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Historically, open shorelines of Lake Malaŵi were free from schistosome, Schistosoma haematobium, transmission, but this changed in the mid-1980s, possibly as a result of over-fishing reducing density of molluscivore fishes. Very little information is available on schistosome infections among people in lake-shore communities and therefore we decided to summarise data collected from 1998 to 2007. Detailed knowledge of the transmission patterns is essential to design a holistic approach to schistosomiasis control involving the public health, fisheries and tourism sectors. On Nankumba Peninsula, in the southern part of the lake, inhabitants of villages located along the shores of Lake Malaŵi have higher prevalence of S. haematobium infection than those living in inland villages. Overall prevalence (all age classes combined) of urinary schistosomiasis in 1998/1999 ranged from 10.2% to 26.4% in inland villages and from 21.0% to 72.7% in lakeshore villages; for school children prevalence of infection ranged from 15.3% to 57.1% in inland schools and from 56.2% to 94.0% in lakeshore schools. Inhabitants on the islands, Chizumulu and Likoma, also have lower prevalence of infection than those living in lakeshore villages on Nankumba Peninsula. This increased prevalence in lakeshore villages is not necessarily linked to transmission taking place in the lake itself, but could also be due to the presence of more numerous typical inland transmission sites (e.g., streams, ponds) being close to the lake. Temporal data witness of intense transmission in some lakeshore villages with 30-40% of children cleared from infection becoming reinfected 12 months later (also lakeshore village). The level of S. mansoni infection is low in the lakeshore communities. Findings are discussed in relation to fishing in the lake.

Health impact assessment (HIA) practice has expanded across the world, since it was established more than two decades ago. This paper presents a snapshot of current global HIA practice based on the findings of an online questionnaire survey. HIA practitioners from all world regions were invited to participate. A total of 122 HIA practitioners from 29 countries completed the survey, following a broad international outreach effort. The large variety in the types of HIAs conducted, and the application of HIA in various fields reported by respondents, demonstrates that HIA practice has evolved over the past two decades. Although differences in the use of HIA were reported across world regions, an overall increasing trend in global HIA practice can be observed. In order to sustain this upward trend, efforts are needed to address the main barriers in the utilisation of HIA. The establishment of new national and international HIA teaching and training offerings seems to be an obvious strategy to pursue along with the strengthening of policies and legal frameworks that specify the circumstances, under which HIA is required, and to what extent.

Background Mass drug administration (MDA) is one of the key interventions recommended by WHO for prevention and control of neglected tropical diseases (NTD). In Malawi, MDA is widely carried out annually since 2009 for prevention and control of schistosomiasis and soil-transmitted helminths (STH). No study has been carried out to assess effectiveness of the MDA approach and to document perceptions of health providers and beneficiaries regarding use of MDA. This study was done to understand how well MDA is being implemented and to identify opportunities for improvement in MDA delivery in Malawi. Methods Designed as a cross-sectional and multi-methods research, the study was carried out in three southern Malawi districts of Chiradzulu, Mangochi and Zomba. In each district, four health centres and 16 villages were randomly selected to participate. A mixed-methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices assessments; and qualitative data for assessing perceptions of health providers and beneficiaries regarding MDA was used. Quantitative data were processed and analyzed using IBM SPSS software version 26 while qualitative data were analysed using NVivo 12 for Windows. Results Knowledge levels about schistosomiasis and STH in the districts varied according to disease aspects asked about. Majority are more knowledgeable about what schistosomiasis is (78%) and whether STH are treatable with drugs (97%); with least knowledgeable about the organism that transmits schistosomiasis (18%), types of schistosomiasis (11%) and what causes STH (20%). In 2018 and 2019 the districts registered high coverage rates for praziquantel and albendazole using community-based MDA (73–100%) and using school-based MDA (75–91%). Both the health authorities and community members perceived the MDA approach as good because it brings treatment closer to people. Conclusion With the high MDA coverage obtained in communities and schools, the effectiveness of MDA in the target districts is satisfactory. There are, however, several challenges including disproportionate knowledge levels, which are hampering progress towards attainment of the 2030 global NTD goals. There is a need for promotion of community participation and partnerships as well as implementation of other recommended interventions for sustainable prevention and control of schistosomiasis and STH.

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