# Schistosomiasis Control Initiative - November 2012 Update

## Summary

• SCI has committed to spend the majority of the unrestricted funds it has received to assist Ethiopia to start a new national deworming program. Other funders will also be contributing to the program (more).
• SCI has also used unrestricted funds to support other new national programs, to contribute additional funds to country programs funded by the United Kingdom's Department for International Development (DFID), and on its own operational costs (more).
• For the money it has spent, we do not yet feel that we have a concrete understanding of the impact that additional funds had on the success of the projects they supported (more). We have obtained plans for future evaluations and hope to know more in the future, but the full process from committing funding to executing programs to collecting data on them can take years (more).
• We have substantial uncertainty about some of the information presented in this report. This is due to a combination of the fact that (a) SCI's plans have been somewhat fluid (we do not consider this a bad thing and have encouraged unrestricted funding to allow SCI flexibility) and (b) we have continued to struggle to communicate with SCI (more).

Bottom line on SCI: We expect to fully refresh our rankings at the end of 2012. We have not yet determined SCI's precise ranking but expect it to remain among our top charities.

Published: November 2012

## Note on reliability of information in this report

We have been following SCI’s progress since we recommended it in November 2011. We have at times struggled to communicate with SCI, and some of the material that we've received from SCI has been inconsistent (details in footnote).1

The report below presents the most accurate view we've been able to form about how SCI has spent and plans to spend unrestricted funding. Where spending figures conflicted, we have relied on an expenditure report SCI provided as we believe this to be more reliable than a program update that SCI compiled at our request.2

## Activities funded with unrestricted funds to date

The table below provides a summary of the unrestricted funds that the Schistosomiasis Control Initiative (SCI) has received (or was already holding) since GiveWell recommended SCI in November 2011. In brief, SCI has had approximately $2.9 million of which it has spent approximately$640,000 and has allocated (but not yet spent) $1.37 million.3 Unrestricted funds received, spent and committed since November 2011 (some figures are approximated)4  Total unrestricted funds held (as of Nov 2011) and received (Nov 2011 to Oct 2012)$2,850,796 Total spent (Nov 2011 to Oct 2012) $637,003 Total committed (as of Oct 2012)$1,374,600 Total committed + spent $2,011,603 SCI told us that it has spent (and plans to spend) these funds in three main categories:5 1. Starting new deworming programs in countries where SCI has not worked before. SCI hopes that by using unrestricted funds to get national treatment programs started in these countries, it will attract large grants from major donors, such as the UK's Department for International Development (DFID), to continue the programs.6 2. Supplementing restricted funding in the set of countries supported by a grant from DFID. 3. Funding a variety of organizational costs including the salary of a staff member and staff travel.7 The table below breaks down funds SCI has spent or committed to each category. Approximately 41% of the money SCI has spent has gone to category 1 (new countries), 32% to category 2 (DFID-funded countries), and 27% to category 3 (SCI's operations). All of SCI's committed funds are for category 1 countries.8 SCI use of unrestricted funds by category Spending category Spent Committed Total Non-DFID-funded country$260,817 $1,374,600$1,635,417
DFID-funded country $201,450$0 $201,450 Operational$174,735 $0$174,735
TOTAL $637,003$1,374,600 $2,011,603 Country-level details of how SCI has spent these funds are available in this footnote.9 Of the$1.374 million committed to non-DFID-funded countries (in the table above), SCI has told us that it intends to spend almost $1.2 million (almost 60% of all the unrestricted funds it has received since November 2011) supporting new programs (category 1) in Ethiopia and Zimbabwe. It intends to spend$158,000 on gathering baseline data and mapping (i.e., determining which areas have high levels of schistosomiasis and need to be treated) in Zimbabwe (update: these funds have been transferred to Zimbabwe10) and $316,000 on mapping and$711,000 on delivering treatments in Ethiopia.11 SCI notes that Ethiopia is likely to receive support for its program from other donors, including the Partnership for Child Development, Dubai Cares and possibly the Children's Investment Fund Foundation (CIFF), the UK government, and Save the Children. Local partners will include the Ethiopian Health and Nutrition Research Institute (EHNRI).12

The rest of the $1.374 million listed in the table above is accounted for by commitments to spend about$95,000 on each of (a) distributing a second round of donated drugs in Senegal, and (b) starting a national schistosomiasis control program in Mauritania.13 SCI is not yet able to say when these funds will be spent, due to the complexities of receiving approval for its plans at multiple levels of government,14 and we will be following up on this in future updates.

