- Top charities
Published: November 2013
What do they do? SCI works with governments in sub-Saharan Africa to create or scale up deworming programs. SCI's role has primarily been to solicit grants from large funders, identify country recipients, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs.
Does it work? We believe that there is relatively strong evidence for the positive impact of deworming. SCI has provided studies on its own national control programs showing large declines in infection rates. Note: As of November 2013, we are reexamining these studies.
What do you get for your dollar? We estimate that children are dewormed for a total of around $0.73 to $0.99 per child, with SCI paying about 70% of these costs. The number of lives significantly improved is a function of a number of difficult to estimate factors, which we discuss in detail in a separate report.
Is there room for more funds? We continue to recommend unrestricted funding to SCI because we believe that SCI has used unrestricted funds in productive ways in the past and because the overall need for funding in the countries in which it is working remains substantially greater than available funding. We do not know how, specifically, SCI would use additional funds.
SCI is recommended because of its:
Major unresolved issues include:
We began reviewing SCI in 2009. Our review has consisted of:
All content on the Schistosomiasis Control Initiative, including past reviews, updates, blog posts and conversation notes, is available here.
SCI works with governments in sub-Saharan Africa to create or scale up mass drug administration programs for neglected tropical diseases (NTD), particularly schistosomiasis and soil-transmitted helminths (STHs), in school-aged children and other groups determined to be at high risk.1 SCI's role has primarily been to solicit grants from large funders, identify country recipients, provide funding to governments for government-implemented programs, provide advisory support, and conduct research on the process and outcomes of the programs.
SCI does not report a comprehensive budget of all of its expenditures. It reports spending for each of its "accounts." It has accounts for each of the grants it has received, as well as accounts for unrestricted donations. We have seen spending details for many of these accounts, including all of the accounts containing unrestricted funds.
SCI's work has been driven by a number of large grants, each with somewhat different program designs and geographic coverage:
SCI's role in mass drug administrations in general is to:10
The grant from DFID comprises the majority of SCI's current funding, between the start of the project in 2010 and March 2013.11
Under the DFID grant, SCI has spent about 48% on salaries and travel expenses for management and technical staff and 52% on program expenses (this excludes the cost of drugs, which are funded under a separate DFID grant).12 To further break down program expenses, SCI provided a budget for Malawi; program expenses in Malawi account for about 14% of all program expenses.13 The types of expenditures listed were in line with our understanding of SCI's role from past conversations (public and private) and our 2011 site visit, though at a higher level of detail.
|Budget item||% of spending||Description|
|Technical personnel and travel||36%||UK-based Technical Director, country programme managers, health economist, biostatistician, data manager; Ugandan-based capacity building advisor. Technical Assistance: Consultancy fees for expertise.|
|Management personnel and travel||12%||UK-based SCI and Liverpool School of Tropical Medicine personnel undertaking project operational and financial management; project administration.|
|Program: Monitoring||14%||Includes sentinel site monitoring for cohort studies, coverage validation surveys, and knowledge, attitudes and practices surveys.|
|Program: Mass drug administration costs||12%||SCI provided a further breakdown of this category for two example countries. The components of this category overlap with other categories listed here (e.g. training and social mobilization). It isn't clear to us what distinguishes expenses in this category.|
|Program: Training||7%||Includes training of trainers, training of teachers and health workers, and training materials.|
|Program: Supervision||5%||No further information available.|
|Program: Office support and materials||5%||Includes program office support, treatment registers and dose poles.|
|Program: Meetings||3%||Includes pre- and post-program meetings for planning and evaluation.|
|Program: Social mobilization||3%||No further information available.|
|Program: Drug transportation||3%||No further information available.|
Prior to 2011, unrestricted funds accounted for a very small portion of SCI's total funding.15 SCI told us that this funding was primarily used to fund treatments in regions of Cote d'Ivoire and Mozambique.16
In part due to GiveWell's recommendation, between November 2011 and October 2013, SCI received about $4.4 million in unrestricted funds. Over the same period it spent about $2.3 million and made spending commitments totaling $1.8 million (details in our October 2013 update). SCI told us that it has spent these funds in three main categories:17
In addition, SCI has received some smaller grants for a variety of projects, including:
We have not seen a spending breakdown from SCI that covers all costs in a particular period. However, we believe that the above information on spending from the DFID grant, unrestricted funds, and other small grants, provides a reasonably complete picture of SCI's past spending.
