Discovery of a Hidden Schistosomiasis Endemic in the Salamat Region of Chad, Africa

There is currently a severe paucity of rural epidemiologic data on urogenital schistosomiasis in the Republic of Chad in north-central Africa that is hindering national control strategies. Our study describes a mobile medical team’s 4-year effort to collect data and provide mass therapeutic and preventive chemotherapy in the Salamat Region of Chad, a previously uninvestigated rural area. To overcome severe limitations in time, resources, support, and infrastructure, the team employed several time- and cost-saving techniques that included: (1) traveling by request and referral to utilize local knowledge to find the areas of highest need, (2) conducting convenience sampling for screening, (3) using simple but validated tools to expedite treatment and data gathering, and (4) working within cultural contexts to find and treat the most school-age children possible. The team managed a total of 11,832 patient encounters and found a 55% rate of hematuria (n=6,495) among school-age children, roughly double previous estimates. Rates of hematuria were higher in males (61%, n=3,955/6,466) than females (48%, n=2,301/4,806) and among adolescents (> 65% in all age groups aged 10 years and older). These methods outline an efficient and effective strategy implemented under real-world conditions to enact therapeutic and preventive chemotherapy campaigns in resource-limited settings by engaging village leadership and developing locally driven solutions. Our data highlight the need for continued local epidemiologic efforts to treat the substantial number of children severely affected with schistosomiasis.