Four days of traveling later…

I have finally settled down in one spot after days of driving and flying. There’s been a complete change of scenery; I am now on the island of Pemba, the less developed of the two main islands that make up Zanzibar.

Pemba. Control your drooling.

SCORE has a completely different project going on in Zanzibar, one that comes after the gaining and sustaining phases of schistosomiasis control. While Kenya, the Ivory Coast and other countries have been working hard to gain control over schistosomiasis and keep it down, Zanzibar has proven itself to be capable of sustaining low rates of infection. This made it the perfect candidate for an elimination program, ZEST (Zanzibar Elimination of Schistosomiasis Transmission), which launches tomorrow.

As with the gaining and sustaining projects, Zanzibar’s elimination effort will be the result of collaboration among numerous parties from all over the world. ZEST is the baby of the Zanzibar NTD Programme, the Public Health Laboratory Ivo de Carneri, the Ministries of Health and Education, the Schistosomiasis Control Initiative, the Swiss Tropical and Public Health Institute, WHO and SCORE.

Tomorrow marks the official beginning of ZEST;  it’s a flurry of activity at the Public Health Laboratory today, with all the big names in each organization flying in one by one on the tiny planes that ferry people between the two islands. The day will include dancing, speeches and the general politics that come with such a huge national endeavor.

The actual interventions are still in the planning stages, but the general idea is similar to the multi-arm gaining and sustaining studies in Kenya. The main island of Unguja has a very low prevalence rate of less than 8 percent, while Pemba has around 15 percent prevalence. The Ministry of Health has been administering Praziquantel with accompanying health education as part of its national control initiative, and this plan will compose the control arm of the study. The national plan involves treating school children on both islands for two years, as well as treating adults on Pemba and in hotspots on Unguja.

The main goal of ZEST is to not only eliminate schistosomiasis as a public health problem on both islands, but also to learn how to best eliminate the disease in a cost effective, realistic manner.

To do this, the study will use two comparative arms. One will involve treatment and snail control, and the other will include treatment and behavior change. Controlling snails means using molluscicides and reducing vegetation. Behavior change could be anything from adding water basins for washing to convincing little boys not to pee in the water.

Formative research has just concluded regarding the behavioral aspects of the study, but an intervention will not be ready for months. Hopefully more details will come out as I speak with the people involved. While elimination is a lofty goal, it has been done successfully in a few other countries, Japan being the biggest success story. With the results of the program on Zanzibar, researchers hope to learn of an effective strategy that could be used as a model for countries that have successfully gained control over the disease.

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