We detail other spending breakdowns that SCI has provided in an older version of this review.
SCI's mass drug administration programs are focused on delivering treatments that have been independently studied in rigorous trials and found to be effective. SCI has provided studies on its own national control programs showing large declines in infection rates. Note: As of November 2013, we are reexamining these studies.
SCI's primary program is mass deworming, which we discuss extensively on another page. There is a very strong case that mass deworming is effective in reducing infections. The evidence on the connection to positive quality-of-life impacts is less clear, but there is a possibility that deworming is strongly beneficial.
Note: As of November 2013, we are reexamining the studies discussed in this section due to questions about the methods used in the studies. We have not yet reached a conclusion about the accuracy or importance of these concerns.
We have seen detailed technical reports for four countries: Burkina Faso, Niger, Uganda, and Burundi. The first three countries accounted for about 74% of SCI funding as of April 2010,21 though the data below covers only the first year or two of these programs, which started in 2003-2004 and continued until at least 2010. We also include Burundi for which we have seen a technical report that appears to cover the full time period of SCI's work in the country. Burundi is the only country for which we have seen data on a program that was not funded by SCI's first Gates Foundation grant. Note that the data from Burundi is from two studies: (a) 2007-2011 results from schools included in a pilot program in three provinces; and (b) 2008, 2009, and 2011 results from schools in the other districts.
We focus on these countries because (a) these countries account for the bulk of SCI's spending prior to April 2010 (and evaluations from more recently-funded countries are not yet available) and (b) we have the most in-depth information on them.
All of the following data is from uncontrolled panel studies, i.e. the same individuals were examined before and after treatment and the changes in their disease status reported as the effect of the treatment. Cross-sectional studies of children in the same schools as the cohort children and selected to match, in age and sex, the cohort group were also conducted in Burkina Faso with roughly similar results.22 In the four countries, significant decreases in parasite prevalence and intensity, anemia, and some disease manifestations were observed. All of the changes reported in the below table are statistically significant at p<0.05.23
|Schistosoma haematobium||Schistosoma mansoni||Hookworm|
|Country||Changes in prevalence||Changes in intensity||Changes in prevalence||Changes in intensity||Changes in prevalence||Changes in intensity|
|Burkina Faso||59.1% at baseline to 7.7% at two years||94.2 eggs/10ml urine at baseline to 6.8 at two years||2.8% at baseline to 0.3% at two years||4.6 eggs per gram of feces at baseline to 0.6 at two years||Not reported||Not reported|
|Niger||75.3% at baseline to 28% at one year||22.8% prevalence of heavy-intensity infections at baseline to 4.6% at one year||Not reported||Not reported||Not reported||Not reported|
|Uganda||Not reported (SCI reports very low baseline prevalence24)||N/A||42.4% at baseline to 17.9% at two years||219.6 eggs per gram of feces at baseline to 37.4 at two years||50.9% at baseline to 10.7% at two years||309.4 eggs per gram of feces at baseline to 21.9 at two years|
|Burundi (pilot)||Not reported (SCI reports very low baseline prevalence25)||N/A||12.7% at baseline to 1.7% at four years||Not reported||17.8% at baseline to 2.7% at four years||Not reported|
|Burundi (other schools)||Not reported (SCI reports very low baseline prevalence26)||N/A||6.2% at baseline to 0.7% at three years||Not reported||15.1% at baseline to 5.4% at three years||Not reported|
For the other two prominent soil-transmitted helminths, ascaris and trichuris, very low prevalence of ascaris was reported in the Niger and Burkina Faso studies,27 and low baseline levels with modest decreases at two years were reported for both ascaris and trichuris in Uganda. In Burundi, effects on ascaris and trichuris appear inconsistent; prevalence both rose and fell by statistically significant amounts over the five years of the study (with the exception of trichuris, where the rise in prevalence was not statistically significant). Data from Uganda and Burundi are given in the footnote.28
|Country||Anemia||Mean hemoglobin concentration29||Blood in urine30||Ultrasound abnormalities of the urinary tract prevalence||Ultrasound abnormalities of the bladder||Thinness or wasting||Shortness or stunting||Firm or hard liver||Firm or hard spleen|
|Burkina Faso||65.75% at baseline to 61.59% at one year||10.97 g/dL at baseline to 11.25 g/dL at one year||Micro: 49.56% at baseline to 10.50% at one year||Not reported||Not reported||Not statistically significant||Not statistically significant||Not reported||Not reported|