## Evaluation of previously funded activities

Above, we detail how SCI has spent and plans to spend additional unrestricted funds. Below, we discuss the information we have seen on progress on SCI's programs.

At this point, we do not have a concrete sense of the impact of the programs that SCI has funded with the unrestricted funds it has received since November 2011. Partly this is because the full process from committing funding to executing programs to collecting data on them can take years.

Ethiopia

This year, SCI has spent about $51,000 on its work to start a national deworming program in Ethiopia, including$13,000 to support a deworming conference in March that SCI saw as the first step towards building a program there and $25,000 on a stakeholders' meeting in July.15 SCI currently plans to significantly scale up spending there, implying to us that SCI (with other partners, including the World Health Organization16) has been successful in advocating for the creation of a larger scale deworming program in the country. (We will be following the progress of this program closely.) SCI shared with us a non-public trip report from a staff member's visit to Ethiopia.17 The report provides insight into the interactions between SCI, government, and other actors, as well as some information on the progress of the program. Other new programs Yemen: We reported in our last update on SCI that SCI has made a grant of$100,000 to Yemen. SCI told us that in Yemen, funding was expected to be available from the World Bank for 2010-2011, but because of instability in the country, funding was delayed and SCI funded the first round of treatment with unrestricted funds.18 Yemen plans to conduct a study of schistosomiasis prevalence "using cluster sampling," and SCI plans to conduct a survey of "knowledge, attitudes, and practices" and a study comparing the "effectiveness of mobile and school-based interventions" in the country.19 SCI's future work in Yemen will be as a technical partner and its research work will be funded by the World Bank.20

Senegal: We reported in our last update on SCI that SCI had made a grant of $80,000 to Senegal. SCI provided a non-public report on a staff member's visit to Senegal to observe the April 2012 mass drug distribution. The staff member visited distribution sites and reported on problems observed.21 SCI also shared a government report on the distribution, which provides treatment coverage data for part of the area that received SCI-funded treatments and notes that not all data is available because some has been withheld by health workers who are involved in a labor dispute.22 Tanzania: In March 2012, SCI told us that it planned to grant$25,000 from unrestricted funds to Tanzania to treat 153,000 students.23 SCI told us that this transfer occurred and that the treatments were completed.24 The grant does not appear on SCI's list of expenditures in January to October 2012.25

Additional monitoring and evaluation: Trip reports

SCI has provided trip reports from SCI staff visits to Burundi (funded by a private donor), Senegal, Ethiopia, Cote d'Ivoire, and Malawi.26 The reports provide insight into the interactions between SCI, governments, and other actors, as well as some information on the progress of the programs. The Burundi and Senegal reports provide some evidence that SCI is informally auditing its programs for problems27 (note that we have these two examples of such "informal audits," which may not be representative of SCI's visits to other countries or to these countries on other occasions). SCI has told us that it will continue to send trip reports to us as it completes them.

Plans for future monitoring and evaluation

DFID-funded countries. SCI shared a draft report it is preparing for DFID detailing progress in each of the eight countries in which DFID is funding schistosomiasis control.28 SCI plans to collect the following data in each country:

• Coverage surveys to check the accuracy of reported treatment coverage rates and to determine the reasons why those not covered did not receive treatment.29
• Prevalence of heavy and moderate infection studies: Cross-sectional and cohort studies in selected schools to measure changes over time in the percentage of children with heavy and moderate infections.30
• Morbidity studies: In the same sample, SCI will monitor signs of morbidity that may be affected by the parasites. Specifically it will collect data on the prevalence of:31
• Anemia and severe anemia
• Haematuria (blood in the urine)
• Stunting (undernutrition as measured by height for age) and wasting (undernutrition as measured by weight for height)

SCI has collected or is in the process of collecting baseline data for the prevalence and morbidity studies in Cote d'Ivoire, Liberia, Malawi, and Mozambique, and is planning baseline data collection in Zambia.32 It does not plan to collect baseline data in Tanzania (SCI states that good historical baseline data is already available)33 or in Niger or Uganda (where treatment programs have been ongoing).34 We have not yet seen the baseline data that SCI has collected.

Other countries. Monitoring plans for other countries include:35

• A treatment coverage survey which was scheduled to take place in Burundi at the end of September 2012.
• A “KAP” (knowledge, attitude, practice) survey in Yemen.36 We do not know when results from this study will be available.

