<?xml version="1.0" encoding="utf8"?>
 <!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.0 20120330//EN" "http://jats.nlm.nih.gov/publishing/1.0/JATS-journalpublishing1.dtd"> <article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" article-type="research-article" dtd-version="1.0" xml:lang="en">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">IJHS</journal-id>
      <journal-title-group>
        <journal-title>International Journal of Health Statistics</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2997-1969</issn>
      <publisher>
        <publisher-name>Open Access Pub</publisher-name>
        <publisher-loc>United States</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">IJHS-22-4227</article-id>
      <article-id pub-id-type="doi">10.14302/issn.2997-1969.ijhs-22-4227</article-id>
      <article-categories>
        <subj-group>
          <subject>research-article</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Fresh Water Snails of Public Health Importance in Canals in Okigwe Imo State Nigeria: Their Infectivity and Implications for Control</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Victor</surname>
            <given-names>Ugochukwu Obisike</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842520836">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Maduabuchi</surname>
            <given-names>Chozuruoke Dike</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842523428">2</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Enwereji</surname>
            <given-names>Ezinna E</given-names>
          </name>
          <xref ref-type="aff" rid="idm1842520836">1</xref>
          <xref ref-type="aff" rid="idm1842422212">*</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1842520836">
        <label>1</label>
        <addr-line>Department of Public Health, Abia State University, Uturu Abia, Nigeria</addr-line>
      </aff>
      <aff id="idm1842523428">
        <label>2</label>
        <addr-line>Department of Animal and Environmental Biology, Abia State University, Uturu Abia, Nigeria.</addr-line>
      </aff>
      <aff id="idm1842422212">
        <label>*</label>
        <addr-line>Corresponding author</addr-line>
      </aff>
      <author-notes>
        <corresp>
  Enwereji E.E, <addr-line>Department of Public Health, College of Medicine and Health Sciences, Abia State University, </addr-line><addr-line>Uturu</addr-line><addr-line>  Abia</addr-line><addr-line>,</addr-line><addr-line>Nigeria</addr-line>, Email: <email>hersng@yahoo.com</email></corresp>
        <fn fn-type="conflict" id="idm1842746516">
          <p>The authors have declared that no competing interests exist.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub" iso-8601-date="2022-08-25">
        <day>25</day>
        <month>08</month>
        <year>2022</year>
      </pub-date>
      <volume>1</volume>
      <issue>1</issue>
      <fpage>21</fpage>
      <lpage>28</lpage>
      <history>
        <date date-type="received">
          <day>22</day>
          <month>06</month>
          <year>2022</year>
        </date>
        <date date-type="accepted">
          <day>21</day>
          <month>08</month>
          <year>2022</year>
        </date>
        <date date-type="online">
          <day>25</day>
          <month>08</month>
          <year>2022</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>© </copyright-statement>
        <copyright-year>2022</copyright-year>
        <copyright-holder>Victor Ugochukwu Obisike, et al</copyright-holder>
        <license xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p>
        </license>
      </permissions>
      <self-uri xlink:href="http://openaccesspub.org/ijhs/article/1859">This article is available from http://openaccesspub.org/ijhs/article/1859</self-uri>
      <abstract>
        <p>Studies have linked freshwater snails with human flukes as a result of repeated contacts with contaminated water. This study is aimed to determine the distribution of freshwater snails and their infectivity rates along human dwellings in Okigwe Imo state using Physico-Chemical parameters. Freshwater snails were collected by using long plastic spoons and with hand-picking method. The Physico-Chemical parameters were determined with appropriate instrument and freshwater snails harvested from the site were morphologically identified. One thousand four hundred and nine (1409) freshwater snails belonging to the species Lymneae and Bulinus were collected once a week throughout the period of study   with the relative percentage of 43.9%; 29.9% ;26.2% respectively.  The infectivity rate was highest in snails that were collected in the month of May compared to those collected in June and July, the rate was 69.2%, 50.1% and 33.6% in the months of May, June and July respectively. Dissolved oxygen (DO), Biological oxygen demand (BOD) and P<sup>H</sup> were found to significantly influence snail distribution in the site (p&lt;0.05). The finding showed that 54.2% of all the snails collected were infected. The snail distribution observed may give an insight into some aspects of the epidemiology of trematodes infection in Okigwe the site for the study and their potential risks to infect human beings  and animals.  </p>
