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Schistosomiasis Control Initiative

The Schistosomiasis Control Initiative (SCI) at Imperial College London, is a non-profit initiative that works with Ministries of Health and Education in sub-Saharan African countries and Yemen. It supports and evaluates treatment programs against schistosomiasis (shis-toe-so-my-a-sis) and soil-transmitted helminthiasis (STH). The majority of programs treat school-age children (5-14 years old), but can include at-risk adults.

Since its foundation in 2002, SCI has supported the delivery of over 140 million treatments for these infections.

The Problem

Intestinal worms and parasites. Schistosomiasis and STH are types of parasitic “worm” infections. They are part of a group called Neglected Tropical Diseases (NTDs) which affect the poorest and most marginalised communities in the world. Schistosomiasis is carried by freshwater snails and is transmitted through contact with contaminated water during everyday activities, such as bathing and washing clothes, where access to clean water is limited. STH is caused by a group of intestinal parasites, and are transmitted by eggs present in human feces, which contaminate the soil in areas where sanitation is poor.

The World Health Organization estimates that 206 million people have schistosomiasis and 1.5 billion have STH. These infections can result in anemia, stunted growth, reduced school attendance, impaired cognitive development, reduced worker productivity and internal organ damage.

The Solution

Cost-effective school deworming programs. SCI works with national governments to create and scale mass school-based deworming programs which provide schoolchildren with pills that protect against the most prevalent neglected tropical diseases. These programs have a strong track record of success and are highly cost-effective, generally at around 49 cents per child per year.

How SCI is different from other charities

SCI supports and monitors deworming initiatives from end-to-ends. They acquire deworming pills from pharmaceutical companies and work with governments, NGOs, and local health authorities to implement effective school distribution programs. SCI also trains teachers and trusted community members to administer the treatments to vulnerable communities.

SCI's exemplary work has attracted a host of exceptional partners worldwide.

Why SCI is effective

Cost-effective

SCI-supported treatment programs are highly cost-effective. The majority of tablets are donated by pharmaceutical companies and governments, resulting in an average treatment cost of 49 cents per person per year for both schistosomiasis and STH.

Designed for scale

Since its foundation in 2002, SCI has supported delivery of over 140 million treatments for schistosomiasis and STH. In fiscal year 2016/17 alone, SCI facilitated delivery of 52 million treatments. Their goal is to support all countries with communities in need of treatment.

Rigorous Research, Evaluation and Monitoring

SCI is committed to robust monitoring, follow-up, self-evaluation and methodology design to determine the effectiveness of past and ongoing treatment programs. They devote roughly 10 percent of their implementation budget to these areas, using this data to make continual improvements to ensure impactful treatment coverage and program efficiency.

Evidence-backed interventions

Studies show that treating schistosomiasis and STH can increase school attendance by up to 25% as well as lead to improved academic performance and more years of schooling. Over the long-term, deworming has been shown to lead to better health, better jobs and up to 20-40% increased earnings. It has a high estimated annualized financial internal rate of return of 32%. 1, 2, 3, 4

High Impact

SCI’s accountability and sustainability

SCI is recommended as a top charity by The Life You Can Save as well as GiveWell, and has received an A+ rating from the UK government's Department for International Development (DFID) for the past 3 years.

SCI publishes information and reports about its support of treatment programs and is a model of nonprofit transparency.

SCI combines the best of public and private healthcare, partnering with pharmaceutical companies, national governments, and local health authorities to support ongoing design and implementation of treatment programs.

Frequently Asked Questions

What does my donation help pay for?

Pharmaceutical companies donate most of the tablets and have committed to provide enough medication to treat up to 100 million children per year—approximately double SCI’s treatment scale in 2016-17. Individual donations help SCI fund all aspects of treatment delivery including training, logistics, advocacy, social mobilization and monitoring and evaluation activities.

How many people does SCI help?

Since its foundation in 2002, SCI has supported the delivery of over 140 million treatments for schistosomiasis and STH. In FY 2016/17 alone, SCI facilitated the delivery of 52 million treatments and aims to support countries in reaching all communities in need of treatment.

