Healing the River: Schistosomiasis in São Tomé and Príncipe – The Borgen Project

Report on Schistosomiasis Control in São Tomé and Príncipe: An Integrated SDG Approach

Executive Summary

This report details the status of schistosomiasis control in São Tomé and Príncipe, analyzing national efforts through the framework of the United Nations Sustainable Development Goals (SDGs). While schistosomiasis, caused primarily by Schistosoma intercalatum, remains endemic, the nation has achieved low but persistent transmission levels following sustained public health interventions. The strategic transition from mass drug administration to targeted surveillance marks a significant milestone. Lasting success is contingent upon continued investment in water, sanitation, and hygiene (WASH) infrastructure, directly aligning with SDG 6 and ensuring the long-term health outcomes targeted by SDG 3.

• SDG 3 (Good Health and Well-being): Successful implementation of preventive chemotherapy has drastically reduced disease prevalence, particularly among children.
• SDG 6 (Clean Water and Sanitation): Efforts to improve WASH are recognized as fundamental to preventing re-infection and achieving permanent disease elimination.
• SDG 17 (Partnerships for the Goals): Progress has been achieved through collaboration between the Ministry of Health, the World Health Organization (WHO), UNICEF, and other partners.

Public Health Interventions and Alignment with SDG 3

Mass Drug Administration Campaigns

In alignment with SDG Target 3.3 to end the epidemics of neglected tropical diseases (NTDs), São Tomé and Príncipe initiated a robust public health response following a nationwide mapping survey in 2014. The Ministry of Health, with partner support, launched a preventive chemotherapy program that has been instrumental in reducing the disease burden.

1. A school-based program was established to administer the drug praziquantel to high-risk groups.
2. In 2015 alone, over 31,000 school-age children received treatment, mitigating the impacts of the disease, such as anaemia and abdominal pain.
3. These repeated rounds of mass drug administration (MDA) successfully lowered national prevalence to sporadic levels.

By protecting children’s health, these interventions also support SDG 4 (Quality Education), as healthier children are better able to attend school and learn effectively.

Strategic Transition to Targeted Surveillance

A major programmatic evolution occurred in 2024, as reported by the WHO Africa region’s ESPEN program. This shift reflects a transition to a more sustainable and targeted phase of the national control strategy.

• Mass drug administration was officially halted in all endemic implementation units.
• The national strategy has transitioned from blanket preventive treatment to a focused surveillance-response model.
• Ongoing monitoring is being integrated into the primary health care system to detect and manage any localized transmission hotspots.

The Foundational Role of WASH in Achieving SDG 6 and Disease Elimination

Link Between Schistosomiasis and Environmental Conditions

The long-term elimination of schistosomiasis is inextricably linked to progress on SDG 6 (Clean Water and Sanitation). The disease thrives where communities lack safe water and adequate sanitation, leading to contamination of water bodies such as streams and rice fields. Treatment alone is insufficient for sustainable control, as individuals face constant risk of re-exposure without improvements to water and sanitation infrastructure.

Current WASH Initiatives

Recognizing this critical dependency, national and international partners are implementing programs to address the root environmental causes of transmission. These efforts are essential for consolidating public health gains.

• UNICEF is supporting actions to strengthen handwashing behaviors and improve hygiene practices.
• A multisectoral WASH platform is being coordinated to integrate efforts across government and non-governmental agencies.
• Investing in WASH infrastructure is critical to closing the service gaps that allow NTDs like schistosomiasis to persist.

Future Outlook and Sustaining Momentum

Recommended Next Steps

To achieve the WHO’s 2030 targets for NTDs, São Tomé and Príncipe must maintain its focus on integrated control measures. The current strategy requires continued vigilance and investment.

1. Maintain robust post-MDA surveillance to ensure any resurgence of transmission is quickly identified and addressed.
2. Strengthen inter-agency coordination between the health, education, and water sectors, embodying the principles of SDG 17 (Partnerships for the Goals).
3. Secure sustained funding for both surveillance activities and essential water and sanitation infrastructure projects.

Conclusion: An Integrated Model for Sustainable Victory

The progress in São Tomé and Príncipe demonstrates a successful model for controlling a neglected tropical disease by integrating targeted public health interventions (SDG 3) with foundational investments in environmental health (SDG 6). By pausing mass drug administration and intensifying surveillance and WASH initiatives, the country has a significant opportunity to achieve the permanent elimination of schistosomiasis. Sustained political commitment and international partnership (SDG 17) will be crucial to turning this public health success into a permanent victory for sustainable development.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   The article on fighting schistosomiasis in São Tomé and Príncipe addresses several interconnected Sustainable Development Goals (SDGs):

   • SDG 3: Good Health and Well-being

     This is the primary SDG addressed. The entire article focuses on the control and elimination of schistosomiasis, a neglected tropical disease (NTD). It discusses public health interventions like mass drug administration (MDA), preventive chemotherapy, and ongoing surveillance to improve the health outcomes of the population, particularly children.

   • SDG 6: Clean Water and Sanitation

     The article explicitly links schistosomiasis to the lack of safe water and sanitation. It states, “Schistosomiasis or bilharzia thrives where people lack safe water and sanitation,” and emphasizes that “Lasting gains depend on safe water, sanitation and hygiene (WASH).” This highlights the critical role of clean water and sanitation infrastructure in preventing the disease and achieving long-term health goals.

