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Roselyne Sachiti and Tatenda Chimbwanda

Tendai Kapota, a witty five-year-old girl holds a small plastic water container while in a long meandering queue at Chitse Clinic, Mudzengerere area under chief Dotito, Mount Darwin.

It is September 21, and Kapota is anxious as she awaits her turn to be served.

She is among hundreds of children aged between one and 15 years of age who are patiently waiting to have their height measured.

The height of each child will determine the dose of de-worming medicines — praziquantel and albendazole — being freely distributed through the Ministry of Health and Child Care (MoHCC) led National Treatment of bilharzia and worms also known as Mass Drug Administration (MDAs).

This year’s MDAs will run from September 21 to 30 with an estimated 300 000 people across Zimbabwe’s 12 districts expected to benefit.

According to the World Health Organisation (WHO), schistosomiasis (also known as bilharzia) is a vector-borne parasitic disease caused by trematode flatworms of the genus Schistosoma.

Freshwater snails act as the vector, releasing larval forms of the parasite into water.

These larvae subsequently penetrate the skin of people who are in that water (e.g. fishermen).

At the onset of the pandemic, Mount Darwin, Shamva and the rest of the districts in Zimbabwe had suspended community-based interventions against Neglected Tropical Diseases (NTDs) and was relying on health facilities-based services.

Coming from Mashonaland Central, a province with a high burden of bilharzia (schistosomiasis) and intestinal worms (soil transmitted helminths), Tendai, at her tender age, knows too well the importance of getting the pills, especially during this era of Covid-19.

“I am happy to be here. Where do I go from here? When am I getting my share of pills?” Tendai asks one of the nurses assisting her to wash her hands.

Also in the queue are 12-year-old twins Michelle and Munashe Butao.

Their resemblance is quite striking.

Both are shy, but passionate about school as well as doing household chores.

The two spend most of their time together and are in the same Grade 4 class at Nyamaswavo Primary School.

At this static centre, the children maintain social distancing as they await for their turn to be served.

“My twin sister and I both have bilharzia. We are excited to get de-worming pills. I am happy that the treatment is free,” reveals Munashe, the chattier of the pair.

As his hands are being sanitised by a village health worker (VHW) at the entrance to the open space being used, his attention is focused on his sister who is in front.

Her height is now being measured and from there she will wash her hands with running water just where the pills are being given out.

Munashe shyly says he does not remember exactly how many times he has had bilharzia, but can count up to 10 times.

He is sure that his love of swimming in the Ruya River exposed him to freshwater snails.

Many times he has been in trouble with his mother after she caught him taking an unsanctioned dive.

“Our mother taught us to detect symptoms of bilharzia early so whenever I notice such, I tell her immediately. She also told us not to swim in stagnant water which has algae, but I keep going back,” he confesses.

Even with enough knowledge, Munashe and his friends are sometimes too daring. If anything, the temperatures here are blistering and the young boys cannot resist temptation of soothing their sunburnt skin with a splash of cool water.

He is happy that the MDAs came when he had bilharzia symptoms.

His sister Michelle is also happy to receive free treatment.

At a mobile centre at Mudzengerere Secondary School, about a kilometre from Chitse clinic, nurses take their turns to help the kids with their medicines.

At another mobile centre, Kajokoto Primary School in Dotito, village health workers help out nurses from the MoHCC and Zimbabwe Republic Police administer treatment to the children. Here, numbers swell as the day progresses.

The same routine and WHO Infectious Prevention and Control (IPC) guidelines being followed at Chitse Clinic and other mobile and static centres around the province are also being applied here.

Sister in charge at Chitse Clinic, Joyce Vumbunu said the MDAs which come at a time of Covid-19, started off well as there was a huge turnout at the static centre.

According to Sister Vumbunu, bilharzia is prevalent in their area.

“Whenever we do our monthly statistics, bilharzia is on top. Most people are into gold panning and get contaminated during the process as they will not be wearing any protective shoes.

“I have been working here for 11 years on average we receive 50 cases per month. This includes babies and adults in their sixties. Young boys also get infected and reinfected regularly,” she reveals.

In this part of Zimbabwe, bilharzia cases decrease whenever national mass treatment campaigns like the current one are done, but rise during the farming season and this worries Sister Vumbunu especially now during Covid-19.

With information showing that the pandemic was far from over and the need to continue essential health services, WHO released recommendations for NTDs interventions in the context of COVID-19. The recommendations focused on illustrating the measures health workers should follow in order to protect themselves and the communities they will be serving from contracting Covid-19.

