Dar es Salaam, Tanzania — Lunchboxes in hand, the children at Vikuruti Primary School in Mlandizi, within the Kibaha District of the Coast region in Tanzania, chat and laugh while they eat. This meal is a necessary step before taking their medication. But this is no ordinary school activity. The campaign is part of Tanzania’s Mass Drug Administration (MDA), which aims to treat neglected tropical diseases (NTDs) such as schistosomiasis and soil-transmitted helminths (STH).
After their meal, the Standard 6 learners sit in neat rows as they wait for their names to be called.
“Each child receives at least one pill, but the right dose of praziquantel and albendazole used to treat schistosomiasis and STHs depends on their height. For example, a pupil measuring 125 centimeters is given two pills, while one at 150 centimeters receives two and a half pills,” said Rehema Matola, the health teacher at Vikuruti Primary School.
Schistosomiasis, also known as bilharzia, and soil-transmitted helminths (STH), also known as intestinal worms, are major public health issues in sub-Saharan Africa. Millions of people are affected by these parasitic infections. They cause serious illness, long-term complications, and a lower quality of life, especially among children, who are the most vulnerable. Schistosomiasis is caused by parasitic worms that spread through contaminated water. It affects more than 290 million people worldwide, mostly in sub-Saharan Africa. More than 700 million people are at risk, primarily children between the ages of 5 and 14. Soil-transmitted helminths (STH), which are caused by intestinal worms like roundworms, whipworms, and hookworms, affect about 1.5 billion people around the world.
In mainland Tanzania, schistosomiasis and soil-transmitted helminthiasis (STH) are widespread, impacting all 184 districts. The 19 districts with a high schistosomiasis rate receive annual treatments, while the 165 districts with moderate rates get biannual treatments. Untreated infections can lead to poor health, malnutrition, anemia, learning difficulties, and long-term health issues. The majority of these diseases are prevalent in low- and middle-income areas with poor sanitation and limited access to clean water.
The World Health Organization (WHO) recommends a main control strategy of widespread preventive treatment using praziquantel. This treatment is often paired with albendazole to deworm against soil-transmitted helminths. According to the WHO guidelines, praziquantel dosing in mass drug administration programs uses a height-based dose pole, making it easy to administer. Height-based dosing ensures that each child receives the right amount based on their body size. This method improves effectiveness and reduces side effects or underdosing. It also lowers the risk of drug resistance. The standard dosage is 40 milligrams for each kilogram of body weight. Albendazole, used for STH, generally follows weight guidelines, but it can also be given using height-based guidelines during mass administration campaigns.
The Ministry of Health, through the National Neglected Tropical Diseases Control Program (NTDCP), is actively fighting these infections through national programs. These include school-based MDA campaigns to tackle these parasitic diseases. Dr. Antony Golinja, from Tanzania’s NTDCP under the Ministry of Health, explained how MDA works and why it is critical.
The first step is ensuring pupils have eaten enough food.
“The MDA exercise is conducted in an orderly way, usually within one to two hours after the children have had something to eat. After treatment, we carry out surveys to assess coverage and measure the disease burden. If prevalence is still above the World Health Organization’s threshold, we continue the MDA. If it drops below the threshold, we may stop treatment but continue surveillance at regular intervals, for example, after two or four years, before declaring a community free of the disease.”
Mlandizi District, where Vikuruti Primary School is located, is one of the endemic areas. Children between 5 and 15 years are often the primary target group because of their higher exposure to schistosomiasis, which is transmitted in stagnant water containing snails. Children frequently play or fetch water barefoot in such environments, increasing their risk of infection. In addition, mapping is a critical step in the programme, as it helps identify endemic communities and determine the scale of treatment needed. And after a certain period of time, reassessment is needed.
“We may screen 300 children, and if 100 test positive, it shows transmission is still ongoing, so treatment must continue. But if prevalence falls below the WHO threshold, then we know MDA has successfully interrupted transmission in that community,” Dr. Golinja said.
Why children?
Schoolchildren are a key focus for treatment because they have the highest infection rates and gain the most from preventive interventions, in line with WHO guidelines for at-risk populations. An estimated 123 million of those affected are children, making them the most impacted group in terms of both prevalence and intensity of infection. Children are particularly vulnerable because of frequent contact with contaminated water during bathing, play, and domestic chores. Chronic infections can result from these exposures. They impair growth, cognitive development, and school performance.
Neglected tropical diseases (NTDs) are a diverse group of 21 infectious diseases caused by viruses, bacteria, parasites, fungi, and toxins, primarily affecting impoverished communities. Tanzania has 15 of the 21 NTDs classified by the World Health Organization. As a result, affected communities face significant health challenges that perpetuate poverty cycles. NTDs not only restrict children’s ability to learn but also prevent adults from working and providing for their families.