|Niger||61.9% at baseline to 50.4% at one year||11.0 g/dL at baseline to 11.4 g/dL at one year||Gross: 7.1% at baseline to 0.4% at one year; Micro: 53.5% at baseline to 6.0% at one year||45.6% at baseline to 15.2% at one year||41.6% at baseline to 14.7% at one year||Not reported||Not reported||Not reported||Not reported|
|Uganda||51.6% at baseline to 36.2% at two years||11.4 g/dL at baseline to 12.0 g/dL at two years||Not reported||Not reported||Not reported||Not reported||Not reported||63.3% at baseline to 0.8% at two years||61.6% at basline to 14.1% at one year|
|Burundi (pilot)||25.4% at baseline to 8.3% at four years||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported|
|Burundi (other schools)||26.0% at baseline to 16.3% at three years||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported||Not reported|
Due to the way in which they were carried out, these studies may overestimate SCI's impact. Potential sources of bias include:
The baseline characteristics measured in the studies did differ in some ways between those children who were found on follow up and those who were not; however the differences do not exhibit consistent patterns across the three studies (not reported for Burundi).39
We have limited information on whether the results presented above from Burkina Faso, Niger, Uganda, and Burundi can be generalized to other countries in which SCI has run programs (see footnote for details of where SCI has worked over what years and what results we have seen40). In addition to the published studies discussed above, we requested monitoring reports from Tanzania, which we did not receive.
For its first year or two of work in Mali and Tanzania, SCI posts results, but not details of how the data was collected, on its website. While reported results show positive effects, results are not reported for many indicators and we do not know if the methods used to collect this data were highly rigorous.41
SCI notes that in Zambia, which received support under SCI's initial Gates Foundation grant, implementation was poor and results below expectations.42
In October 2013, SCI reported that it had collected baseline and at least one follow up round (following one or more rounds of treatment) of data from 8 of the 15 countries it is working in and baseline data only from an additional 5 countries.43 Prevalence mapping data only has been collected in the remaining two countries: Cote d'Ivoire and Ethiopia.44 We have seen baseline data and detailed methodology from Liberia only.45 We have not seen follow up data from any country. Judging from the Liberia example, SCI has and will collect data using the same methods that it used in the studies detailed in the previous section.46
We have not seen evaluations of SCI's work on diseases other than schistosomiasis and soil-transmitted helminths and our understanding from conversations with SCI is that it does not monitor these programs. We have not seen evaluations of SCI's work with populations other than schoolchildren. Adults also receive treatment in some SCI-funded programs.47
We have seen limited information on the success of activities SCI has funded with unrestricted funds:
We remain unsure about how many treatments are needed to impact health. SCI told us that its views on what groups should be treated and how often "is largely based on intuition and common sense, though it usually works and SCI collects sufficient data to know when it isn't working. In general, in high endemicity areas re-infection is a major issue; in lower endemicity areas, a single treatment can be sufficient."55 One example of the variation in treatment patterns is what SCI told us about its program in Yemen:
The details of our calculation of SCI's full cost per treatment are in this spreadsheet. In short, we have used the following information to estimate SCI's cost per treatment delivered:
Non-SCI costs were 18% of the total cost of the program and 33% of the cost of school-based deworming (the program also included community-based deworming).63 It is our understanding that in recent programs SCI has continued to do some community-based deworming but that most of its treatments are delivered through schools. Therefore, we conservatively estimate that non-SCI actors contribute 30% of the cost of a SCI deworming program.
Note that SCI's USAID grants involved some treatments for diseases other than schistosomiasis and STHs; we do not include these on either side of the calculation, i.e., we do not include the treatments in the denominator of "cost per treatment" or the value of donated drugs in the numerator of "cost per treatment."
We discuss how the above figures relate to how much it costs to improve a child's health and development at our report on mass treatment programs for schistosomiasis and STHs.
SCI told us in November 2013 that it could effectively absorb up to $10 million in additional unrestricted funds in the next year. These funds would allow it to expand programs to reach additional at-risk populations in the countries it is currently working in and to plan with more confidence for activities in 2015.