Some of the key recommendations also included precautionary measures to take into account when identifying a distribution point venue which has sufficient space for the expected number of people, and if indoors, use of the most well-ventilated areas available.

Sister Vumbunu attended a two-day workshop in Mount Darwin between 9 and 10 September in preparation of the MDAs for bilharzia and worms and this gave her new insights especially during the Covid-19 era.

A similar training was also conducted in Shamva, between 11 and 12 September which is in the same province.

“The training was empowering. In the Covid-19 era, we made sure we had sanitisers and buckets of water with taps. I was also happy when they told us everyone should bring their own cup or empty container so they can put their water to avoid sharing. All the children we are attending to here brought their own containers, are being sanitised and also washing their hands,” she notes.

Adds Sister Vumbunu: “I learnt of IPC measures at the training. We have been telling the children to maintain social distancing and also wear masks.

“We advise those without masks to find something to cover their mouth and nose.”

Mashonaland Central Provincial Epidemiology and disease control officer Dr Stanley Tapesana said the World Health Organisation (WHO) is supporting disease control interventions in the province.

“Some of them are the MDAs we are currently running in Mount Darwin and Shamva district. As far as the response for Covid-19 is concerned, WHO is also supporting the coordination of all the pillars in the response.

“There is financial, capacity building and technical support. WHO has been key in strengthening the response in health activities within our province,” he explains.

He says cases of bilharzia kept reoccurring in some people as they frequently get in contact with contaminated water sources. One of the interventions, he suggests, is addressing water and sanitation issues and also the community’s livelihoods.

“There is defecation, urination in the water sources which will be used for watering the gardens, doing laundry, bathing etc.

“We need to address the environment to deal with the host. Currently several interventions which can address all the challenges around the social determinants are in place.

“These include social behaviour communication which has been put in place,” he explains.

However, he points out, if the communities do not have alternative sources of clean and safe water for drinking and washing, they will still come to the river to do laundry.

“The challenge is boreholes are drying up, there is climate change and dam water levels have decreased.”

He further reveals that they do not anticipate medicine shortages as this programme was well planned.

“We knew our target population well ahead of time. We are currently mobilising medicines from other provinces and districts to add to what has been already distributed.

“The drugs we had have been strategically distributed to distant clinics such that the ones from other provinces will go to closer areas.”

WHO National Professional Officer, Caspser Tarumbwa, says WHO is supporting MDAs for bilharzia and schistosomiasis.

“We started with the training in Mount Darwin and Shamva between 9 and 12 September. Activities and actual administration began on 21 September 2020.

“They will run till 30 September 2020. What we have observed during the rounds we made on all the stations where activities are taking place is that there was enough preparation.”

He further explains: “It does not matter whether it was the first day. We know there are always challenges on first day, but we are impressed that the people were well prepared.

“The turnout was good, they were observing IPCs like sanitisation of surfaces, hand-washing of children who were receiving the medication. We noticed that essential services were continuing and had not been stopped because of the MDA.

“It seems people got the message during the training. We are quite impressed that people were prepared.”

He expounded that community mobilisation was successful as some stakeholders participated in the MDAs.

“For example we had a senator who provided transport for use at Kajokoto primary school. Health workers from the police also assisted during the exercise,” he notes.

In Zimbabwe the two NTDs of public health significance are bilharzia and intestinal worms. Bilharzia ranks among the top ten causes of hospital admissions in the country.

Although Zimbabwe has not eliminated bilharzia completely, the country has made great progress in reducing the burden as a result of the National Treatment Campaigns conducted every year. MDAs ensure people in hard to reach places receive the deworming medication without necessarily having to walk long distances to access the service.

Consequently, under the MoHCC leadership, Zimbabwe has managed to provide access to praziquantel and albendazole with support from WHO to all infected people regardless of age (living no-one out).

According to the MDA impact assessment done in 2018, Zimbabwe has had an 78.3 percent prevalence reduction of bilharzia.

This is down from a national prevalence of 23 percent in 2010 to 5 percent in 2018.

It appears the country is on course to fulfil one of the United Nations’ Sustainable Development Goals (SDG 3) whose objective is promoting good health and well-being within communities.

SDG 3, subsection 3.3, places emphasis on ending epidemics of NTDs, among other diseases.

In Africa, WHO seeks to attain this goal by translating into action the WHO Global Roadmap for NTDs through the Regional Strategic Plan for NTDs 2014-20, which includes the control and elimination of bilharzia and intestinal worms.

Tatenda Chimbwanda is the Communications Officer at the World Health Organisation Zimbabwe.