58% over two years | About 90% at baseline to about 50% at two years | About 30% prevalence of heavy-intensity infections at baseline to about 3% at one year | About 21% at baseline to about 13% at two years | Not reported | About 7% at baseline to about 2% at two years | Not reported | Not reported | Not reported |
Tanzania | 65% at one year | Not reported | Not reported in aggregate; about 3-52% at basline to 2-10% at follow up | Not reported | Not reported | 39.81% at baseline to about 17.36% at one year | Not reported | 47.15% at baseline to about 32.97% at one year | Not reported |
"Zambia has been less successful in reaching its original programme target of expanding coverage to treating 2 million school-aged individuals and had only achieved, according to incompletely reported coverage, around 25% of this target by July 2007." Fenwick et al. 2009, Pg 9.
"Who has been treated (adults/school children/pre-school children):
Burundi: For STH: children 1-14 yrs, pregnant women under 49 yrs; For schisto: children 5-14 yrs, adults in high prevelance areas…
Malawi: School aged children 4.4 m and adults 1.2 m…
Niger: communities…
Senegal: MDA in April 2012 - private and public schools, islamic schools (called Dahara) and communities…
Uganda: Communities on Lake Victoria islands…
Yemen: Children and adults…
Zimbabwe: Predominantly school aged children but adults if justified."
Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By County 2012.
MANNA, "Campanha do Controle de Shistosomiase e Parasitoses Intestinais (February to June 2008)."
MANNA, "A Firsthand Look at the Problems and Pathways to Controlling Schistosomiasis in Mozambique."
"Withholding of the data by the health unionists since 2010. Negotiation was started during the meetings and the great importance of the MDA had was also highlighted as well as the negative consequences the MoH might have to face regarding the future of partnership, in case of not being able to get data and reports."; "Due to health information withholding, it was impossible to collect all data." Government of Senegal, "Report on MDA (2012)," Pgs 10 and 12.
Date of MDA (April 2012) from Schistosomiasis Control Initiative, "Program Update (September 2012)."
See our November 2012 update.
"Single-dose oral therapies can kill the worms, reducing ... infections by 99 percent ... Reinfection is rapid, however, with worm burden often returning to eighty percent or more of its original level within a year ... and hence geohelminth drugs must be taken every six months and schistosomiasis drugs must be taken annually." Miguel and Kremer 2004, Pg 161.
Alan Fenwick, conversation with GiveWell, October 17, 2011.
See table "Funding for mass treatment | Have we seen disease prevalence/intensity or morbidity results?" in previous footnote.
Alan Fenwick, conversation with GiveWell, October 17, 2011.
Alan Fenwick, conversation with GiveWell, October 17, 2011.
"Drug distribution channels:
Drug distributors need a minimum of one day’s training to understand the basis for calculating dosages, the necessary actions to deal with side-effects and treatment record keeping and reporting." Schistosomiasis Control Initiative, "Neglected Tropical Diseases in Mozambique," Pg 23.
"For schistosomiasis and STHs, treatment will be conducted through schools by the teachers. For LF, treatment will be conducted through community directed treatment, by the CDDs and community health agents, managed by the district medical officer." Schistosomiasis Control Initiative, "Proposal by SCI, Imperial College to Manage the Program for Integrated Control of Neglected Tropical Diseases in Côte d'Ivoire," Pg 23.
See our overview of priority programs.
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.
Alan Fenwick, phone conversation with GiveWell, August 13, 2012.
Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By country plans.
GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.
Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By country plans.