Which diseases do SCI’s treatments target?

Treatment programs target schistosomiasis and STH. In certain countries, SCI support will be delivered alongside other donor support to treat onchocerciasis, lymphatic filariasis and trachoma where the program is integrated to control and eliminate all neglected tropical diseases.

What are neglected tropical diseases (NTDs)?

These are a diverse group of treatable and preventable infectious disases. Their impact on individuals and communities can be devastating, including disfigurement and disability. They affect the poorest and most marginalised communities in the world, placing a heavy burden on over 1 billion people. NTDs impact life expectancy, education and economic opportunities, costing developing economies billions of dollars each year.

Can schistosomiasis and STH be eliminated?

The World Health Assembly passed a resolution in 2012 urging the initiation of elimination campaigns where appropriate through strengthening health systems, provision of WASH interventions (Water, Sanitation and Hygiene), hygiene education and snail control – all underpinned by treatment. SCI will continue to directly support delivery of treatment and work with partners to ensure the implementation of further initiatives for elimination.

How often is treatment given?

Each program is tailored to meet the given population's needs and resources, e.g. depending on how heavily infected an area is and the country’s treatment plan. According to the WHO guidelines, any district that has over 50% of the population infected should consider delivering treatment twice a year while a country with 10-50% of the population infected is recommended to only treat once a year. Countries with lower infection rates may only treat every three years.

How much confidence do you have in SCI's work, given recent debate over the benefits of deworming?

In July of 2015, a re-analysis of an influential study on deworming was released, kicking off an ongoing debate about the benefits of mass deworming (a partial timeline of this debate is available here). Generally speaking, there appears to be a division between the health community (which is more skeptical about the benefits of mass deworming) and the development economics community (which is more enthusiastic). Each community has its own standard analytical methodology, and these different methodologies lead to different interpretations of the data.

In addition to following the public discussion, The Life You Can Save has had conversations with various experts on deworming to improve our understanding of this issue. A common thread in these talks has been the observation that there are important differences between schistosomiasis and other intestinal worms. Simply put, schistosomiasis causes particularly severe health issues. Unlike soil-transmitted intestinal worms, schistosomiasis worms live a long time (up to 20 years) and the eggs they lay build up in infected persons' organs. As a result, prolonged schistosomiasis infections can lead to fibrosis of the liver and bladder, and even death due to burst varices (dilated blood vessels).

In light of these differences, we believe there is a stronger case for eliminating schistosomiasis than STH. Moreover, this case can be made simply on the basis of the health benefits of schistosomiasis elmination and is less reliant on the potential knock-on benefits to school attendance and performance.

SCI concentrates primarily on schistosomiasis (though they will also provide medicine for other types of worms as a synergistic health intervention), and going forward SCI expects the bulk of its budget to be spent on schistosomiasis elimination and ensuring the most effective treatment strategies are delivered. We are confident that SCI will conduct these efforts in a cost-effective manner, having received donations of hundreds of millions of tablets of praziquantel (an anti-schistosomiasis medicine). Therefore, we continue to rate SCI as one of our recommended charities.

Why does The Life You Can Save recommend Schistosomiasis Control Initiative?

We recommend SCI because they have been named a Top Charity by GiveWell, a highly respected charity evaluator.

Is my donation tax-deductible?

UK donors can claim Gift Aid on their donations. US donors can claim tax relief by donating to SCI via the Imperial College Foundation, Inc. Canadian donors can donate tax-deductibly via Rethink Charity Forward. Australian donors can make tax-deductible donations via Effective Altruism Australia. German and Swiss donors can make a deductible gift through Effective Altruism Foundation (use the drop down menu to choose SCI). Donors in other EU countries may be able to claim tax-deductions through the methods described here.

More Information

Image credits
#1 © SCI, www.sci-ntds.org
#2 and background image © SCI, www.sci-ntds.org
#3 © Dr Peter Jourdan/SCI www.sci-ntds.org
#4 © Dr Peter Jourdan/SCI www.sci-ntds.org

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