   • SDG 4: Quality Education

     The article connects health with education by noting that preventive chemotherapy was launched “in schools” and that over “31,000 school-age children received treatment.” Furthermore, it states that eliminating the disease saves children from “missed classes,” directly linking the health intervention to improved educational opportunities and attendance.

   • SDG 17: Partnerships for the Goals

     The success of the program is attributed to collaboration among various entities. The article mentions the country’s Ministry of Health working with “support from WHO and international partners,” and specifically names UNICEF and the WHO Africa region’s ESPEN program. This coordinated effort, including a “multisectoral WASH platform,” exemplifies the importance of partnerships in achieving sustainable development.

2. What specific targets under those SDGs can be identified based on the article’s content?

   Based on the article, the following specific SDG targets can be identified:

   • Target 3.3: End the epidemics of neglected tropical diseases

     The article is centered on efforts to control and eliminate schistosomiasis, which is classified as a neglected tropical disease (NTD). The text mentions that São Tomé and Príncipe is committed to “meeting WHO’s 2030 targets for neglected tropical diseases,” which directly aligns with this target to end the epidemic.

   • Target 6.1: Achieve universal and equitable access to safe and affordable drinking water for all

     The article underscores that lasting prevention of schistosomiasis requires that people are not “re-exposed to rivers and irrigation canals,” which can only be achieved through access to “safe water.” This points directly to the goal of providing safe drinking water sources to eliminate the need for contact with contaminated water.

   • Target 6.2: Achieve access to adequate and equitable sanitation and hygiene for all

     The text highlights the importance of “sanitation and hygiene (WASH)” and mentions UNICEF’s actions in “strengthening handwashing behaviours.” This directly relates to the target of improving sanitation and hygiene practices to prevent the transmission of water-borne diseases like schistosomiasis.

   • Target 4.a: Build and upgrade education facilities that are child…sensitive and provide safe…and effective learning environments for all

     The school-based treatment program, which administered praziquantel to over 31,000 children, is an effort to make the school environment healthier and safer. By tackling a disease that causes “missed classes,” the program contributes to creating a more effective learning environment where children can thrive.

   • Target 17.16: Enhance the global partnership for sustainable development

     The article details a multi-stakeholder partnership involving the São Tomé and Príncipe Ministry of Health, WHO, UNICEF, and the ESPEN program. Their coordinated work on mass drug administration, surveillance, and WASH initiatives is a clear example of a partnership mobilizing resources and expertise to support a national health goal.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   The article mentions or implies several indicators for measuring progress:

   • Indicators for Target 3.3

     The article provides both qualitative and quantitative data that can serve as indicators. This includes:

     • Prevalence of the disease: The article notes that “national prevalence remains low” and that surveillance turns up “only sporadic cases.” This is a direct measure of disease burden.
     • Number of people requiring and receiving interventions against NTDs (Indicator 3.3.5): The text states that “more than 31,000 school-age children received treatment” in 2015.
     • Programmatic milestones: The report that São Tomé and Príncipe “halted mass drug administration (MDA) in all endemic implementation units” serves as a key progress indicator toward elimination.

   • Indicators for Targets 6.1 and 6.2

     While not providing specific numbers for São Tomé and Príncipe, the article implies the use of standard WASH indicators by mentioning that “many health facilities and households worldwide still lack basic WASH services.” This points to indicators such as:

     • Proportion of population using safely managed drinking water services (Indicator 6.1.1).
     • Proportion of population using safely managed sanitation services, including a hand-washing facility (Indicator 6.2.1).

   • Indicators for Target 4.a

     The article implies an educational indicator by stating that eliminating schistosomiasis “saves children from…missed classes.” This suggests that progress could be measured by:

     • School attendance rates: An increase in attendance, particularly in formerly endemic areas, could be an indirect indicator of the health program’s success.

   • Indicators for Target 17.16

     Progress is demonstrated through qualitative descriptions of partnership activities rather than numerical indicators. These include:

     • Existence and effectiveness of multi-stakeholder partnerships: The article describes the coordinated actions of the Ministry of Health, WHO, UNICEF, and ESPEN, as well as the creation of a “multisectoral WASH platform,” as evidence of a functioning partnership.

4. Table of SDGs, Targets, and Indicators

   SDGs	Targets	Indicators Identified in the Article
   SDG 3: Good Health and Well-being	3.3: End the epidemics of…neglected tropical diseases…	National prevalence of schistosomiasis. Number of school-age children receiving treatment (31,000+ in 2015). Status of Mass Drug Administration (halted in 2024).
   SDG 6: Clean Water and Sanitation	6.1: Achieve universal access to safe drinking water. 6.2: Achieve access to adequate sanitation and hygiene.	(Implied) Proportion of households and health facilities with basic WASH services. Implementation of hygiene programs (“strengthening handwashing behaviours”).
   SDG 4: Quality Education	4.a: Build and upgrade education facilities to provide safe and effective learning environments.	(Implied) Reduction in “missed classes” and improvement in school attendance rates.
   SDG 17: Partnerships for the Goals	17.16: Enhance the global partnership for sustainable development.	Coordinated actions between the Ministry of Health, WHO, UNICEF, and ESPEN. Establishment of a “multisectoral WASH platform.”

Source: borgenproject.org