Eradication of schistosomiasis in Guangxi, China. Part 1: Setting, strategies, operations, and outcomes, 1953-92

Abstract

Reported are the results of an analysis of a 40-year programme leading to eradication of schistosomiasis in Guangxi, China, a large, poor autonomous region of the country that had the heaviest global burden of the disease. We used historical county data and maps showing the initial distribution and density of Oncomelania snails and the initial prevalence of schistosomiasis to assess the correlation between snail occurrence and human infection. All annual county schistosomiasis reports were collected and analysed, including information on snail abundance and infection, human and animal infection control, stool examinations and patient treatments, clinical and serology examinations, skin test surveillance, patient follow-up, patient treatments, animal examinations, water supply and sanitation, and environmental modification. The findings bear witness to the laborious, systematic and scientific basis of the control programme and how it changed over the 40 years. Of note is the continual search for and treatment of cases, the killing of snails, and the permanent alteration of their habitats using mass community participation and methods adapted to local conditions. The programme has freed more than 10 million people from the risk of schistosomiasis and boosted rural economic development and health. The persistence, good record keeping, evolving and locally flexible strategies, and the clear focus of the control programme were crucial to its eventual success.

PIP: Guangxi, a large autonomous region in southwest China, has historically had the heaviest global burden of schistosomiasis. This article reports the results of an analysis of the 40-year history (1953-92) of the successful schistosomiasis eradication program in this area. Collected and analyzed were data on the correlation between snail occurrence and human infection, human and animal infection control initiatives, patient treatments, clinical and serologic examinations, skin test surveillance, water supply and sanitation, and environmental modification. In light of the close links between schistosomiasis and farming, fishing, water use, and the rural economy, a multisectoral strategy was selected. The strategy was based on the documented relationship between snail density and transmission intensity and the ecologic dependence of snails on local human and physical geography. The control program had a horizontal cross-sectoral multi-bureau structure at the top for planning and policy and another horizontal structure at the bottom for implementation and reporting in collaboration with local residents. Notable was the continual search for and treatment of cases, the killing of snails, and the permanent alteration of their habitats. Mass community participation, persistence, good record-keeping, and the clear focus of the control program on snail elimination were critical to its eventual success. The control program downsized after eradication in 1989 and county schistosomiasis staff have been retrained and deployed in general health work.