As of November 2013, SCI's top unfunded priorities are:64
These four projects total about $4 million for the next year (including only the first year of work in Mauritania). If SCI were to receive more than $4 million, it would use the funds for a combination of:65
SCI believes it could productively absorb up to $10 million in 2014; some of these funds would not be spent in 2014 but would allow it to better plan for activities in 2015.
It is our understanding that SCI's priorities can change due to factors such as availability of donated drugs in particular countries, delays due to coordination with other actors, results of disease mapping, and grants from other donors. GiveWell encourages unrestricted funding to allow SCI flexibility to change its plans as necessary.
Note that DFID is in the final stages of considering a second grant to SCI in 2014 totaling £15 to 18 million (about $24-29 million), including funding for Ethiopia, which was previously supported with unrestricted funds.66 The funding gaps above take into account this expected funding.
More on how we think about evaluating organizations at our 2012 blog post.
|Alan Fenwick, SCI Director, conversation with GiveWell, October 17, 2011||Source|
|Alan Fenwick, SCI Director, email to GiveWell, February 1, 2011||Unpublished|
|Alan Fenwick, SCI Director, email to GiveWell, November 15, 2011||Unpublished|
|Alan Fenwick, SCI Director, email to GiveWell, November 17, 2011||Unpublished|
|Alan Fenwick, SCI Director, email to GiveWell, November 20, 2011||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, August 13, 2012||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, February 16, 2011||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, July 2009||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, June 17, 2010||Source|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, November 15, 2011||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, November 28, 2011||Unpublished|
|Alan Fenwick, SCI Director, phone conversation with GiveWell, September 15, 2011||Unpublished|
|Alan Fenwick and Wendy Harrison, SCI Director and Deputy Direction, phone conversation with GiveWell, November 26, 2013||Unpublished|
|Anna Phillips, SCI Country Program Manager for Burkina Faso and Niger, email to GiveWell, October 13, 2011||Source|
|Benjamin Styles, SCI Senior Biostatistician, phone conversation with GiveWell, August 12, 2011||Unpublished|
|Fenwick et al. 2009||Source (archive)|
|Gabrielli et al. 2006||Source|
|Gates Foundation, Imperial College London (June 2002)||Source (archive)|
|GiveWell, SCI financial details and summary (November 2011 to October 2012)||Unpublished|
|Global Atlas of Helminth Infections. Malawi||Source (archive)|
|Global Atlas of Helminth Infections. Mozambique||Source (archive)|
|Global Atlas of Helminth Infections. Senegal||Source (archive)|
|Government of Senegal Report on MDA (2012)||Unpublished|
|Kabatereine et al. 2006||Source|
|Kabatereine et al. 2007||Source|
|Koukounari et al. 2007||Source|
|Leslie et al. 2011||Source|
|MANNA A firsthand look at the problems and pathways to controlling schistosomiasis in Mozambique||Source|
|MANNA Campanha do controle de shistosomiase e parasitoses intestinais (February to June 2008)||Source|
|Miguel and Kremer 2004||Source|
|RISEAL Homepage||Source (archive)|
|Schistosomiasis Control Initiative, Account summary (May 2011)||Source|
|Schistosomiasis Control Initiative advisory board financial report (June 2013)||Source|
|Schistosomiasis Control Initiative advisory board strategic direction (June 2013)||Source|
|Schistosomiasis Control Initiative, Board management accounts (April 2010)||Source|
|Schistosomiasis Control Initiative, Burkina Faso: Impact||Source (archive)|
|Schistosomiasis Control Initiative, Burundi: Impact||Source (archive)|
|Schistosomiasis Control Initiative director's presentation (June 2013)||Source|
|Schistosomiasis Control Initiative financial update (September 2013)||Source|
|Schistosomiasis Control Initiative, Gates2 Burkina Faso spending report||Source|
|Schistosomiasis Control Initiative, IC Trust summary (September 2011)||Source|
|Schistosomiasis Control Initiative, Imperial initiative to protect children from tropical disease awarded ₤25m government backing||Source (archive)|
|Schistosomiasis Control Initiative Liberia cohort study protocol||Source|
|Schistosomiasis Control Initiative, Mali: Impact||Source (archive)|
|Schistosomiasis Control Initiative, Monitoring and evaluation report for Burundi||Source|
|Schistosomiasis Control Initiative, Neglected tropical diseases in Mozambique||Unpublished|
|Schistosomiasis Control Initiative, Niger: Impact||Source (archive)|
|Schistosomiasis Control Initiative, Program update (September 2012)||Source|
|Schistosomiasis Control Initiative, Proposal by SCI, Imperial College to manage the Program for Integrated Control of Neglected Tropical Diseases in Côte d'Ivoire||Unpublished|
|Schistosomiasis Control Initiative report to GiveWell (September 2013)||Unpublished|
|Schistosomiasis Control Initiative report to Ethiopia donor (August 2013)||Unpublished|
|Schistosomiasis Control Initiative, Rwanda: Strategy||Source (archive)|
|Schistosomiasis Control Initiative, Summary sheet of treatments instigated and overseen by SCI||Source|
|Schistosomiasis Control Initiative, Tanzania: Impact||Source (archive)|
|Schistosomiasis Control Initiative, USAID RTI Y1 to Y3 accounts||Unpublished|
|Schistosomiasis Control Initiative, What we do||Source (archive)|
|Schistosomiasis Control Initiative, Gates Foundation final report (January 2011)||Source|
|Tohon et al. 2008||Source|
|Touré et al. 2008||Source|
"Objectives of SCI
Fenwick et al. 2009, Pg 3.