SCI has not yet developed plans for monitoring and evaluating programs in Ethiopia, DRC and Zimbabwe. In Ethiopia, a government agency will be responsible for monitoring and evaluation.37 We have not seen monitoring plans for Rwanda (SCI is waiting for the government to sign a memorandum of understanding before moving forward38) or Kenya.

## Future plans for using unrestricted funds

This information is from SCI’s program update39 and from our conversation with SCI in August.40 We note that SCI's plans have been somewhat fluid to date. We do not consider this a bad thing and have encouraged unrestricted funding to allow SCI flexibility.

• SCI aims to establish a national schistosomiasis and STH treatment program in Ethiopia. We do not know the overall cost to SCI of this program.
• SCI has pledged to deliver 1 million treatments in Zimbabwe. It expects to spend $200,000 on the program in the next 12 months, which may include the$160,000 for mapping noted above.
• SCI believes that DFID funding for Cote d'Ivoire, Mozambique, Malawi, and Tanzania is not sufficient and it may allocate unrestricted funding to deliver additional treatments in these countries.
• SCI is considering allocating funding for monitoring and evaluation of a treatment program in Yemen that is funded primarily by the World Bank.
• SCI is considering funding NTD education for university students and water and hygiene work in Burundi.

## Sources

• Fenwick, Alan. SCI Director. Email to GiveWell, March 29, 2012.
• Fenwick, Alan. SCI Director. Email to GiveWell, September 12, 2012.
• Fenwick, Alan. SCI Director. Email to GiveWell, October 15, 2012.
• Fenwick, Alan. SCI Director. Email to GiveWell, November 7, 2012.
• Fenwick, Alan. SCI Director. Email to GiveWell, November 8, 2012.
• Fenwick, Alan. SCI Director. Phone conversation with GiveWell, August 13, 2012.
• GiveWell. SCI financial details and summary (November 2011 to October 2012) (XLS).
• Government of Senegal. Report on MDA (2012).
• Schistosomiasis Control Initiative. Expenditures (January to August 2012) (XLS).
• Schistosomiasis Control Initiative. Field trip report: Burundi (June 2012). SCI has asked us to keep this document confidential.
• Schistosomiasis Control Initiative. Field trip report: Cote d'Ivoire (October 2012). SCI has asked us to keep this document confidential.
• Schistosomiasis Control Initiative. Field trip report: Ethiopia (June 2012). SCI has asked us to keep this document confidential.
• Schistosomiasis Control Initiative. Field trip report: Malawi (October 2012).
SCI has asked us to keep this document confidential.
• Schistosomiasis Control Initiative. Field trip report: Senegal (April 2012). SCI has asked us to keep this document confidential.
• Schistosomiasis Control Initiative. Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd annual report (October 2012 draft). SCI has asked us to keep this document confidential until a final version is available.
• Schistosomiasis Control Initiative. Newsletter (November 2012) (PDF).
• Schistosomiasis Control Initiative. Mauritania: Summary of the current situation (October 10, 2012) (DOC).
• Schistosomiasis Control Initiative. Program update (September 2012) (XLS).
• Yemen National Schistosomiasis Control Program. Joint NSCP/WHO/WB/SCI EMTR meeting - Actions (September 28, 2012). SCI has asked us to keep this document confidential.
• 1.

Examples include:

