Schistosomiasis (SCH) Elimination Dossier Overview

Kids playing in irrigation channels (Ghana, 1993)
© WHO / TDR / Ane Haaland

Schistosomiasis is a neglected tropical disease caused by parasitic trematode worms of the genus Schistosoma. The disease remains a major public health problem in many tropical and subtropical regions, particularly in sub-Saharan Africa, where the majority of the global burden occurs. Control strategies have historically focused on preventive chemotherapy with praziquantel, alongside improvements in water, sanitation, hygiene (WASH), snail control, and health education.

In 2022, the World Health Organization adopted the new WHO guideline on control and elimination of human schistosomiasis, which introduced revised evidence-based thresholds. More recently, WHO has developed draft guidance on dossier preparation outlining pathways toward elimination of schistosomiasis as a public health problem (EPHP) and interruption of transmission (IoT), with the official publication expected soon. These recommendations align with the WHO NTD Road Map 2021–2030, which targets the elimination of schistosomiasis as a public health problem in all endemic countries and interruption of transmission in selected countries by 2030.

WHO has subsequently developed standardized monitoring and evaluation guidance (2024) and dossier preparation requirements (2026) to support countries in documenting achievement of schistosomiasis elimination targets and requesting validation by WHO. These procedures are intended for use by Member States that have achieved the required epidemiological thresholds following implementation of recommended interventions, including preventive chemotherapy, surveillance, morbidity management, and intersectoral control measures.

The WHO criteria for elimination of schistosomiasis as a public health problem include:

• Heavy-intensity infection prevalence below 1% in all implementation units;
• Overall prevalence below 10% in all implementation units;
• Sustained achievement of these thresholds for at least three consecutive years under adequate surveillance systems; plus
• Evidence that the health system can continue surveillance, detect recrudescence, and manage schistosomiasis morbidity and residual transmission foci. 

For countries progressing toward interruption of transmission, additional requirements include demonstration of absence of transmission through sensitive surveillance approaches over a defined surveillance period, absence of zoonotic transmission and in intermediate snail hosts, supported by evidence of robust response capacity.

These standardized procedures are intended to guide Member States in preparing national schistosomiasis dossiers for submission to WHO for validation of elimination milestones.

Current situation

In the World Health Organization Regional Office for Africa African Region, schistosomiasis remains endemic in many countries, although substantial progress has been achieved through expanded preventive chemotherapy coverage, strengthened surveillance, and integrated control strategies. Several countries are approaching elimination thresholds for schistosomiasis as a public health problem, while others are advancing toward interruption of transmission in specific implementation units.

The Region has also witnessed increasing integration of schistosomiasis activities within broader health systems, including primary health care, school health programmes, water and sanitation initiatives, and reproductive health services, particularly for female genital schistosomiasis (FGS). As more countries achieve elimination benchmarks, preparation and review of national schistosomiasis dossiers are becoming an increasingly important regional priority.

Role of ESPEN

The Expanded Special Project for Elimination of Neglected Tropical Diseases supports endemic countries in progressing toward validation of schistosomiasis elimination milestones through:

• Provision of technical assistance for schistosomiasis dossier development and finalization;
• Support for strengthening surveillance, monitoring, and evaluation systems aligned with WHO guidelines;
• Review of draft dossiers and provision of informal technical feedback to countries;
• Convening Regional Dossier Review Groups for formal technical review of officially submitted dossiers;
• Supporting countries to address recommendations and comments from dossier review processes;
• Facilitating regional coordination, capacity strengthening, and sharing of best practices for schistosomiasis elimination. 

Contact Section:
ESPEN Technical Officer for schistosomiasis: Dr Pauline Mwinzi – mwinzip@who.int