      </abstract>
      <kwd-group>
        <kwd>Intermediate host</kwd>
        <kwd>trematode</kwd>
        <kwd>drainage system</kwd>
        <kwd>public health</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="3"/>
        <page-count count="8"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <sec id="idm1842277668">
      <title>Background </title>
      <p>Many species of freshwater snails have been reported as intermediate hosts of highly infective fluke (trematode) larvae of the genus Schistosoma which cause schistosomiasis also known as bilharziasis.                      Some ecological factors like water quality,                      temperature, microphytes, human settlements contribute significantly to the distribution of these intermediate hosts of Schistosoma. Freshwater snails are considered to be intermediate hosts because the sexual stages of the parasites are found in man while the snails harbour the asexual stage <xref ref-type="bibr" rid="ridm1842312828">1</xref><xref ref-type="bibr" rid="ridm1842318956">2</xref><xref ref-type="bibr" rid="ridm1842387924">3</xref><xref ref-type="bibr" rid="ridm1842172260">4</xref>. Humans serve as vectors by contaminating the environment.  Transfer of the infection requires no direct contact between snails and humans, but rather, the disease is acquired by repeated contacts with freshwater                    snails <xref ref-type="bibr" rid="ridm1842169164">5</xref><xref ref-type="bibr" rid="ridm1842164412">6</xref><xref ref-type="bibr" rid="ridm1842155588">7</xref>. Therefore, researchers have shown that the prevalence and distribution of schistosomiasis  are  dependent on the presence and distribution of the intermediate snail host in natural freshwater                        bodies <xref ref-type="bibr" rid="ridm1842161276">8</xref><xref ref-type="bibr" rid="ridm1842141436">9</xref><xref ref-type="bibr" rid="ridm1842149068">10</xref><xref ref-type="bibr" rid="ridm1842131908">11</xref>.</p>
      <p>Urinary schistosomiasis, caused by <italic>Schistosoma </italic><italic>haematobium</italic>  which  has  a suitable snail host  species of aquatic freshwater  <italic>Bulinus</italic> snails, is one of the neglected tropical diseases very common in Nigeria, with some States having very high  prevalence especially in  the southeastern part of the country <xref ref-type="bibr" rid="ridm1842128668">12</xref><xref ref-type="bibr" rid="ridm1842123052">13</xref>. Urinary schistosomiasis constitutes  a  major infection of public health importance in Nigeria  and   affects mainly the rural poor and some disadvantaged urban populations <xref ref-type="bibr" rid="ridm1842121252">14</xref><xref ref-type="bibr" rid="ridm1842136588">15</xref><xref ref-type="bibr" rid="ridm1842134140">16</xref>.  It is characterized by haematuria, dysuria, bladder wall pathology, hydronephrosis (swelling of   kidney due to  build-up of urine) , It  can also present with  squamous cell carcinoma <xref ref-type="bibr" rid="ridm1842107036">17</xref><xref ref-type="bibr" rid="ridm1842104516">18</xref><xref ref-type="bibr" rid="ridm1842100412">19</xref>. In adults, the infection can result to genital ulcers and other types of  lesions that can cause  poor reproductive health  with sexual dysfunction and infertility. These pathological  effects  occur mostly  among   school-age children, adolescent and young adults <xref ref-type="bibr" rid="ridm1842097820">20</xref><xref ref-type="bibr" rid="ridm1842095948">21</xref><xref ref-type="bibr" rid="ridm1842075860">22</xref><xref ref-type="bibr" rid="ridm1842070460">23</xref><xref ref-type="bibr" rid="ridm1842068444">24</xref><xref ref-type="bibr" rid="ridm1842080108">25</xref>.  </p>