"The move towards national control programmes in sub-Saharan Africa was facilitated by an award from the Bill and Melinda Gates Foundation (BMGF; http://www.gatesfoundation.org) Global Health Program in 2002, to the SCI for the implementation and evaluation of control of schistosomiasis." Fenwick et al. 2009, Pg 2. Amount at Gates Foundation, Imperial College London (June 2002).
"Six countries were selected by October 2003 for full support: Burkina Faso, Mali, Niger, Uganda, Tanzania and Zambia. The countries each proposed a different implementation approach and management structure for their large-scale schistosomiasis control. This was readily accepted because the BMGF required SCI to test the ‘proof-of-principle’ of national scale, Ministry of Health (MoH)-led schistosomiasis control programmes. SCI is based in Imperial College London and operated with the principle that all programmes were country owned and run, with SCI staff offering technical and other assistance, but not as expatriates living in-country. Programmes were based in the MoH in the respective country, and SCI offered support to improve the national health system." Fenwick et al. 2009, Pg 2.
Between 2003 and 2008, SCI provided treatment for schistosomiasis and soil-transmitted helminths to the following number of people (Fenwick et al. 2009, Pg 3, Table 1).
"Current and future rounds of treatment in all six countries are being delivered in an integrated manner to include schistosomiasis, STH, lymphatic filariasis, onchocerciasis and trachoma." Fenwick et al. 2009, Pg 10. The "six countries" refers to the six countries funded by SCI's first Gates Foundation grant.
Countries and dates from Schistosomiasis Control Initiative, Board management accounts (April 2010)
"A team from Imperial College London has been awarded 25 million funding from the UK Government to continue its fight against neglected tropical diseases, it was announced this week. The money will enable the Schistosomiasis Control Initiative (SCI) to provide 75 million treatments to protect some of the world’s poorest children against schistosomiasis – an illness caused by parasitic worms – and soil-transmitted helminths (STH). £15 million of the funding will be spent directly on procuring drug treatments, through an organisation called Crown Agents. The rest will be administered by SCI." Schistosomiasis Control Initiative, Imperial initiative to protect children from tropical disease awarded ₤25m government backing.
"SCI will be assisted in their drug delivery by the Centre for Neglected Tropical Diseases at Liverpool School of Tropical Medicine via a sub contract through LATH (Liverpool Associates in Tropical Health). In six countries, this will lead to treatment for lymphatic filariasis – another worm disease – becoming integrated with schistosomiasis and STH treatment." Schistosomiasis Control Initiative, Imperial initiative to protect children from tropical disease awarded ₤25m government backing.
Data from Schistosomiasis Control Initiative report to GiveWell (September 2013), Pgs 2-4.
As of July 2011, it had received about $580,000 in unrestricted funding (Schistosomiasis Control Initiative, IC Trust summary (September 2011)) and $108 million overall (Schistosomiasis Control Initiative, Gates Foundation final report (January 2011) Pg. 20).
"For the smaller donor, we have two or three projects, which we have been supporting and which will hopefully lead to pilot project in their respective countries.
