Organization and decentralization of the Malawi National Bilharzia Control Programme

The Bilharzia Control Project, supported by GTZ in collaboration with the Ministry of Health, began in late 1981 with two pilot areas, namely Nkoma and Pirimiti. The aims of the programme are to decrease the level of morbidity due to schistosomiasis through health facilities, chemotherapy, sanitation and health education. The glass sandwich diagnostic technique is used for the diagnosis of S. mansoni infection. The Nytrel urine syringe filtration technique, with Lugol's solution to stain eggs, and urine test strips are used for diagnosis of S. haematobium infection. Chemotherapy using the "test and treat" (TAT) approach, is carried out in a community, whether at a school or in a village. It is possible to treat between 100 and 300 people per day for S. mansoni infection using this approach with three bilharzia assistants (health surveillance assistants). This is also possible in S. haematobium areas. The "test and treat" teams can spend more than 3 weeks in a village and can treat up to 300 persons per day (using a microscope). Mapping and census of a village is done on the afternoon before the day of treatment. Health education talks are conducted on this same afternoon. Health education is to be the number one priority in the schistosomiasis control programme in Malawi. The role of man in the cycle of the infection will have to be emphasized in the informational component of schistosomiasis control. The Bilharzia Control Programme needs to join forces with other ministries or organizations through the primary health care approach, to motivate and mobilize the communities in its control activities.