      <p>Apart from reports on the prevalence of schistosomiasis, there is  scarcity of research on the risk factors associated with this infection especially in the South East  region of the country including Imo State                <xref ref-type="bibr" rid="ridm1842043836">29</xref><xref ref-type="bibr" rid="ridm1842055716">30</xref><xref ref-type="bibr" rid="ridm1842038044">31</xref><xref ref-type="bibr" rid="ridm1842035092">32</xref>. This lack of  information on risk factors have been shown  to constitute   limitations in providing intervention and control programmes. This is because availability of   such information is crucial in identifying and              implementing effective control measures <xref ref-type="bibr" rid="ridm1842030844">33</xref><xref ref-type="bibr" rid="ridm1842026740">34</xref><xref ref-type="bibr" rid="ridm1842023356">35</xref>. However, studies have observed that the complex schistosome life cycle and the intricate  interactions  that are  encountered with the host immune system make it difficult for neither drugs nor vaccines to adequately control schistosomiasis without first identifying the parasite load. Studies have shown that in Nigeria, the  main disease control measures are the provision of potable water, population-based chemotherapy and health education , but that most of these  control  measures   are  affected  by lack of baseline data on the distribution of the host and its infectivity <xref ref-type="bibr" rid="ridm1842017380">36</xref><xref ref-type="bibr" rid="ridm1842013996">37</xref><xref ref-type="bibr" rid="ridm1842011188">38</xref><xref ref-type="bibr" rid="ridm1841997380">39</xref><xref ref-type="bibr" rid="ridm1841990828">40</xref>. This study therefore, examined the distribution of  snail species and their infectivity rates along freshwater canals in the rural poor  areas of Imo State Nigeria.</p>
      <p>This study is of interest because most individuals including school children living close to the study area  use water from the canals for several domestic activities including swimming. Also, the snails from these canals serve as the main source of protein as well as   means of raising money for sustenance. It is as a result of  the activities of people living  close to  these canals  that the researchers  deemed it necessary to identify the snail species and their infectivity rates so as to protect the individuals resident in this rural area from likely  infection  that could result to disease conditions. This study is unique because it   helped to reconcile the public health objective of eradicating deadly pathogens so as to protect their environmental biodiversity.</p>
      <p>This study also aimed to contribute a quota in  helping to achieve the World Health Assembly (WHA) endorsed resolution which has  the vision of having  a world free from schistosomiasis so as to eliminate  schistosomiasis as a public health problem by the year  2025. If this goal is realized, millions will be spared from future sufferings from the pathological effects of this disease condition. </p>
    </sec>
    <sec id="idm1842251372" sec-type="materials">
      <title>Materials and Method</title>
      <sec id="idm1842251084">
        <title>Study Area</title>
        <p>The study area is Okigwe. It  is the zonal capital of Okigwe district  in Imo State of Nigeria. The district is made up of six Local Government Areas  namely: Isiala Mbano, Ihitte Uboma, Ehime Mbano, Onuimo, Obowo and Okigwe. The study area  lies between latitude 5°30-5°57N and longitude 7°04-7°26 E (covering a land area of about 1,824 km<sup>2</sup>. (www.maplandia.com).   </p>
        <p>The main occupation here is peasant farming and petty trading, The major source of protein for most individuals is snail consumption. Some individuals also trade on  snails as sources of income for sustenance. Freshwater canals are common sources of water for several domestic activities , while the source of drinking water is  from bore holes which are strategically located for commercial purposes. The residents travel few kilometers to purchase  the  drinking water.  </p>
      </sec>
      <sec id="idm1842250004">
        <title>Snail Collection and Identification </title>
        <p>Snail collection was carried out from May-July 2021. The study site was visited weekly for snail collection using a long plastic spoon and hand picking wearing a hand glove. The sites where the snails were collected were mainly in places  where there are obvious constant human activities  like  school  compounds. The freshwater snails collected were transferred to a labeled plastic container that was covered with a net for ventilation and air passage. </p>