School-based preventive chemotherapy programs, such as mass drug administration (MDA), efficiently target high-risk populations. For MDA to be sustainable and effective, it needs to be supported by health education and efforts to improve access to safe water, sanitation, and hygiene (WASH). Children receive medicines from trained teachers in schools. Coordinating these efforts is crucial to maintaining progress and eliminating the disease from public health concerns.
A lot of improvement
Chengelo Magungu Beno, the Principal at Vikuruti Primary School, said that since the MDA programme began, student health has improved significantly. He said that illnesses such as stomach aches, fever, and coughs had previously caused absenteeism, but after treatment, attendance improved and performance in class went up.
“Before treatment, about 10% of pupils would be absent because of illnesses such as schistosomiasis or stomach problems. After the treatment, this dropped to just 2%. So, there is a lot of improvement,” said Beno.
He added that pupils at Vikuruti Primary School receive medication once a year as part of the nationwide campaign, with sick children referred to local dispensaries when necessary.
“Health education is incorporated in the science curriculum. Children are taught about neglected tropical diseases and other illnesses, their symptoms, and what to do if they notice signs like blood in the urine. This helps them recognize when something is wrong and seek help,” said the principal.
The principal acknowledged that at first, some parents resisted the programme because of fears and misconceptions.
“Some parents were hesitant, saying the drugs might cause infertility. But we now have a strong relationship with parents. Each class has two parent representatives, and through regular meetings, we build trust. This has helped eliminate hesitation and ensure smooth participation.” However, he said that at one time, a parent came to school and refused to let their child receive the medicine. But with continuous education and communication, parents now understand the importance of the program.
According to Beno, the school has hosted the programme for many years, and he estimates it has been running for close to two decades.
From resistance to acceptance
For nearly three decades, volunteer health worker Pembe Kizigo has walked through Mlandizi’s villages, helping to protect his community from neglected tropical diseases. He has served as a community health worker since 1994, supporting national health programmes on the ground. Over the years, he has seen firsthand how mass drug administration (MDA) has transformed the health of children and families.
“This programme of mass drug administration has been running for more than ten years,” Kizigo said. “Before it started, many people suffered from ringworm, stomach problems, and blood in the urine. Now, after treatment, those cases are far fewer.”
Before the intervention, children often missed school due to stomach pain, fever, or schistosomiasis symptoms. Kizigo recalled how visible the suffering once was. “You could see children with ringworms on their heads and bodies. Some missed school because of stomach pain or because they were passing blood in their urine. After the programme began, those problems reduced, and now only about two percent of children miss school because of sickness,” said Kizigo.
He also admitted that not everyone accepted the programme immediately, as there was resistance at the beginning. He said some people believed the drugs could cause infertility or even shorten their lives. But with time, they saw the benefits and began to participate.
Kizigo said that much of the success lies in awareness campaigns led by health workers, doctors, and local leaders. ‘To ensure people participate, health workers, doctors, and community leaders first go into the villages to raise awareness about the importance of the drugs. That way, parents understand and allow their children to take part.”
It’s not only the schools that benefit, it’s everyone.
“Both the schools and the community benefit,” he said. “The thing is, people have understood the importance of the drugs. Sometimes, when the drugs come, they are not enough. The community asks if it is possible to bring more, so that whenever people need them, they will find them. Sometimes the drugs are simply not there.”
According to Kizigo, testing has shown encouraging results. Last year, health workers tested about 200 people and found only 12 cases of infection. In the same school, when 300 people were tested later, only three cases were found.
“That tells us the drugs work,” he said. “But the question is, are these three the same ones who were among the 12 treated earlier? Or are they new cases? This is something the health workers will follow up on, to see if there is any resistance to the drug or if it is simply new infections.”
Kizigo said that this year, they will follow up to see if there is any resistance to the drug or if these are new infections.
Road to 2030
By 2030, the WHO aims to eradicate schistosomiasis and soil-transmitted helminths (STHs), aligned with its goal to eliminate neglected tropical diseases (NTDs). To meet the 2030 goals, Tanzania’s NTDCP works with local and international partners to provide mass drug administration, improve WASH infrastructure, and raise community awareness.
Chironda was in Tanzania as part of a workshop and field visits hosted by Sightsavers and Tanzania’s Ministry of Health, in collaboration with other partners, including Uniting to Combat Neglected Tropical Diseases, a global advocacy organisation that exists to end NTDs by mobilising resources.