• In one report, SCI stated that it had spent $27,000 on the DRC program on laboratory materials: Haemastix ($25,000) and Kato Katz kits ($2,000) (Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By County 2012). In its spending report for the first eight months of 2012, SCI reported that it had spent £1,329 (about$2,100) in DRC (Schistosomiasis Control Initiative, "Expenditures (January to August 2012)"). When we asked SCI to clarify, "The program update you sent indicates that SCI has spent $27,000 on lab materials. The expenditure report indicates that SCI has spent$2,100 in DRC." SCI replied, "a typo – there should have been a 7 – $27,100" (Alan Fenwick, email to GiveWell, September 12, 2012). However, the figure SCI had provided was in pounds, which we converted to dollars, so a missing ‘7’ could not account for the discrepancy. • In its spending report, SCI reported that it had committed £200,000 (about$320,000) for disease mapping in Ethiopia (GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.). In a report SCI sent to us before it sent the spending report, it stated that it has committed $100,000 for disease mapping in Ethiopia (Schistosomiasis Control Initiative, "Program Update (September 2012)," By Country Plans). When we asked SCI for clarification, it repeated the$100,000 figure (Alan Fenwick, email to GiveWell, September 12, 2012). There were two additional discrepancies in funding committed to the Ethiopia program in the two reports; these could be explained by a misstatement of the currency for the figures.
• We asked SCI for details on each of the countries in which it works, including the source of funding for each. In SCI’s response to this request, it indicated that unrestricted funding had been used in two countries: Ethiopia and the Democratic Republic of the Congo (DRC) (Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By Country 2012). Later, SCI sent a report on its spending of unrestricted funding in 2012. This report showed that SCI has spent unrestricted funds in eight countries, and spending in Ethiopia and DRC accounted for a small percentage of total unrestricted spending (Expenditure report: GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.). Because we received the spending report toward the end of our research for this update, we have not investigated the details of how the other 85% was spent (we only have the name of the country in which these funds were spent, not details of how the funds were spent within the country).
• SCI reports that it spent £32,139 (about $51,000) on its work in Ethiopia in the first 10 months of 2012 (GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.). When we asked SCI for details of what this had been spent on, SCI specified two budget items for$13,000 and $25,000, respectively, leaving about$18,000 unaccounted for (Schistosomiasis Control Initiative, "Program Update (September 2012)").
• We requested more detail on SCI's spending. SCI sent us list of expenditures by vendor (GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheets L24009 expenditure and P10099 expenditure). It was difficult to determine the purpose (purchase of PZQ to treat schistosomiasis, grant to the government of Senegal to deliver drugs, etc.) of these expenditures from these lists. As SCI had provided a summary of how much it had spent for each country program, we asked SCI: "You note below that you have categorized country-level expenditures by country and then summed them for the expenditure report you sent us. Would you be able to send us these details that you compiled, i.e. a list of expenditures and what country they each belong to?" In response, SCI re-sent the country-level summary information (GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6).
• 2.

Expenditure report: GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.
Program update: Schistosomiasis Control Initiative, "Program Update (September 2012)."

• 3.

GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.

• 4.

For details, see GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)."

• 5.

Spending allocation in GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary. List of expenditures by broad category in same source, Sheet Totals. More detail on each program in Schistosomiasis Control Initiative, "Program Update (September 2012)." Details from Alan Fenwick, phone conversation with GiveWell, August 13, 2012.

• 6.

Alan Fenwick, phone conversation with GiveWell, August 13, 2012.

• 7.

See our April 2012 update on SCI.

• 8.

GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.

• 9.

Data from:

• GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6. This is report on expenditures in January to October 2012 and spending commitments as of October 31, 2012.
• Schistosomiasis Control Initiative, "Program Update (September 2012)."

Expenditures:

• $100,000 granted to Yemen to fund the first year of a delayed World Bank funded schistosomiasis mass drug administration program. • About$84,000 in Liberia. Liberia is also supported by a grant from DFID. SCI told us that it has supported mapping and 17,400 treatments in the country. We do not know what role unrestricted funds played in the country.
• About $82,000 to deliver donated drugs in Senegal. • About$47,000 in Cote d'Ivoire. SCI funded treatments in 3 districts in March 2012. Cote d'Ivoire is also supported by a grant from DFID. We do not know what role unrestricted funds played in Cote d’Ivoire.
• About $51,000 in Ethiopia. This includes$37,000 for two meetings with the government and other stakeholders. We do not know what the other funding was spent on.
• About $34,000 in Mozambique. SCI's program update notes that SCI funded mapping and treatment for 3.5 million people in the country. Unrestricted funding supplemented funding from DFID. We do not know what role unrestricted funds played in the country. • About$32,000 in Niger. We do not know what this was used for, though the amount roughly matches the amount that a donor had requested SCI spend on hydrocele surgeries (a symptom of lympathic filarisis) in the country. ("Niger hydrocoele treatments: £25,000.00." Schistosomiasis Control Initiative, "IC Trust Summary (September 2011)." £25,000 is worth about $39,500, using the exchange rate in GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Summary.) • About$28,000 in the Democratic Republic of the Congo (DRC) on laboratory materials.
• About $4,200 on “equipment” for Malawi. SCI has also spent$400,000 from DFID in Malawi this year.
• About $74,000 on general SCI costs, including advocacy, fundraising, staff salaries, and staff travel. This figure is estimated: we have totals for this category for November 2011 to March 2012 and from January to October 2012, and have estimated the size of the overlapping amount. • 10. Alan Fenwick, email to GiveWell, October 15, 2012. • 11. GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6. Converted to USD in Sheet Summary. • 12. Alan Fenwick, email to GiveWell, November 8, 2012. • 13. "Mauritania: SCI has committed$64,000 for mass drug administration (MDA) in areas where prevalence is 30% and above. This will include training of health workers, mobilisation and sensitisation of the population, monitoring & evaluation.
Senegal: Following on from the successful delivery of 400,000 treatments in April 2012 of donated drugs that were about to expire, SCI has committed \$60,000 over the next 6 months to support the development of a national programme." Schistosomiasis Control Initiative, "Newsletter (November 2012)," Pg 4.
Updated commitment amounts from Alan Fenwick, email to GiveWell, November 7, 2012.

