Description
Introduction:
Malaria and schistosomiasis are endemic and a public health challenge in Malawi. The Malawi government through the National Malaria Control Program (NMCP) and National Schistosomiasis Control Programme (NSCP) have put in place measures to eliminate these diseases. Chikwawa district in southern Malawi is undergoing rapid land cover changes due to 133-kilometers irrigation canal construction and climate change. There is evidence that links land cover changes to changes in vector abundance and subsequently vector-borne diseases. This link however is context-specific and in some cases not clear. This study aimed to establish baseline epidemiological data on malaria and schistosomiasis among school-going children in Chikwawa district with a long-term goal of understanding the impacts of land cover changes, irrigation agriculture and climate change on vector-borne diseases in the district.
Methodology:
We conducted cross-sectional surveys in 21 government-owned primary schools that were within three kilometers of the irrigation canal in Chikwawa district. At each school, we tested pupils for malaria using malaria rapid diagnostic testing. We also tested for urogenital schistosomiasis using Circulating Cathodic Antigen (CCA) with urine-CCA lateral flow test and urine reagent dipstick. Intestinal schistosomiasis was determined using urine microscopy.
Results & Discussions:
A total of 1,159 school-going children between the ages of 8 and 12 were enrolled in the surveys. The overall malaria prevalence was 9.7% [95% CI 0.09-0.11], Intestinal schistosomiasis prevalence was 1.8% [95% CI 0.01-0.02] and urogenital schistosomiasis was 34.8% [95% CI 0.33-0.36]. 5.4% [95% CI 0.05-0.06] of the participants (n=1134) had a coinfection of malaria and urogenital schistosomiasis and 2 participants (n=1,145) had a co-infection of intestinal schistosomiasis and malaria. Schools on the west side of the study area had a relatively high prevalence, although overall disease prevalence varied across schools. A third of the surveyed schools had malaria prevalence and urogenital schistosomiasis above the national averages with two schools reporting 37.3% and 83.1% respectively. It is concerning to note that our study took place within 3 days of a mass drug administration of praziquantel and various ongoing malaria control programs within the district. We also observed that Tomali and Mangulenje schools, which had the highest mean prevalences of intestinal and urogenital schistosomiasis, are located very close to the irrigation canal (less than 500m).
Conclusions:
Our study revealed an alarmingly high burden of malaria and schistosomiasis among school children in the Chikwawa district despite ongoing control programs. These findings call for a reflection on current control measures, enhanced disease surveillance, and targeted interventions. This understanding will support the development of more effective control mechanisms and reduce disease burden. This study therefore provides the necessary foundation for understanding vector-borne diseases' changing dynamics in the face of changing landscapes.
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