Inside Rwanda’s Strategy to Eliminate Bilharzia and Intestinal Worms

Rwanda has intensified efforts to eliminate bilharzia and intestinal worms through community-based, sustainable interventions, as part of a broader national commitment to eradicate Neglected Tropical Diseases (NTDs) by 2030.

At the center of these efforts is a targeted initiative known as Interruption of Transmission (IoT), currently being implemented in Bugesera and Ruhango districts, areas selected for their relatively low prevalence rates to allow faster, measurable impact before scaling up nationwide.

According to Eric Saramba, the NTDs Coordinator at the Rwanda NGO Forum on AIDS and Health Promotion (RNGOF), the IoT project focuses specifically on halting the transmission of bilharzia and intestinal worms, two of the nine NTDs Rwanda has pledged to eliminate.

“The Interruption of Transmission project aims to stop the spread of intestinal worms and bilharzia in Bugesera and Ruhango by 2027. Once we succeed, we will share best practices with other districts, supporting the national goal of elimination by 2030,” Saramba said.

Understanding Bilharzia and Its Impact

Bilharzia, also known as schistosomiasis, exists in two main forms. One type affects the intestines and is caused by Schistosoma mansoni, while the other affects the urinary system, known as Schistosoma haematobium, often identified by blood in urine.

The disease is transmitted through contact with freshwater contaminated by parasites released by infected snails, commonly found in marshlands and wetlands where farming activities are widespread.

Globally, bilharzia kills an estimated 200,000 people every year, making it the second deadliest disease in Africa after malaria. In Rwanda alone, the Rwanda Biomedical Centre (RBC) has identified bilharzia cases in 1,013 administrative cells, representing 47 percent of all cells nationwide.

Progress Through Community Ownership

The IoT project, now midway through its three-year implementation, has recorded encouraging progress, driven largely by community engagement and capacity building.

Saramba emphasized that sustainability begins with empowering citizens rather than relying solely on medical treatment.

“Our first partner is the citizen. We equip communities with long-term skills through training, so prevention becomes part of daily life,” he said.

So far, the project has trained 308 youth, 490 community health workers and opinion leaders, 125 laboratory personnel, 502 religious leaders, and 86 journalists. In addition, 597 community members have received specialized training in snail control and management, a key intervention in breaking the transmission cycle of bilharzia.

All these figures apply exclusively to Bugesera and Ruhango districts, with training activities still ongoing.

Why Bugesera and Ruhango?

The two districts were deliberately selected because of their lower disease prevalence compared to other high-burden areas such as Burera and Rubavu, where intestinal worm prevalence can reach up to 80 percent.

“In Bugesera, prevalence stands at around 16 percent. Starting where prevalence is lower allows us to see faster results and refine our model before expanding,” Saramba explained.

Addressing Sanitation Gaps in Marshlands

Assessments conducted under the project revealed critical sanitation gaps, particularly in marshlands used for agriculture. In some cases, marshlands hosting over 2,000 farmers had as few as four toilets, making proper hygiene nearly impossible.

As a result, farmers are now being encouraged to construct and use adequate sanitation facilities near marshlands to reduce open defecation, a key driver of bilharzia transmission.

In addition to preventive measures, the project also supports the distribution of praziquantel, the primary drug used to treat bilharzia, in collaboration with district authorities to ensure sustainability.

Government’s Community-Based Approach

Nathan Hitiyaremye, NTD–WASH Coordination Officer at the Rwanda Biomedical Centre, highlighted Rwanda’s shift toward community-led elimination models.

“Beyond providing medication, we are equipping farmers with practical skills to identify, remove, and destroy snails and larvae in endemic areas,” Hitiyaremye said.

He noted that bilharzia breeding sites are commonly found in weeds and grasses surrounding marshlands and wetlands, and that lack of awareness remains a major barrier.

“You cannot prevent what you don’t understand. That’s why we teach communities how bilharzia breeds, how to identify the snails, and how to take action when they encounter them,” he added.

While Rwanda has not yet achieved 100 percent access to clean water, Hitiyaremye said about 90 percent coverage has been reached in endemic communities. The remaining gaps are being addressed through partnerships with local organizations and development partners.

Four priority areas remain critical to sustaining progress in the fight against bilharzia and intestinal worms. These include expanding access to clean water, constructing more toilets, strengthening social and behavior change interventions, and intensifying community mobilization to ensure communities take ownership of prevention efforts.

Toward 2030 Elimination Goals

Rwanda’s approach to combating bilharzia and intestinal worms demonstrates a shift from treatment-focused interventions to prevention-driven, community-owned solutions. By combining training, sanitation improvements, environmental management, and strong local partnerships, the country hopes to not only eliminate the diseases but prevent their re-emergence.

As the IoT project moves into its final phase in Bugesera and Ruhango, health stakeholders remain optimistic that the model will serve as a blueprint for nationwide elimination by 2030.