        <p>The collected snails were taken to the Department of Animal and Environmental Biology laboratory, Abia State University where the snails were sorted and identified by specie level using morphological               characteristics standard key as described by Gillei (1986). The identified snails were counted and recorded. </p>
      </sec>
      <sec id="idm1842248924">
        <title>Snail Infectivity</title>
        <p>The collected snails were put in petri dishes with a little quantity of water in the dishes and thereafter, placed under the sun. The petri dishes were monitored for cercariae shedding at the intervals of 30 minutes using a dissecting microscope and hand lens. The number of snails that shed was recorded and those unable to shed also recorded. Water quality index was determined using the methods described by Association of Official Analytical Chemistry (AOAC, 2005). </p>
      </sec>
    </sec>
    <sec id="idm1842249212">
      <title>Findings</title>
      <p>A total of one thousand four hundred and nine (1,409) snails was collected from drainage systems around the residential areas close to the Iyiechu Stream Okigwe. The snails so collected were identified as Lymneae and Bulinus genera. </p>
      <p><xref ref-type="table" rid="idm1842396252">Table 1</xref>. Shows the monthly distribution and the relative percentage of the freshwater snail species collected from Iyiechu Stream Okigwe, the area of study.  From this table, there is a marked variation in the number of snails collected. In the first month of snail collection, (May), 619 snails were collected, in June 421 snails  were collected while in July, 369 were collected.  In  May, the snails collected  consisted of 318 (53.1%) Lymnaea,  and  301(48.63%) Bulinus. This is the largest collection made during the period of study.  For the second month, June, the snails collected were made up of 309 (73.4%) Lymnaea, 112(26.6%) Bulinus, while in July, being the third month, the snails collected were 249(67.5%) Lymnaea, and 120(32.5%). For all the collections made  during the period of  study, 876(62.2%) were of the  Lymnaea  and  533(37.8%) Bulinus genera respectively.</p>
      <table-wrap id="idm1842396252">
        <label>Table 1.</label>
        <caption>
          <title> Monthly distribution of Freshwater snails. </title>
        </caption>
        <table rules="all" frame="box">
          <tbody>
            <tr>
              <td>Snail Genera</td>
              <td>May  (%)</td>
              <td>June     (%)</td>
              <td>July   (%)</td>
              <td>Total</td>
            </tr>
            <tr>
              <td>LYMNAEA</td>
              <td>318 (53.1)</td>
              <td>309 (73.4)</td>
              <td>249(67.5)</td>
              <td>876(62.2)</td>
            </tr>
            <tr>
              <td>BULINUS</td>
              <td>301(48.63)</td>
              <td>112(26.6)</td>
              <td>120(32.5)</td>
              <td>533(37.8)</td>
            </tr>
            <tr>
              <td>TOTAL</td>
              <td>619 (43.9)</td>
              <td>421(29.9)</td>
              <td>369(26.2)</td>
              <td>1,409</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="idm1842219788">
            <label/>
            <p>p&lt;0.01</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
      <p><xref ref-type="table" rid="idm1842342924">Table 2</xref> contains the proportion of fresh water snails that shed cercariea showing that they were infected. From the table, out of 619 fresh water snails collected in May, 428 of them representing 69.2% were infected. In June, out of 421 snails collected, 211(50.1%) shed cercariea, while in July, out of 369 snails collected 124(33.6%) were also infected giving a total of 764(54.2%) that were infected. </p>
      <table-wrap id="idm1842342924">
        <label>Table 2.</label>
        <caption>
          <title> Infectivity rate of Freshwater snails collected from  Iyiechu Stream, Okigwe of imo State, Nigeria. </title>
        </caption>
        <table rules="all" frame="box">
          <tbody>
            <tr>
              <td>Months</td>
              <td>Total number</td>
              <td>Infected</td>
              <td>%Infected</td>
            </tr>
            <tr>
              <td>May</td>
              <td>619</td>
              <td>428</td>
              <td>69.2</td>
            </tr>
            <tr>
              <td>June</td>
              <td>421</td>
              <td>211</td>
              <td>50.1</td>
            </tr>
            <tr>
              <td>July</td>
              <td>369</td>
              <td>124</td>
              <td>33.6</td>
            </tr>