See our October 2013 update on SCI.
Spending breakdown in Schistosomiasis Control Initiative financial update (September 2013), Sheet Combined with previous updates.
SCI's summary of active accounts as of May 2013 lists five research grants totaling £2.4 million, or about $3.9 million. Schistosomiasis Control Initiative advisory board financial report (June 2013).
"Once we have people that want to give at least $100,000, we talk to them directly. Two examples:
Schistosomiasis Control Initiative advisory board financial report (June 2013), Pg 2 notes programs in Burundi and Rwanda:
Alan Fenwick, SCI Director, phone conversation with GiveWell, September 15, 2011. Note: "SCI generally doesn't do water and sanitation programs because of the expense. In Burundi they're doing water and sanitation programming because they have been successful there with running a program and treating schistosomiasis, but soil-transmitted helminth infections remain persistent." Alan Fenwick, SCI Director, conversation with GiveWell, October 17, 2011.
Data on spending by country is from Schistosomiasis Control Initiative, Board management accounts (April 2010) Pg 1. Funding, as of April 2010, was concentrated in Burkina Faso (34% of country-specific funding), Niger (33%), Uganda (10%), Burundi and Rwanda (10%; we don't have data for these countries independently), and Tanzania (7%).
"In addition to the cohort follow-up, a cross-sectional survey was conducted during the second follow-up (2 years post-treatment), in which a group of children (7–14 years old) outside the original cohort were randomly selected and examined in the sentinel schools. The number, age and sex structures were matched to those in the cohort who were present at the second follow-up in each school. Infection status in these children should represent the quality of treatment in children outside cohorts in schools, to confirm and validate the cohort data, i.e. no preferred treatment was given to cohort children…As in the cohort data, the proportion of heavy [S. haematobium infections was reduced from 25% to just 3.2% (Fig. 2). However, these children outside the cohort did show a slightly higher prevalence and intensity of S. haematobium infection than those in the cohort as in Table 1 (P<0.01) at 2 years post-treatment…In baseline children (7–14 years old) in the original cohort in this region, prevalence of S. mansoni infection was 14.2% (95% CI: 10.8–17.6; n = 408) [13.6% in the cohort baseline] and intensity of infection was 23.0 epg (95% CI: 11.8–34.2; n = 408) [22.4 epg in cohort] before treatment. Two years after treatment, S. mansoni prevalence in this region was 7.6% (95% CI: 4.4–11.0; n = 248) [1.5%in cohort] and intensity of infection was 16.5 epg (95% CI: 1.9–31.0; n = 248) [2.9 epg in cohort] (both P>0.05)." Touré et al. 2008, Pg 781-783.
Sources for the data in the tables:
Results from Kabatereine et al. 2007, Pg 93, Table 2 (see source for 95% confidence intervals) and Schistosomiasis Control Initiative, Monitoring and evaluation report for Burundi (see source for statistical significance). We report "as measured results" for Burundi; SCI also reports model results.
|Baseline||Year 1||Year 2||Year 3||Year 4|
|Ascaris in Uganda||2.8%||1.6%||0.6%||-||-|
|Trichuris in Uganda||2.2%||2.5%||1.6%||-||-|
|Ascaris in Burundi (pilot)||14.9%||12.9%||20.1%||10.6%||10.1%|
|Trichuris in Burundi (pilot)||3.2%||1.8%||3.9%||1.5%||2.4%|
|Ascaris in Burundi (other schools)||21.6%||11.7%||-||9.1%||-|
|Trichuris in Burundi (other schools)||10.4%||10.0%||-||4.3%||-|
"The SCI-supported schistosomiasis control program was implemented during 2004 and had treated 3,322,564 school-aged children in the 13 regions of the country through October 2006...For the present study, parasitological and morbidity data were collected from a cohort of 1727 Burkinabé children 6–14 years old, randomly sampled from 16 schools before and 1 year after chemotherapy (2004 and 2005, respectively). The schools included in these surveys were randomly selected from all schools in 4 Regional Health Directorates known a priori to be places where schistosomiasis is highly endemic." Koukounari et al. 2007. Pg 660.
