**3. Factors promoting the neglect of** *Schistosomiasis* **and reasons for persistent transmissions**

Author and colleagues [2], emphasize the place of human culture in the persistent transmission of *schistosomiasis*, in Nigeria. Their emphasis was based on human behavior related to occupation, recreation, and daily house chore that necessitate the people to have contact with freshwater bodies that carries the snail with the *schistosomiasis* lava. Notably, *schistosomiasis* is one of the 20 NTDs, is a water-based parasitic disease of public health importance [27].

The NTDs in the early 2000s was categorized as 17 conditions in the WHO portfolio [1, 28], there was a varied group of communicable diseases caused by bacteria, *helminths*, *protozoa*, or viruses, such as *Buruli ulcer*, *Chagas* disease, *dengue*, *dracunculiasis* (guinea worm disease), *echinococcosis*, *foodborne trematodiasis*, human African *trypanosomiasis* (sleeping sickness), *leishmaniasis*, leprosy, *lymphatic filariasis* (elephantiasis), *onchocerciasis* (river blindness), rabies, *schistosomiasis* (snail fever), soil-transmitted *helminthiasis* (intestinal worms), *taeniasis*/*cysticercosis* (pork tapeworm), blinding *trachoma*, and yaws [1, 28]. Since 2016, this list was expanded with three groups of diseases to currently include 20 NTDs or groups of NTDs. Those new NTDs include *mycetoma*, *chromoblastomycosis*, and other deep *mycoses*; *scabies* and other *ectoparasites*; and snakebite *envenoming* [1].

Generally, Africa lacks accurate data on the NTDs, moreover, the constant contact with water containing S. *haematobium cercariae* released from the *Bulinus* snail, often

occurs regularly, resulting in re-infection with the disease [27], this also affects the data on the prevalence of *schistosomiasis* in Africa. Using documented evidence in data gathering, research shows that adult worms could live in humans for as long as 30 years [29]. When humans host the worm for such long a time in endemic areas it becomes possible for infection or/and re-infection at some point in their life [27], leading to a vicious cycle within the communities irrespective of preventive chemotherapy. For example, statistics affirmed that the highest *schistosomiasis* disease burden globally can be found in Nigeria (see **Table 1**), however, Nigeria does not have accurate national data on *schistosomiasis* prevalence. Although, she sometimes embark on a large-scale deworming implementation exercise for SAC in endemic areas with *praziquantel* [30], neglecting the adults and out-of-children as they were not covered by mass administration of *praziquantel* would be a challenge to the control of the disease.

Sometimes, the affected communities and individuals affected by *schistosomiasis* tend to neglect the symptoms, depending on the stage of the infection, because of the wide range of clinical symptoms that may occur, many of which are hard to distinguish from several other diseases [15]. It was also argued from the perspectives of the medical sociologist as perceived by the people as a disease but not an illness [26]. From that argument, the affected community does not see *schistosomiasis* as a serious ailment since they can go about their daily business without being bed riding. However, a study shows that schistosomiasis causes morbidity with many infected persons experiencing *hematuria*, *dysuria*, bladder-wall pathology, and *hydronephrosis* [27]. But because these conditions are not peculiar to *schistosomiasis* alone it tends to be neglected.

From the Nigeria scenario as related to other sub-Sahara Africa, is the cost for diagnosis and tool kits that inform the diseases being neglected. Nigeria did tackle *schistosomiasis* through a 2-step approach: case management and a control program [31]. According to Isere and colleagues, in the case management approach, cases are diagnosed at the primary care level. While for the control program, school-aged children are given *praziquantel* for the treatment of *schistosomiasis*. Sturrock [32], affirmed that *schistosomiasis* is common among children with the highest intensity of infection found in children between ages 5 and 15 years. However, the study also revealed that women and men carry a high risk of urinary *schistosomiasis* due to social and occupational activities such as farming and washing, especially in areas with poor water, and sanitation services [2]. Water-related domestic activities such as washing clothes and fetching water, as well as recreational water activities also increase the risk of infection for women and children [33]. It is also more common in fishing and agriculture dominant communities where direct interactions with water increase the risk of contracting the disease.

Other concerns for *schistosomiasis* being tag neglected disease include missed diagnosis, need for more sensitive, accurate, cheaper, and easy to use devices for the diagnosis and control of *schistosomiasis*. Study shows that several persons do not pass bloody urine which is characteristic of the disease [34]. Notably, most of the control program does not include adults in MDAs [30], meaning that adults with schistosomiasis infections are not being treated. "*Schistosomiasis haematobium* infection is mainly diagnosed using microscopy to detect parasite eggs in urine specimens which are not sensitive in detecting light infections of <50 eggs per 10mls of urine; while labor-intensive, and sensitivity of diagnosis depends on the skill of the laboratory personnel" [35]. "Also, egg excretion in urine varies daily and can be complicated by interaction between the host and the parasite" [36]. There are other tests for the detection of *S. haematobium* infection, but they are contested for their poor specificity and high cost for endemic countries [37].

*Dancing in a Cycle: Global Health Agenda and* Schistosomiasis *Control in Africa DOI: http://dx.doi.org/10.5772/intechopen.103164*

Although some of the tests are useful they are at the stage of *schistosomiasis* elimination, a phase that the majority of the African countries are yet to reach [17]. From the various range of factors and the tendencies for continuous transmission, it is certain, that the challenge and burden of the *schistosomiasis* will be burdensome.