• 14.

Alan Fenwick, email to GiveWell, October 15, 2012.

• 15.

Schistosomiasis Control Initiative, "Program Update (September 2012)."

• 16.

Alan Fenwick, email to GiveWell, November 8, 2012.

• 17.

Schistosomiasis Control Initiative, "Field Trip Report: Ethiopia (June 2012)."

• 18.

Alan Fenwick, phone conversation with GiveWell, August 13, 2012.

• 19.

"Proposal in Schisto prevalence in Yemen using cluster sampling: NSCP.
Design KAP study and budget: SCI.
A study on the comparison of effectiveness of the mobile and school based interventions: SCI."
Yemen National Schistosomiasis Control Program, "Joint NSCP/WHO/WB/SCI EMTR Meeting - Actions (September 28, 2012)," Pgs 3 and 6.

• 20.

Alan Fenwick, email to GiveWell, November 8, 2012.

• 21.

Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."

• 22.

"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. " (pg 10) "Due to health information withholding, it was impossible to collect all data." Government of Senegal, "Report on MDA (2012)," Pg 12.

• 23.

Alan Fenwick, email to GiveWell, March 29, 2012.

• 24.

Alan Fenwick, phone conversation with GiveWell, August 13, 2012.

• 25.

GiveWell, "SCI Financial Details and Summary (November 2011-October 2012)," Sheet Email from SCI Nov 6.

• 26.

Schistosomiasis Control Initiative, "Field Trip Report: Burundi (June 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Ethiopia (June 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Cote d'Ivoire (October 2012)."
Schistosomiasis Control Initiative, "Field Trip Report: Malawi (October 2012)."

• 27.

Examples of problems and potential problems identified in the Burundi report:

• "Every supervisor at the district and commune level is given 20 litres per day, which means that probably certain sites that are far from the district health administration office may never be checked, even by the community supervisors." Pg 4.
• "I decided to go to this school because of the results from the impact survey suggested a poor decrease of prevalence in the past. […] IMPORTANT NOTE: the teacher said that the school received drugs every time there was vaccination going on, so NOT twice a year, but once a year. When questioned she said that possibly the distribution was twice a year, but she repeated that it was done always when a vaccination was on going […] Hence this means that this schools possibly had only MDA in June and never in Dec, so the children received ALB only once a year. I came away unsure. And since the last measles vaccine was done in 2009, it could mean that this school has possibly received drugs only 2 times in 3 years! To be investigated…" Pgs 5-6.
• "Important to discuss with the team how to get the true answer from women – it is well known that they do not take drugs, but it is not known why they do not take drugs. According to Onesime they might give a false answer and say that they did take drugs, a factor that would invalidate the coverage results from the survey." Pg 7.

Schistosomiasis Control Initiative, "Field Trip Report: Burundi (June 2012)."
Examples of problems and potential problems identified in the Senegal report:

• "The only concern raised by the head of this district was that there was not sufficient MBZ because migration from nearby districts for seasonal activities had increased substantially the population eligible for treatment. However as a result of this migration, other districts were left with extra MBZ, as their target population decreased." Pg 2.
• "No forms for the recording of side effects was available on site." Pg 3.
• "Supervisors were supposed to be there on the days of the distribution but considering that the administration happened in one day, the supervision could not occur." Pg 3.
• "The head of the district department of health mentioned a problem that is affecting a few schools: teachers were demanding extra payments for administering drugs to children, and were not going to do the work if not paid. Dr Conte intervened promptly to try to enforce drug distribution in these schools – hopefully the problem will be solved in the next few days." Pg 3.
• "Some children vomited the drugs – this was a problem as these children could not be persuaded to take drugs on the same day – the only option: to contact these children after a few days to try again to administer PZQ." Pg 3.
• "In his district, as well as in a few others, nurses were on strike and although they accepted to administer drugs to children, they might not release the information to the MoH at the end of the campaign." Pg 3.

Schistosomiasis Control Initiative, "Field Trip Report: Senegal (April 2012)."