"Eight villages located in schistosomiasis endemic regions were randomly selected to represent the two main transmission patterns in Niger: six villages located near permanent (Tabalak, Kokorou) or semi-permanent (Kaou, Mozague, Rouafi, and Sabon Birni) ponds and two (Saga Fondo, Sanguile) located along the Niger River. The villages represented the south-western region (Tillabe´ry) and the central-northern region (Tahoua) of the country, with four villages from each region. One village is located in the Sudanian climatic zone and the seven others are in the Sahelian climatic zone." Tohon et al. 2008, Pg 2.
Kabatereine et al. 2007, Pg 92.
Funding sources in table below are compiled from:
Schistosomiasis Control Initiative, Summary sheet of treatments instigated and overseen by SCI
Alan Fenwick, SCI Director, phone conversation with GiveWell, June 17, 2010
Schistosomiasis Control Initiative, Board management accounts (April 2010)
April 2012, November 2012, and October 2013 updates on SCI.
|Burkina Faso||-||Gates | Results with details||Gates | Results with details||Gates/ USAID | Results with details||Gates/ USAID | Results without details||Gates/ USAID | No results||Gates / USAID | No results||Gates / USAID | No results||Gates / USAID | No results||(Taken over by HKI)||-|
|Burundi||-||-||-||-||GNNTDC | Results with details||GNNTDC | Results with details||GNNTDC | Results with details||GNNTDC | Results with details||Individual | Results with details||Individual | No results yet||Individual | No results yet|
|Cote D'Ivoire||-||-||-||-||-||-||-||-||-||DFID | No results yet||DFID | No results yet|
|Liberia||-||-||-||-||-||-||-||-||DFID | No results||DFID | No results yet||DFID | No results yet|
|Malawi||-||-||-||-||-||-||-||-||DFID | No results||DFID | No results yet||DFID | No results yet|
|Mali||-||Gates | Results without details||Gates | Results without details||Gates/ USAID | Results without details||USAID | No results||USAID | No results||USAID | No results||(Taken over by HKI)||-||-||-|
|Mozambique||-||-||-||-||-||-||-||-||DFID | No results||DFID | No results yet||DFID | No results yet|
|Niger||-||Gates | Results with details||Gates | Results with details||Gates/ USAID | Results without details||Gates/ USAID | No results||Gates/ USAID | No results||Gates/ USAID | No results||Gates/ USAID | No results||DFID | No results||DFID | No results yet||DFID | No results yet|
|Rwanda||-||-||-||-||GNNTDC | No results||GNNTDC | No results||GNNTDC | No results||GNNTDC | No results||?||End Fund | No results yet||End Fund | No results yet|
|Tanzania / Zanzibar||Gates | Results without details||Gates | Results without details||Gates | No results||Gates | No results||Gates | No results||Gates | No results||Gates | No results||Gates | No results||DFID | No results||DFID | No results yet||DFID | No results yet|
|Uganda||Gates | Results with details||Gates | Results with details||Gates | Results with details||Gates/ USAID | Results without details||Gates/ USAID | No results||Gates/ USAID | No results||Gates/ USAID | No results||Gates/ USAID | No results||DFID | No results||DFID | No results yet||DFID | No results yet|
|Yemen||-||-||-||-||-||-||-||-||Unrestricted SCI funds | No results||World Bank and unrestricted funds | No results yet||World Bank and unrestricted funds | No results yet|
|Zambia||-||Gates | Known failure||Gates | Known failure||Gates | Known failure||Gates | Known failure||-||-||-||DFID | No results||DFID | No results yet||DFID | No results yet|
|Schistosoma haematobium||Schistosoma mansoni||Hookworm||Anemia|
|Country||Follow up rate||Changes in prevalence||Changes in intensity||Changes in prevalence||Changes in intensity||Changes in prevalence||Changes in intensity||Changes in prevalence||Changes in mean haemoglobinemia|
|Mali||58% over two years||About 90% at baseline to about 50% at two years||About 30% prevalence of heavy-intensity infections at baseline to about 3% at one year||About 21% at baseline to about 13% at two years||Not reported||About 7% at baseline to about 2% at two years||Not reported||Not reported||Not reported|
|Tanzania||65% at one year||Not reported||Not reported in aggregate; about 3-52% at basline to 2-10% at follow up||Not reported||Not reported||39.81% at baseline to about 17.36% at one year||Not reported||47.15% at baseline to about 32.97% at one year||Not reported|
"Zambia has been less successful in reaching its original programme target of expanding coverage to treating 2 million school-aged individuals and had only achieved, according to incompletely reported coverage, around 25% of this target by July 2007." Fenwick et al. 2009, Pg 9.