            <tr>
              <td>Total</td>
              <td>1409</td>
              <td>764</td>
              <td>54.2</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="idm1842198508">
            <label/>
            <p>p&lt;0.01</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
      <p><xref ref-type="table" rid="idm1842315524">Table 3</xref> contains  physico-chemical parameters of the  analysis of  the water canals from Iyiechu Stream  where the snails studied were collected. From the  physico-chemical analysis on this table, dissolved oxygen (DO), Biological oxygen demand (BOD) and P<sup>H</sup> significantly influenced snail distribution in the area studied  (p&lt;0.05).</p>
      <table-wrap id="idm1842315524">
        <label>Table 3.</label>
        <caption>
          <title> Physico chemical analysis of water canal from Iyiechu Stream</title>
        </caption>
        <table rules="all" frame="box">
          <tbody>
            <tr>
              <th>
                <bold>Parameters</bold>
              </th>
              <td>
                <bold>Result</bold>
              </td>
              <td>
                <bold>Mean</bold>
              </td>
              <td>
                <bold>0035limit</bold>
              </td>
            </tr>
            <tr>
              <td>pH</td>
              <td>7.0</td>
              <td>7.0</td>
              <td>5 - 9 (Domestic water), 6 -9(fresh water),  6.5 - 8.5 (marine).  FEPA: 6-9</td>
            </tr>
            <tr>
              <td>Temperature</td>
              <td>26.5</td>
              <td>26.5</td>
              <td>FEPA:&lt;40°C in 15ml of out fall</td>
            </tr>
            <tr>
              <td>BOD</td>
              <td>1.2</td>
              <td>1.2</td>
              <td>FEPA:50mg/l</td>
            </tr>
            <tr>
              <td>DO</td>
              <td>4.6</td>
              <td>4.6</td>
              <td>100ug/l, marine</td>
            </tr>
          </tbody>
        </table>
        <table-wrap-foot>
          <fn id="idm1842177676">
            <label/>
            <p>p&lt;0.01</p>
          </fn>
        </table-wrap-foot>
      </table-wrap>
    </sec>
    <sec id="idm1842173356" sec-type="discussion">
      <title>Discussion</title>
      <p>The fact that the  snails  collected were more in May and June when the rains are not yet heavy  than the ones collected in July when  rainfalls  are  heavy,  shows that snails breed  less during heavy rains than other  periods. The result obtained from the study showed  the abundance and diversity of freshwater snail intermediate hosts in the water canals studied. This  abundance and diversity of freshwater snail hosts are of public health importance because of the risks to  human infections. This finding corroborates with that of <xref ref-type="bibr" rid="ridm1842312828">1</xref><xref ref-type="bibr" rid="ridm1842104516">18</xref> that the   presence of freshwater snails is of public health importance because of the indication for parasitic transmission.   </p>
      <p>The  high proportion  of cercariae shed in both  Lymneae and Bulinus  genera reflect the extent  to which   consumers of these snail species and those with regular contacts with the freshwater canals including school children are exposed to infections. The findings that individuals living in this vicinity use water from the canals for domestic activities  means that they are likely to have regular contacts with the freshwater from the canals and therefore, human and animal excreta may be common  in the freshwater where the  snails grow.  This finding agrees with those of <xref ref-type="bibr" rid="ridm1842100412">19</xref><xref ref-type="bibr" rid="ridm1842097820">20</xref><xref ref-type="bibr" rid="ridm1842030844">33</xref> in which they observed that   freshwater body is usually polluted with human and animal excreta and that snails that grow in freshwater body polluted with human and animal excreta produce some organic matters that increase the concentration of detritus and the proliferation of algae which form the diets for planorbid and prosobranch snails. </p>
      <p>The fact that some of the infected freshwater snails studied were of <italic>Bullins</italic> specie which serves as intermediate host to highly infective larval trematode of the genus Schistosoma shows that Schistosomiasis infection may be common in the study area especially among school children who were seen swimming in the canals near their school premises as well as picking snails for food. This regular human contacts with the canals presupposes the extent to which the surface water must have been contaminated by excreta and others.   </p>
