Schistosomiasis or bilharzia thrives where people lack safe water and sanitation. Schistosomiasis remains endemic in São Tomé and Príncipe, primarily caused by Schistosoma intercalatum. The World Health Organization (WHO) classifies the country as requiring preventive chemotherapy, indicating ongoing transmission. Despite multiple rounds of mass drug administration, the disease persists in certain communities, particularly near streams and rice fields, where children remain at risk. Ongoing surveillance is essential to monitor and address localized transmission hotspots.

A Low-Level but Stubborn Threat

Recent studies confirm that São Tomé and Príncipe maintains a low but persistent level of schistosomiasis transmission, primarily caused by Schistosoma intercalatum. According to research published in PLOS Neglected Tropical Diseases in 2023, national prevalence remains low following repeated rounds of mass drug administration and health education campaigns. Ongoing surveillance continues to identify limited transmission in certain communities, underscoring the need for sustained control measures under World Health Organization guidance.

Momentum Since 2014

After a nationwide mapping survey in 2014, the Ministry of Health launched preventive chemotherapy with praziquantel in schools. In 2015 alone, more than 31,000 school-age children received treatment—an essential step to cut infections and protect those most at risk. Continued surveillance has turned up only sporadic cases, including a rare neuroschistosomiasis report in 2020, underscoring why vigilance still matters even as prevalence drops.

A 2024 Milestone: Halting Mass Drug Administration

Regional partners now point to a major achievement. The WHO Africa region’s ESPEN program reported in its 2024 annual review that São Tomé and Príncipe halted mass drug administration (MDA) in all endemic implementation units, marking a key waypoint toward elimination. ESPEN’s 2025 data updates also list STP among countries that did not conduct MDA in 2024, consistent with a transition from blanket treatment to targeted surveillance and response.

Water, Sanitation and Hygiene: The Long Game

Treatment alone cannot finish the job. Lasting gains depend on safe water, sanitation and hygiene (WASH) so people aren’t re-exposed to rivers and irrigation canals. UNICEF reports recent WASH actions in STP, including strengthening handwashing behaviours and coordinating a multisectoral WASH platform—efforts that protect families from schistosomiasis and other infections. Global JMP updates from WHO/UNICEF show why this matters: many health facilities and households worldwide still lack basic WASH services, a gap that sustains NTD transmission.

What’s Needed Next

São Tomé and Príncipe continue national efforts aligned with World Health Organization (WHO) guidance to control schistosomiasis. Current work includes post–mass drug administration monitoring, integrating surveillance into primary health care and coordinating with education and water agencies to sustain prevention gains. The Ministry of Health, with support from WHO and international partners, maintains praziquantel distribution in areas where transmission remains and tracks infection data to guide control strategies. These ongoing initiatives reflect the country’s commitment to meeting the WHO’s 2030 targets for neglected tropical diseases.

Why it Matters

Eliminating schistosomiasis saves children from anaemia, abdominal pain and missed classes, and it strengthens primary health care. With MDA paused and WASH investments growing, São Tomé and Príncipe has a real shot at stopping transmission. Sustained funding for surveillance and water infrastructure can help the islands turn a quiet success into a permanent victory.

– Katie Williams

Katie is based in the United Kingdom and focuses on Global Health for The Borgen Project.

Photo: Flickr