Identifying Entry Points for Integrated Disease Control Programs and Effective Prevention and Control Strategies for Malaria and Schistosomiasis in Tanzania and Benin

Malaria and schistosomiasis are two diseases that are preventable, treatable, and affect people living in vulnerable circumstances - in particular, young children in rural areas of sub-Saharan Africa. Yet, in sub-Saharan Africa in 2021, there were an estimated 237 million malaria cases and 226 million people requiring preventative treatment for schistosomiasis. Important prevention and control strategies for malaria include long-lasting insecticidal nets, access to early diagnostics and treatment with artemisinin-based combination therapy, among others; while prevention and control strategies for schistosomiasis primarily focus on mass drug administration campaigns that deliver praziquantel tablets without prior diagnosis to at-risk populations [23-26]. There is a critical need to revise and optimize current disease prevention and control strategies for malaria and schistosomiasis to meet the goals set out by the Sustainable Development Goals - especially given that current strategies are vulnerable to disruptions such as those experienced during the COVID-19 pandemic. This doctoral thesis aimed to understand population vulnerabilities, infection exposures and risk factors for malaria and schistosomiasis to inform targeted, and possibly integrated, interventions using two mixed-methods studies in two different settings (Tanzania and Benin) and a scoping review. We found that malaria and schistosomiasis overlap geographically and co-infect the same people living in vulnerable circumstances in the Mwanza Region of Tanzania, and that there remains widespread exposure to both diseases despite ongoing prevention and control efforts. The results from the study in Benin demonstrate that malaria prevention and control strategies are vulnerable to disruptions and there is a need to emphasize the importance of sustaining malaria control interventions during health emergencies. The results from the scoping review concludes that there is an opportunity to link control programs to increase access and coverage of interventions to improve outcomes for malaria, schistosomiasis, and their co-infection. We suggest that current prevention and control measures for malaria and schistosomiasis are not sufficient in reducing disease exposures and propose to combine interventions within and between disease prevention and control programs to increase program resiliency.