Schistosomiasis & STH in Ethiopia: A Reality Check

Discover an insightful analysis of schistosomiasis and soil-transmitted helminths in Ethiopia, highlighting public health challenges

Reflections from the 2014 National Mapping Study Through a HAWADI Lens

From Assumptions to Alarming Realities: A Haldoor's Decisive Shift

When Ethiopia embarked on its national mapping of schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) in 2014, initial assumptions suggested that Somali Region and Afar had minimal disease burdens. This belief led to zonal-level mapping rather than the district-level surveys conducted elsewhere.

As team leader in the field, I quickly recognized the stark gap between expectation and reality. This demanded immediate and thoughtful reassessment – the very essence of a Haldoor (Decision Maker). A Haldoor doesn't rush, but gathers information and carefully weighs consequences. The Somali Region emerged as an unexpected hotspot, particularly for Schistosoma haematobium (uro-genital schistosomiasis), with a 12.9% prevalence—the highest nationwide.

These results challenged long-standing assumptions and underscored the need for a more tailored and aggressive intervention strategy. As a team lead, acting as a Haldoor, it was crucial to clearly communicate these findings and take responsibility for advocating for necessary shifts in approach.

Fieldwork Realities: Challenges & Insights – The Alife Initiator and Aamin's Foundation

Conducting NTD mapping at scale comes with logistical and operational hurdles:

• Geographical Barriers – Several districts were remote and difficult to access, limiting timely data collection. This demanded the proactive and resourceful spirit of an Alife Initiator, finding new ways to reach every corner.
• Community Engagement – Misinformation and distrust created initial resistance in certain areas, requiring extensive dialogue to secure participation. Here, the Aamin (Trustworthy) quality was paramount. Building trust through honest communication and consistent effort was crucial to securing cooperation and ensuring the data collected was truly representative.
• Environmental Conditions – Water proximity is a critical SCH risk factor, yet many schools lacked functional WASH infrastructure, exacerbating transmission risks. An Alife Initiator would see this not just as a problem, but an an opportunity to propose new solutions and mobilize resources for broader change.
• Technical Precision – Ensuring quality control in sample analysis required rigorous training, balancing speed with accuracy.

Despite these challenges, the collaboration across Ethiopian health agencies, international partners, and local communities enabled comprehensive data collection—data that is now shaping Ethiopia’s NTD Master Plan. This collaborative spirit is a testament to the relationship-building and ethical standards championed by Aamin leaders.

Disease Burden Across Regions: How Somali Stands Out – A Waayo Arag's Strategic View

The mapping revealed critical data, offering insights that only an experienced and strategic Waayo Arag (Experienced) leader could fully appreciate for long-term planning.

1. Schistosoma haematobium Prevalence

Region	Prevalence	Key Insight
Somali	12.9%	Highest prevalence nationwide; 218 cases detected.
Afar	1.2%	Expected low burden, reflected in results.
Oromia	0.1%	Minimal S. haematobium despite high *S. mansoni.
Tigray	0.1%	Negligible uro-genital schistosomiasis.
Benishangul-Gumuz	0.2%	Low prevalence, but widespread intestinal S. mansoni.

Why This Matters: Somali Region’s 12.9% prevalence of uro-genital SCH demands targeted interventions, as other regions predominantly battle S. mansoni. A Waayo Arag leader would provide context from past health campaigns and anticipate challenges in implementing this specific intervention.

Under the most varying circumstances, our team's ability to investigate stands out. I remember personally committing to and taking the lead on the S. haematobium investigation, where we detected 218 cases across only 7 mapped districts – the fewest of any team. Strategically empowering other members to focus on different STH, this specialized yet comprehensive approach is our hallmark, demonstrating remarkable efficiency and impact.

2. Schistosoma mansoni (Intestinal Schistosomiasis)

Region	Endemic Districts	Total Surveyed
Benishangul-Gumuz	19	21
Oromia	98	269
Somali	3	7
Tigray	34	46

Key Insight: While Somali had fewer endemic districts for S. mansoni, every district surveyed had STH infections, showing the broad parasitic burden in the region. This highlights the need for a comprehensive, rather than isolated, strategy, a hallmark of Waayo Arag thinking.

3. Soil-Transmitted Helminthiasis (STH)

Region	Endemic Districts	Total Surveyed
Oromia	255	269
SNNPR	154	154
Somali	7	7
Tigray	41	46

Key Takeaway: Somali’s 100% STH endemicity suggests a high environmental transmission cycle, demanding urgent mass drug administration (MDA).

Implications for NTD Policy & Interventions: An Indheer Garad's Vision and a Daadaheeye's Guidance

The findings of this mapping study clearly dictate the strategic direction for NTD control in the Somali Region, requiring the foresight of an Indheer Garad (Visionary) and the practical guidance of a Daadaheeye (Coach).

1. Somali Region Requires Tailored MDA – SCH interventions should prioritize uro-genital schistosomiasis rather than the more common S. mansoni. An Indheer Garad leader sets this long-term goal, articulating a clear vision for disease elimination based on these specific findings.
2. Strengthening WASH Infrastructure – High STH co-occurrence suggests improved sanitation and clean water access are critical to breaking transmission cycles. A Daadaheeye would work directly to develop skills and capacity within local health workers and communities to implement sustainable WASH solutions.
3. Data Refinement & Follow-Up Mapping – WHO and Gates Foundation are supporting expanded surveys in Somali and Addis Ababa, refining disease risk maps for future control strategies. This continuous learning and adaptation are vital for an Indheer Garad to refine the long-term strategic plan.

A Call for Adaptive Strategies: Leading with HAWADI

The Somali Region’s results underscore a fundamental lesson: assumptions must always be tested against real-world data.

Though large regions like Oromia and SNNPR face higher absolute disease burdens, Somali’s unexpectedly high prevalence rates and environmental vulnerabilities demand targeted intervention strategies.

As a team leader, witnessing these findings firsthand reinforced the importance of local engagement, precise diagnostics, and evidence-based health policies. My role encompassed the Haldoor's decisive action to challenge assumptions, the Alife Initiator's drive to overcome field challenges, the Waayo Arag's ability to interpret complex data for strategic insights, the Aamin's imperative to build trust with communities, the Daadaheeye's work in capacity building, and the Indheer Garad's vision for future health policy.

Only by adapting our strategies to fit actual transmission patterns—rather than relying on historical assumptions—can we ensure effective, equitable NTD control across Ethiopia. This is the essence of HAWADI leadership in public health.

Author’s Note: The Power of Data and HAWADI Leadership

This study was an eye-opening experience, revealing the hidden burden of schistosomiasis and STH in overlooked regions. While challenges in logistics, community cooperation, and diagnostic consistency made fieldwork demanding, the impact of these findings will shape NTD treatment strategies for years to come.

I recall vividly how, years back, an accidental encounter with the original mapping paper brought back a rush of memories. The initial assumption about our region's low burden and the surprising reality of our results—especially the highest S. haematobium prevalence nationwide—highlighted the critical importance of on-the-ground data collection. It reinforced that the valuable outcomes we achieved were truly a testament to the HAWADI qualities embodied by our team and the leadership involved.

I encourage fellow researchers, policymakers, and health professionals to embrace real-time data-driven approaches—because, as Somali’s case shows, the truth often defies expectations. This requires HAWADI leaders who are not just knowledgeable, but also decisive, trustworthy, innovative, empowering, and visionary.

Ahmed Suane
Fieldwork Team Leader, Somali Region

For further reading, the full mapping study document can be accessed here: Mapping of Schistosomiasis and Soil-Transmitted Helminthiasis in Ethiopia (2014)

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