For the children of Gwagwalada, a town in Nigeria, the local river is an irresistible playground, despite their parents’ warnings. Unseen dangers lurk beneath the surface: tiny flatworms that can infest their bodies.
In this sun-drenched region west of Abuja, Nigeria’s capital, options for entertainment are few, and the cool river offers a much-needed escape from the scorching heat.
However, on a sweltering November day at a government school in Gwagwalada, a grim reality emerged. Dozens of students confided in aid workers about symptoms like fevers, blood in their stool or urine, and body pains – classic signs of schistosomiasis, also known as bilharzia.
All students, regardless of whether they reported symptoms, received doses of praziquantel, a drug effective against the illness. This approach, known as mass drug administration, is recommended by the World Health Organization (WHO) for areas where over 20% of the population is affected by schistosomiasis.
Gwagwalada far exceeds the WHO’s threshold. As Amadou Garba Djirmay, who manages the WHO’s schistosomiasis program, explained, with children repeatedly swimming and adults relying on the river for water, ‘they cannot really avoid contact and reinfection.’
‘The primary goal is to treat and cure the majority,’ he affirmed.
With an estimated 200 million people affected worldwide, schistosomiasis stands as one of the most significant parasitic infections globally, second only to malaria. It has haunted regions like Egypt and the Nile Delta for centuries.
Despite its immense impact, schistosomiasis remains classified as a neglected tropical disease, failing to attract the crucial funding and attention typically given to deadlier illnesses like malaria.
[Image: A young boy, Mohammed Aliyu, 11, wearing a red-and-white T-shirt, whose eyes were itchy and who sometimes felt odd movements around them, having contracted schistosomiasis in the past. This image introduces the personal impact of the disease.]
[Video: This video showcases the river in Gwagwalada, the site of the parasitic flatworms, and then transitions to a scene at Gwako LGA Primary School during recess, where aid workers, including Rinpan Ishaya from the nonprofit HANDS, are measuring children like Yusuff to determine the correct dosage of praziquantel, the medication used to prevent schistosomiasis. This highlights both the source of the infection and the ongoing treatment efforts.]
Global efforts to combat schistosomiasis face immense obstacles. The drug praziquantel, while effective, is often scarce. Furthermore, it can cause unpleasant side effects such as gagging or vomiting, particularly if not taken with a meal. For many impoverished families who lack consistent access to food and clean water, following this recommendation is a significant challenge.
The future of schistosomiasis control is further complicated by dwindling global health funding. A recent budget proposal for 2026 entirely cuts support for neglected tropical diseases and significantly reduces funding for many others, raising concerns about the sustained effort against such widespread infections.
Adding to the challenge, doctors in Nigeria frequently miss the symptoms, according to Louise K. Makau Barasa, a senior director at the End Fund, a nonprofit dedicated to combating neglected diseases. ‘It’s truly a visibility problem,’ she noted.
In Gwagwalada, mass drug distribution initially brought down prevalence from 52 percent in 2014 to around 39 percent by 2024. However, some other areas have seen a rise in infection rates.
The Gwagwalada river is home to tiny freshwater snails, which act as hosts for the larvae of parasitic schistosome worms. These fork-tailed larvae are released into the water, penetrating the skin of children as they bathe, swim, or play. Once inside, the larvae travel to the children’s bowels, where they mature into half-inch-long adult worms.
These adult worms then produce eggs that can settle in various body tissues, and in rare instances, even reach the eyes.
Back at the school that November, Rinpan Ishaya, an aid worker from the nonprofit HANDS, paused his conversation to examine Mohammed Aliyu, a quiet 11-year-old student, more closely.
‘Look at his eyes,’ Mr. Ishaya pointed out.
Mohammed’s eyes appeared pale, stiff, and somewhat bulging. In a soft, almost inaudible voice, he confirmed that his eyes were frequently itchy and he occasionally felt strange sensations around them.
