**4.** *Schistosomiasis* **burden and the challenge of eliminating the disease in Africa**

*Schistosomiasis* disease burden is high in Sub-Saharan Africa [38]. This is because Sub-Saharan Africa accounts for not less than 93% of the world's burden of diseases. As of 2015, there were about 207 million *schistosomiasis* cases, with the highest prevalence found in Nigeria, Tanzania, Ghana, Mozambique, and the Democratic Republic of Congo, these 5 countries account for 78 million cases [39]. In this region, after Nigeria, Tanzania was the second country having the highest cases of *schistosomiasis* and approximately 51.5% of the Tanzanian populations were either exposed or live in areas with a high risk of exposure [40], in current data [6] Mozambique has slightly overtaken Tanzanian (See, **Table 1**).

To combat *schistosomiasis*, WHO did develop numerous roadmaps for NTDs, and significant progress has been made by many sub-Saharan African countries by rolling out national action plans and programs targeting *schistosomiasis* control and elimination [7]. Considering all these efforts, we are tempted to ask why is it that *schistosomiasis* still remains a huge problem in sub-Saharan Africa? With such an unmet need for the treatment [5]. Conversely, over 150 000 deaths are attributable to chronic infection with *S. haematobium* in Africa [41]. Researchers affirm that *schistosomiasis* commonly affects the poor, the majority of them living in rural, underprivileged urban, or peri-urban settings with limited access to clean water, inadequate sanitation, and lack hygienic services [42]. *Schistosomiasis* burden is beyond health impact it also has social and economic implications for communities [39].

Children are at a greater risk of acquiring the infection as well as reinfection [43]. *Schistosomiasis* is known to cause anemia, growth stunting, and reduced productivity; and accounts for between 1.6 and 4.2 million disability-adjusted life years (DALYs) lost annually in sub-Saharan Africa [42, 44, 45]. New data show a reduction of an estimated 1.43 million DALYs lost to *schistosomiasis* in 2016 globally [46]. However, in aggregate *schistosomiasis* with other NTDs were estimated to affect close to 2 billion people at the turn of the millennium, with a collective DALYs burden that was equivalent to HIV/ AIDS, tuberculosis, or malaria [47]. There exist indirect consequences of NTDs, which are beyond condemning affected people to live long years with disability and stigma, it was noted that it keeps children out of school, adults out of work, burden households with considerable costs to seek health care, trap communities in endless cycles of poverty and cost developing economies billions of dollars every year [48].