• 28.

Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)."

• 29.

"Coverage validation surveys are essential to validate the routine reporting of treatment numbers from the MDA and provide a true estimate of the proportion of individuals reached at national level. ICOSA has developed a coverage validation survey protocol and questionnaire which will:

• Assess the reported programme coverage and provide an independent coverage verification
• Determine gender‐specific coverage
• Assess proportions of both enroled and non-enroled school age children reached by the MDA
• Quantification of the reasons why those not covered did not receive treatment at the time of MDA.
• Offer an opportunity to collect other information surrounding MDA such as the most frequently used communication method by the eligible treated and untreated population.

Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 25.

• 30.
• On study design: "ICOSA evaluation of the health impact of the programme will use concurrent longitudinal and cross-sectional studies. The monitoring surveys include important baseline data collection and a series of follow-up surveys. A longitudinal survey design requires a baseline data collection prior to the initiation of large-scale distribution of PZQ and ALB/MBZ within schools to be targeted, and is therefore only possible in those districts where PCT has not yet started. Follow up surveys are conducted immediately prior to the treatment for the life of the programme to monitor the impact of the health intervention… The longitudinal study will follow a cohort of randomly sampled primary Standard 1, 2 and 3 (nominally 6, 7 and 8-year-olds) recruited at baseline, carrying out annual measurement. The aim of the longitudinal study is to monitor prevalence, intensity and morbidity over the course of PCT rounds. The cross-sectional study will recruit new Standard 1 pupils every year. The aim of the cross-sectional study is to monitor levels of transmission in the non‐treated population."
• Indicators:
• "Percentage of heavily infected children with S. mansoni: Number of children with ≥400 eggs per gram in their stool / total number of children tested
• Percentage of moderate infected children with S. mansoni: Number of children with between 100 and 399 eggs per gram in their stool / total number of children tested
• Percentage of heavily infected children with S. haematobium: Number of children with more than ≥50 eggs per 10ml in their urine / total number of children tested"

Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 27-28.

• 31.

Study design described in previous footnote.
"Morbidity indicators:

• Anaemia: Average level of haemoglobin measured in school children after implementation of large‐scale distribution of PZQ compared to average level of haemoglobin detected in school‐aged children prior to initiation of the large‐scale distribution of PZQ
• Percentage of children with anaemia: Number of anaemic children (Hb Percentage of children with severe anaemia: Number of children with Hb Haematuria: Levels of haematuria detected in school‐aged children after implementation of large‐scale distribution of PZQ compared to levels of haematuria detected in school‐ aged children prior to initiation of the large‐scale distribution of PZQ
• Percentage of stunting: Number of children exhibiting stunting/total number of children measured for height and age.
• Percentage of wasting: Number of children exhibiting wasting/total number of children measured for height, weight and age.

When measuring these indicators, they will inevitably be confounded by a number of other interventions. A variety of different diseases will all impact on height, weight and anaemia. However reduction of prevalence and intensity of SCH can be solely attributed to MDA."
Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.

• 32.

"Group 1:

• Cote D’Ivoire: Baseline data collection to be conducted after mapping complete in new intervention areas
• Liberia: Baseline data collection is currently in progress  Malawi: Results of baseline data being analysed. 2,750 children from 22 schools in 10
districts (randomly selected) will be followed annually.

Group 2:

• Mozambique: Baseline data collection is currently in progress
• Tanzania: Good historical baseline data is already available.
• Zambia: Baseline data will be collected following mapping and prior to MDA."

Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.

• 33.

Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 28.

• 34.

"For Group 3 countries (Niger and Uganda), M and E activities that were started 6 years ago have already shown the impact of long term control." Schistosomiasis Control Initiative, "Integrated Control of Schistosomiasis and Intestinal Helminths in sub‐Saharan Africa (ICOSA): 2nd Annual Report (October 2012 Draft)," Pg 29.

• 35.

Schistosomiasis Control Initiative, "Program Update (September 2012)."

• 36.

Yemen National Schistosomiasis Control Program, "Joint NSCP/WHO/WB/SCI EMTR Meeting - Actions (September 28, 2012)."

• 37.

Schistosomiasis Control Initiative, "Program Update (September 2012)."

• 38.

Alan Fenwick, email to GiveWell, October 15, 2012.

• 39.

Schistosomiasis Control Initiative, "Program Update (September 2012)," Sheet By Country Plans.

• 40.

Alan Fenwick, phone conversation with GiveWell, August 13, 2012.