[Image: Mohammed at home with his mother, Amina Aliyu, a scene reflecting family life amidst health challenges.]
[Image: Mohammed, on the left, participates in a school health talk about deworming, raising his hand.]
Mohammed had battled schistosomiasis before. A quiet boy, he endured a burning sensation during urination and saw blood in his urine and stool for nearly three years. His mother, Amina Aliyu, only recognized the severity of the problem when she noticed his constant eye scratching.
‘Some people are slow,’ his mother stated, matter-of-factly, referring to her son’s reserved nature.
Nigerian children face a multitude of parasitic worm infections. Some may suffer vision loss from river blindness, caused by fly-borne roundworms, while others experience swollen limbs due to helminths spread by mosquitoes. Over half of the nation’s children carry soil-transmitted helminths from contact with contaminated soil.
While soil-transmitted helminths can lead to anemia, weight loss, and stunted growth, they are rarely fatal. Schistosomiasis, however, can be far more dangerous; if left untreated, it can severely harm the liver and intestines, cause infertility, and even result in bladder cancer.
[Image: A detailed video shows freshwater snails, the hosts of schistosome larvae, in the river. This is followed by an image of the river in Gwako, emphasizing the source of these parasitic flatworms, which cause the illness known as snail fever.]
To address co-infections, praziquantel is often distributed alongside mebendazole, a treatment for soil-transmitted helminths. While mass drug administration for other worms can be controversial, it is a more widely accepted strategy for schistosomiasis.
When Mohammed first complained about his eyes, his mother, Ms. Aliyu, consulted several doctors. They examined him and simply prescribed eyeglasses. Growing up in a village where many, including her own brothers, had contracted the illness, Ms. Aliyu now resided in a clean city home with modern amenities and access to clean water. It hadn’t occurred to her that her son could be reinfected. ‘I was very surprised,’ she admitted.
At the school, volunteers administered one to five praziquantel tablets per child, with dosage determined by height. Only about 60% of the 644 enrolled students were present, meaning the remaining children would require treatment either at Gwagwalada’s single clinic, serving 50,000 residents, or through home visits by volunteers.
Clinic volunteers tirelessly manage year-round health campaigns: measles during the hot season, diarrhea in the rainy season, and schistosomiasis throughout the dry season, from October to March.
[Image: Amina Aliyu, Mohammed’s mother, engaging with her son. She expresses her surprise at his schistosomiasis diagnosis, especially after doctors initially only prescribed glasses for his eye complaints.]
[Image: Informative posters about schistosomiasis displayed on the faded yellow wall of Gwako Primary Health Care Center, highlighting ongoing public health awareness efforts.]
Sam Macintosh, Vice President of the End Fund, noted that while the Gwagwalada program hasn’t been immediately impacted by foreign aid cuts from the Trump administration, ‘we know the same health systems that we support are stretched much further now, and we are likely to see a bigger impact on programs in 2026.’
However, the efficacy of these treatment programs is inherently limited without simultaneous improvements in clean water access and other essential changes.
Perhaps the most daunting challenge remains altering long-standing behaviors. Baseera Salinhu, the third of five children, has suffered from recurrent schistosomiasis for six years, having first been diagnosed and treated three years prior at the community health center.
Last year, when the usually outgoing Baseera became withdrawn and developed nausea and blood in her urine, her mother, Halimatu Salihu, recognized the recurring symptoms. Despite the severity of this episode, her mother lacked the financial means and time to take her back to the clinic.
Halimatu felt immense relief when Baseera brought home a school consent form for praziquantel. Impressed by the medication’s effectiveness, she even obtained some for herself as a preventive measure.
Despite recent signs of blood in her urine, Baseera has returned to the river with her friends. ‘She doesn’t listen,’ her mother sighed, highlighting the ongoing struggle against deeply ingrained habits.
[Image: A serene view of a river in Gwagwalada, its rocky and grassy banks illustrating the local landscape where women wash clothes and children find their recreation, inadvertently engaging with the source of infection.]