Grassroots attack on bilharzia

(by Mike Muller, a freelance journalist specializing in Third World affairs)

An African researcher has made encouraging progress in using a pesticide from an indigenous plant to
combat bilharzia-the parasitic disease that afflicts 250 million people in the Third World. Over the past
five years, an experiment has been going on in Ethiopia which has made encouraging progress in the fight
against a disease that ravages three continents. The village of Adwa in northern Ethiopia is already
remembered in African history as the place where the 19th century Italian colonizers were halted. Now, it
is the setting for a new initiative against a harder and more insidious enemy-the bilharzia parasite.

Bilharzia ranks with malaria as one of the most widespread and serious parasitic diseases in the world,
afflicting an estimated 250 million people in Asia, Africa, Latin America, and the Caribbean. It is
transmitted through contact with contaminated water. So, unlike malaria with its more democratic vector,
bilharzia is invariably a problem among poorer communities in the developing countries. It is a
debilitating disease rather than a fatal one. It can take years for tissue damage caused by the parasite to
manifest itself in the form of internal bleeding and malfunctions of the bladder, liver, and intestines. The
disease saps energy and shortens the life span but it does not contribute obviously to mortality statistics.

Perhaps, for these reasons it has not been the focus of any major health offensive-outside of mainland
China. Treatment is possible although expensive and pointless in communities where reinfection is almost
inevitable. In isolated irrigation schemes, the disease has been limited by eradicating the parasite’s
intermediate host with commercial pesticides. But these solutions are not practicable for most poor rural
communities.

It is in this context that the work of Dr.Aklilu Lemma of the Haile Selassie University in Addis Ababa is
important. Dr.Lemma has just completed the field work of a five year pilot bilharzia control project in
Adwa. Such control programmes have been carried out before but in this one there is a vital new factor.
The key to it is a pesticide produced from a locally occurring plant. The availability –and low cost in
foreign currency –of the plant extract may make bilharzia control practicable on a community scale in
Ethiopia and probably other countries as well.

Life cycle

The parasite responsible for bilharzia has a life cycle which is dependent on an intermediate host-a
common species of water snail-for transmission to the final host. Eggs from the mature parasite are
continually excreted by infected persons or animals. If they reach water, they hatch into an intermediate
form which seeks out a snail host. In the snail, after further transformations, the parasite begins to release
numerous ‘cercariae’ the form which affects man. These cercariae can penetrate skin, so any contact with
infected water is enough to transmit the disease.

Bilharzia can be controlled by eradicating the snails by keeping humans (and their waste) away from
water bodies that could be infected. Treatment itself is of little value for even if all human carriers were
temporarily cured, the parasite population could be maintained by infected animals. Even if all affected
communities were provided with safe water, washing facilities and toilets, farmers and fishermen would
still be vulnerable and children would still swim in rivers. So in practice, snail eradication has to be the
focal point of any control programme.

Dr. Lemma’s present work on bilharzia control started almost by accident. While conducting a survey of
the snail population along a stream in northern Ethiopia, he found a large number of dead snails just
downstream from a village washing place. Upstream and further downstream there was an abundant
population of live snails. Investigation revealed that the “soap” used by the villagers for washing clothes-
ground berries of a plant called endod-had molluscicides as well as detergent properties.

Further investigation showed that Sundried ground endod kills snails at a dilution of 15-30 ppm and that it
has a very low toxicity to mammals and plants. The endod bush (Phytolacca docecandra) is popular with
villagers in northern Ethiopia as a hedge and the berried can be bought locally.

In 1969, Dr. Lemma began a field trial at Adwa. The idea was to control the snail population in the two
streams that cross the village by regular application of endod and to check the effectiveness of these
efforts by observing, among other factors, the incidence of infection amongst local inhabitants,
particularly young children. A preliminary survey in 1971 showed that the incidence had already dropped
dramatically-from 50 to 15 percent –and the final results are expected to show an even further decline.
The large decline in the rate of infection among one to five year-olds has been particularly encouraging as
this group became vulnerable to infection after the control programme began.

While the field programme was progressing, Dr.Lemma worked for a while at the Stanford Research
Institute in California to elucidate the structure and functions of the active ingredient in the endod berry,
to examine its properties, and to develop a sample extraction technique to concentrate it. He established
that a butanol extract comprising 20 percent of the berry weight is effective at dilutions of two to three
ppm, which is in a comparable range to available commercial products.

Other avenues of research are still open. Dr. Lemma wants to see villagers encouraged to use endod as
soap. But with an eye to social trends he is also investigating the possibility of formulating a detergent
cum molluscicide from the endod. In Adwa and elsewhere villagers have begun to take cardboard cartons
of synthetic detergent to the streams with them. There is also a need to develop improved strains of the
plant and to overcome if possible the loss of potency that was observed when the plant was cultivated in
East Africa.

Perhaps the most exciting aspect of the Adwa project is its simplicity. Endod berries are bought in the
local market. They are ground, a few hundred kilos at a time, in the mill usually used by the villagers for
grinding chili peppers. The endod is applied along stream banks with watering cans every three to eight
weeks. The control programme for a community of about 20 000 involves only three people full time and
much of their work is part of on-going research.

The simplicity of the project contrasts dramatically with the procedures necessary when the more
expensive synthetic molluscicides are used. The consequence of this was highlighted by a Rhodesian
health worker who wrote “due to the more or less stringent requirements in dispensing molluscicides the
application generally rests with specially trained personnel. Snail control can therefore be carried out with
little or no cooperation from these people who are being protected.”
The irony is that community involvement is essential if any bilharzia control programme is to be
successful. Here Lemma believes that his current work can make an impact. “Community involvement
through health education, active participation by the people involved and the systematic application of
locally grown and processed endod should become routine. These activities by individuals, families, and
villages when developed become a truly self-help form of health control.”

Activity

Instruction A: Write a conclusion of your own to the passage above.

Instruction B: Answer the following questions based on the information in the passage.
1. What are the three continents that were ravaged by Bilharzia?
2. What are the symptoms of Bilharzia?
3. Why is it easy to apply Aklilu’s pesticide in developing countries?
4. Why is malaria’s vector considered ‘democratic’ by the author?
5. Why did the author describe the discovery of the cure for Bilharzia at Adwa incidental?
6. What made the project on Endod different from other projects in health?
7. How is Bilharzia transmitted to humans?
Instruction C: The following words are taken from the reading passage you have read. Use the
word that has a similar meaning with the word in italics in the following sentences.

ravage debilitate vital toxicity

1. It occasionally happens that a change in concentration affects the chemical action that occurs
2. This acute infection of the brain is almost similarly fatal.
3. What we're accomplishing with Howie is important; we can't stop doing it.
4. That is the deceptive nature of gambling that must be controlled.
5. The teacher felt she needed to give out compliments to each student so that they could feel better about
themselves.
6. The public work suffers from the consequences white ants.

Activity

Check your understanding of the following terms.