"In order to demonstrate in more detail an on-going monitoring and evaluation process within a designated country supported by SCI we have taken the example of Liberia (see below)." Schistosomiasis Control Initiative report to GiveWell (September 2013), Pg 11. Data on Pgs 12-14.
"Who has been treated (adults/school children/pre-school children):
Burundi: For STH: children 1-14 yrs, pregnant women under 49 yrs; For schisto: children 5-14 yrs, adults in high prevelance areas…
Malawi: School aged children 4.4 m and adults 1.2 m…
Senegal: MDA in April 2012 - private and public schools, islamic schools (called Dahara) and communities…
Uganda: Communities on Lake Victoria islands…
Yemen: Children and adults…
Zimbabwe: Predominantly school aged children but adults if justified."
Schistosomiasis Control Initiative, Program update (September 2012), sheet “By county 2012”.
"Withholding of the data by the health unionists since 2010. Negotiation was started during the meetings and the great importance of the MDA had was also highlighted as well as the negative consequences the MoH might have to face regarding the future of partnership, in case of not being able to get data and reports."; "Due to health information withholding, it was impossible to collect all data." Government of Senegal Report on MDA (2012) Pgs 10 and 12.
Date of MDA (April 2012) from Schistosomiasis Control Initiative, Program update (September 2012).
"As part of the national control programme, a longitudinal cohort of individuals will be recruited in order to help monitor the health impact of the programme. These individuals (mostly school-aged children) will be taken from a representative sample of areas across the country, with the size of the cohort estimated using a statistical sample-size calculator. These individuals will be followed up prior to mass treatment at baseline and every year in order to provide an estimate of the impact of the control programme on those people who receive treatment." Schistosomiasis Control Initiative report to Ethiopia donor (August 2013), Pg 3.
"Single-dose oral therapies can kill the worms, reducing ... infections by 99 percent ... Reinfection is rapid, however, with worm burden often returning to eighty percent or more of its original level within a year ... and hence geohelminth drugs must be taken every six months and schistosomiasis drugs must be taken annually." Miguel and Kremer 2004, Pg 161.
See table "Funding for mass treatment | Have we seen disease prevalence/intensity or morbidity results?" in previous footnote.
"Drug distribution channels:
Drug distributors need a minimum of one day’s training to understand the basis for calculating dosages, the necessary actions to deal with side-effects and treatment record keeping and reporting." Schistosomiasis Control Initiative, Neglected tropical diseases in Mozambique, Pg 23.
"For schistosomiasis and STHs, treatment will be conducted through schools by the teachers. For LF, treatment will be conducted through community directed treatment, by the CDDs and community health agents, managed by the district medical officer." Schistosomiasis Control Initiative, Proposal by SCI, Imperial College to manage the Program for Integrated Control of Neglected Tropical Diseases in Côte d'Ivoire, Pg 23.
See our overview of priority programs.
“This was a retrospective study which covered a two year period from April 2004 to May 2006, including the first and second years of MDA and related programme activities in four health districts. All data on first year costs at national, regional, district, and sub district levels were taken from the PNLBG accounts and receipts and records of staff missions or activities. Second year cost data for national and regional level activities were taken from receipts. District and sub district, school and community MDA resource use data for 2005 were collected in June 2006 through a retrospective survey…
The main cost elements include: the programme specific expenditure; the opportunity cost or value of government contributions related to in-kind costs of using local government staff and vehicles and the value of CDD’s time (taken as the daily agricultural labour rate); and the international costs of programme co-ordination, reporting and technical support." Leslie et al. 2011, Pg 3.
Two examples of how the area of study may not be representative of all areas in which SCI works:
Leslie et al. 2011, Pg 5.
It is our understanding from the paper and our past conversations with SCI that "programme expenditure" was fully funded by SCI. It is also our understanding that "international tech. support" refers to SCI staff time and travel costs; we're somewhat less confident in this than in the former understanding. Government costs are "related to in-kind costs of using local government staff and vehicles and the value of CDD’s time (taken as the daily agricultural labour rate)." Leslie et al. 2011, Pg 3.
Calculating non-SCI costs of school-based delivery:
More in our October 2013 update on SCI