      <p>The finding that majority of the freshwater snails that were infected were of the Lymmeae specie which according to studies by  <xref ref-type="bibr" rid="ridm1842318956">2</xref><xref ref-type="bibr" rid="ridm1842161276">8</xref>  is  the chief intermediate host of Fasciola which  predisposes human and animals  to liver disease (fascioliasis), shows that  some individuals  resident in this area may be infected with fascioliasis.  </p>
      <p>Realizing the fact that snail is the main source of protein and avenue for generating revenue for sustenance among some residents in the area of study, presupposes that a significant proportion of the residents may have continuous contacts with the definitive host which would influence the occurrence of disease conditions like fascioliasis, schistosomiasis and others. Other human activities near the canal such as farming, bathing, swimming, washing of clothes, cassava and vehicles that were observed during the study, may be what contributed to the poor environmental conditions noted around the freshwater canals. These numerous human activities suggest constant contacts with parasites which   occur on aquatic plants that serve as foods and shelter to freshwater snails thereby, increase their number and diversity. Also the fact that there is increase in the number and diversity of the freshwater snails make them available even on semidried soils where they are easily picked by individuals.  One striking observation in the study  is that  a good number of individuals  picking these snails move  barefooted, thereby add to the predisposing factors  to schistosoma and Fasciola infections  as also pointed out in the researches done by <xref ref-type="bibr" rid="ridm1842164412">6</xref><xref ref-type="bibr" rid="ridm1842149068">10</xref>.</p>
      <p>The finding that dissolved oxygen (DO), Biological oxygen demand (BOD) and P<sup>H</sup> significantly influenced snail distribution in the area shows that the presence of snails  increased the biomass of filamentous green algae and decrease  the biomass of periphyton thereby reducing the DO of the water which is needed by aquatic organisms for existence. This finding agrees with that of <xref ref-type="bibr" rid="ridm1842131908">11</xref><xref ref-type="bibr" rid="ridm1842080108">25</xref>.</p>
      <p>This shows that the more the presence of snails, the more the biomass of periphyton is reduced. </p>
    </sec>
    <sec id="idm1842171412" sec-type="conclusions">
      <title>Conclusion</title>
      <p>Freshwater snail intermediate hosts of    trematodes were common in the freshwater canal studied. Inhabitants in the area depended largely on water from the canal   for several domestic activities probably because water from most of the bore holes were sold and as a result, it may not be easy considering the economic status of most individuals in the rural areas, to have the resources to buy water for drinking as well as for other domestic activities. As a result, a good number of those who cannot afford the money, resort to using water from the canals.  It is evident that the numerous activities that occurred near the canals contributed to the poor environmental sanitation which could facilitate infection of snails and the continuation of their life cycles.</p>
      <p> Since  most people in this area consume some of these snails as a source of protein  as well as  market  them for sustenance, and realizing that the infective larvae (cercariae) develop within freshwater snails which  when released penetrate the skin of a human/mammalian body in contact with the water, it  may be right to conclude that a good number of the individuals who have contacts with the freshwater canal  and the snails that grow here may be infected with schistomiasis and fascioliasis. Therefore, there is the need to health educate residents in this area on the need for hygienic practices, provision of potable water, less contact with freshwater canals, and to avoid the consumption of freshwater snails so as to prevent infections associated with freshwater snails and their attendant pathological effects on humans.     </p>
      <p>Therefore, the findings in this study will   contribute a quota to support the   WHA   resolution to maintain a world free of schistosomiasis by controlling its morbidity and eliminating schistosomiasis as a public health problem by 2025.</p>
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