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To prevent schistosomiasis-associated disease, the cycle of transmission must be broken. This will require a combination of drug treatment, water management, snail control and sewage treatment, says Charles H. King.

More than 207 million of the world's poorest people are infected with schistosomiasis, which can affect nutritional status and growth, cause anaemia, and increase the risk of inflammation, renal failure and bladder cancer.

Control strategies based on drug delivery alone might reduce deaths, but they only partially suppress parasitic transmission in high-risk communities, argues King.

A combination strategy based on modifying habitats, changing irrigation patterns and spraying molluscicides (snail pesticides) has been trialled in rural China, and shows better results for interrupting the parasite's lifecycle and reducing transmission.

External benefits such as cleaner water and biofuel production were also gained from this strategy.

Eliminating schistosomiasis will be a long-term process, says King. He advises governments to coordinate between sectors, and suggests long-term commitment and planning that draws on informed and locally-adaptive prevention strategies.

Link to full article in The New England Journal of Medicine

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