Mathematical tools to inform sustainable interventions against schistosomiasis in Uganda

Schistosomiasis is a neglected parasitic disease, second only to malaria in its socio-economic and public-health importance. It is estimated that 240 million people are infected worldwide, most of which belong to the poorest populations in many sub-Saharan African countries. Individuals with this disease, the majority children, acquire the infection when they contact infected fresh water through behaviours such as fishing and bathing, and transmit the disease in areas with inadequate sanitation. There is a drug available to treat cases, and the World Health Organization recommends mass treatment of school-age children or whole communities, depending on the disease burden. However, the drug does not prevent reinfection, which occurs rapidly.

Combining the drug treatment campaigns with improving sanitation infrastructure could hold the key to finally controlling and eventually eliminating this disease in these populations. The question then becomes what is the best intervention, or combination of interventions, that will most rapidly and efficiently reduce disease burden. To tackle this, we propose to develop a mathematical approach, that integrates the biological infection process (i.e. modelling transmission of infections) with individual behaviour and preference for the different interventions (i.e. using a process of modelling interaction between humans called game theory). Combining these two we can find the most suitable combination of interventions that would be successful in the community and decrease disease. We can then explore the costs associated with the combination of interventions, to leverage the most popular and effective, with the most affordable. Another important aspect is evaluating the interventions, once they are implemented, to measure progress. We need to add the use of different diagnostics to our model, as they might provide different information depending on the setting.

The combination of all of this work will then enable us to write recommendations for a field trial to test a control program, with an efficient and popular campaign, which we can effectively monitor. The project is highly multidisciplinary and will bring together expertise from mathematics and biology, as well as, statistics, epidemiology and health economics. We will build the models based on our previous work and additional published materials in the literature, using social and economic data locally collected with our partners in Uganda. The project outcomes, specific to local populations in Uganda, could then be expanded to other countries by engaging with other communities and key stakeholders.

There are a number of beneficiaries to this project and impact will be maximised through many channels:

Staff working on the project:
Project staff will have the opportunity to develop a range of scientific skills, such as data analysis, mathematical modelling and health economics. In addition, staff will also gain experience in project management, team leading, writing research publications and presenting research to both academics and the general public. There will be opportunities in the project to travel to Uganda and participate in important meetings with key stakeholders, which will enhance the visibility of the project. The project will also impact other academics working in related fields (see academic beneficiaries).

Government bodies and policy makers:
There are three main areas of impact which are of interest to government bodies: disease control, sustainability, and water and sanitation development. The project outcomes will be shared with relevant government bodies and key stakeholders in the countries of interest, and will include time-frames for expected control and elimination as a public health problem. One particular area of interest is reducing dependence on drugs to limit development of resistance as well as preventing or reducing reinfection, and therefore our integrative approach with WASH infrastructure development and associated behaviour change will directly address these concerns.

Ugandan stakeholders and researchers:
One focus of the project is to make the research approachable and applicable in the real world to benefit these rural less developed communities. There will be various meetings along the project's duration to discuss concerns with our partners in Uganda. Resources have also been allocated to organise a meeting at the end of the project with local stakeholders in Uganda to present the project outcomes and maximise the impact of the interventions, as well as a training workshop in health economics, strengthening capacity in Uganda's academic researchers.

Endemic communities:
The work leading up to this project have worked closely with endemic communities with the key focus being on what they want and are willing to either work or pay for. Whilst this project itself will not collect data from endemic communities, the findings will be directly relevant to them as well as needing to be discussed with them. Mini workshops with Acting for Health will be run in the communities after the Stakeholder meeting to gain an understanding of their views of potential interventions as well as to disseminate the findings of the models.

Additional time and funding has been allocated to public engagement and outreach activities (see Pathways to Impact). This includes, but is not limited to, sessions with undergraduate students, outreach activities with the general public and interaction with non-scientific media. This will increase awareness on the problem of schistosomiasis, and Neglected Tropical Diseases in general, and how integrative approaches can provide additional insights for designing control interventions and monitoring.