Integration of schistosomiasis control activities within the primary health care system: a critical review

BACKGROUND: Schistosomiasis is a chronic disease linked to poverty and is widely endemic, particularly in sub-Saharan Africa. For decades, the World Health Organization has called for a larger role of the primary health care system in schistosomiasis control, and its integration within the routine activities of primary health care facilities. Here, we reviewed existing studies on the integration of schistosomiasis control measures within the primary health care system, more precisely at the health centre, and we analysed their outcomes. METHODS: An online search of studies published via PubMed and Embase databases was carried out until December 2017. Keywords were used to identify articles related to the integration of schistosomiasis control within the primary health care system, especially at the health centre level. Studies on integration of the following control measures were included: diagnosis and treatment, supplemented or not with (i) health education; (ii) snail control; and (iii) clean water supply and sanitation. A qualitative review was undertaken. To conclude on the effectiveness of an intervention, intermediate outcomes (knowledge, attitude and practice, coverage, access to health care) and distal outcomes (prevalence, incidence, mortality) were considered, and pre/post-intervention results were compared. RESULTS: Of 569 records found, 11 met the inclusion criteria. Studies were classified in three groups, according to the control measures they included. Integration of diagnosis and treatment, and health education in the first group resulted in an improvement of knowledge level of care providers, access to health care and health care seeking behaviour of the community. However, no positive effect was observed on the knowledge level of symptoms and modes of transmission at the community level. Most studies in the second group (with snail control as additional measure) and the third group (with clean water supply and sanitation as additional measure) showed a positive effect on schistosomiasis prevalence and incidence post-intervention, independent of the additional control measures implemented. CONCLUSIONS: The results of this review suggest a positive impact of integration of schistosomiasis control within the primary health care system. However, more robust studies are needed, especially in resource-limited regions, for conclusive evidence on the effectiveness and the sustainability of this strategy.