Hello, friends. You are welcome to Mandaka-Mnono, which is rural Moshi, an area where people are engaged primarily in agriculture cultivation of rice, and these are paddy rice cultivations. These there are. You see a few people here but this area is occupied, in terms of agriculture, by about 3,000 people. But here, today there're only a few of them here. And is very large, about 800 meters from sea level. The mountain is up there, Kilimanjaro, about 6,000 meters. So, this is ideal. Because you need water, that is almost as stationary for the eyes for the cultivation of rice. Now we have chosen Mandaka-Mnono as our demonstration for what I would call a unique ecological niche, for most efficient way of Schistosomiasis transmission. My name is Mramba Nyindo associate professor of parasitology, entomology, and immunology at the Kilimanjaro Christian Medical University College of Tumaini University. So you find here there are two things which I would like to tell you here, two or three things. These people here are actually removing the weeds from the rice that they have grown. The weeds must be removed and the water there is almost stationary. It's not moving at all compared to water, which I will show you there, which is running very fast. This water is most ideal for the snails that will carry the parasite in the vector. The snails. This area is actually primarily Schistosomiasis mansoni, which means intestinal schistosomiasis. There is very little, if anything, in the way of urinary schistosomiasis. Urinary schistosomiasis is a problem mainly of the coastal region. Here, is right up, so the snails do very well in this situation, here. Now, it's about 1 o'clock here. You find that there is a lot of sunshine here. Now, the snails which are infected like a lot of sunlight and heat, so that they can shed out this carrier, which will then come in and infect the people who are working in the fields. The lifecycle is very interesting, because the eggs must reach water, and for these people here it's very peculiar. They can stay here for about four or five hours. How do they attend to the call of nature? Urination and defecation is anybody's guess, but probably they would urinate here, if they have the eggs, these eggs will hatch in this water. They'll give rise to miracidia, which are highly motile. These miracidia will seek their proper snail species, in this case Biomphalaria snail, and there are two generation cycles of sporozis in snails before cercariae is released. The cercariae will be released, as I said, and in fact the people who are actually working here. The sunlight is very important for this generation of cercaria, and you'll find these very young people here, for example, these are the people who are highly vulnerable to schistosomiasis. You know, they can not attend school properly. Their performance is very poor, examination performance is very poor. So, what we're talking about in this disease complex is morbidity. Schistosomiasis is a disease that does not kill you as much as you'd think of something like a malaria. But morbidity is an issue, so these people here, they'll certainly be affected. They are not, I'm wearing gloves here. I have gum boots. These people are bare. No. This lady, she doesn't have protective clothing, whether on the feet or on the hands. But she's working here. So she's highly vulnerable. The cercariae I would tend to think there, and they will penetrate. So this is a situation which is very, very bad. But, what we would also like to say. That this Mandaka-Mnono facility for paddy rice cultivation was actually improved. From 1985, by JICA. Who came up and provided the canals, so that water can be distributed and move very, very closely. And each one of these farmers, they own from one quarter to three acres of land for this rice cultivation. In the past, the farmers here would get only one crop a year. When the Japanese came here, they introduced a better variety of rice. Now they harvest two crops per year. January to June, and June to December. So it is very important. They use this rice for meals and domestic. But they can also have a little bit of surplus for selling to generate some income. So this is a very important ecological set-up. The waters here for the snails. The people are here who are the definitive host for this parasite. The sunlight is here, beautiful. So, the parasite has no problem in this development, in this sort of setting. This is Mandaka-Mnono. This is Hilary. >> Yes. >> Is a friend of mine, actually a very close relative. He has been a farmer in this area for about ten years. Hilary. Can you tell us how you protect yourself against being infected with the schistosomiasis. >> Yes, I just protected by using the gum boots and the gloves. Just, while in the farm, just working, I just use. But this, it is not easy to get it, because it's very expensive. And most of the farmers doesn't afford to buy the gloves and the gum boots. And they also have the problem, because our area is not well prepared, so sometimes few more people, farmers are failed to use this because finally he entered or she entered to the farm. You just go deep. And sometimes it's a problem. But if the farm is well prepared, so you can just go with the boots and the gloves. >> Let me ask you the next question. >> Yeah? >> Have you had people complaining, of stomach problems and the diarrhea? >> Yes. >> With the blood? >> Yes. >> That sort of thing that you know, will happen where there is schistosomiasis. Have you had any people complaining of this problem? >> Yes, I have heard it. Most of the people are complaining. >> okay. >> Yeah. >> Do you know whether they know what what we are talking about bilharzia schistosomiasis or they are just uninformed? >> Yes, they are informed. >> They are informed? >> Yes. >> And do they take any precaution? >> No. >> As they say, they are not wearing any protective clothing and whatnot. >> Yeah. >> As as so is, we are very much worried, particularly for children like this. Because there's a lot of absenteeism. there is very high. So, have you ever heard of a person who went into hospital, complaining of these problems? >> Mm-hm, I'm not well, but sometimes they are going to the hospital, and they are checked, but the because there is no educational center. >> Mm-hm. >> While the farmers are called and adjusted to get the education. Because people are going to the different hospital- >> Mm-hm. >> And they got the treatments. >> Mm-hm. >> And sometimes possibly, doctor doesn't inform that you are suffering bilharzia or something like that. >> Yeah. >> Yeah, just, just give the medicine, and then- >> Yeah, that sort. See, what we see here, Mandaka-Mnono, with the vast land of agricultural for rice cultivation. A lot of stagnant water which would really maintain the snails for the transmission for this matter. These are people on these farms. Doing the agriculture would we expect that probably, would we suspect that probably they would urinate in this sort of situation. >> Yes. >> And if they're infected, they could also defecate in this sort of. This is very vast. Where is the toilet. There is no toilet or facility here. So then, if there are any eggs that are released into the system, they will hatch into miracidia. Miracidia will go the cycles outside and the cercaria will infect the people working here, so ecologically this is most admirable, if you want to call it them, for the transmission schistosomiasis. At Mandaka-Mnono the people are not fully educated on how to protect themselves. But these things, their gloves, they cost money as well. So poverty is an element out here. Schistosomiasis is a disease of poverty. >> Yeah. >> For schistosomiasis, you must have fresh water for the snails to survive in. And also for the miracidium and the cercaria to be able to survive in there. What you see here, this water here is moving relatively faster, for anybody to be affected. What we've seen on the other, what to see on the other side, is that the water is very slowly moving, literally stagnant and when you get into the water system definitely you will be infected. This area here, the canal is not developed at all. You see a lot of vegetation here. But, by the end of the day. If you go into a vegetation system like that, and there are the parasites, you'll get infected. This is actually a bifurcation here. And the people who, here, they will use some blocks to stop the water running. But, this is the milieu. Outside that, if the egg does not reach the water, there's no transmission. If there is no water, there will be no snails. And if there are no snails, then there will be no transmission of schistosomiasis. And the cercaria will need the water equally, so fresh water is what we would like to stress. One thing is you have to realize that particularly the children who have seen. In this area, they would like to take a swim, during this time because is hot and humid. And definitely that is the way they get infected. So, to summarize, you need this water. Everything is in the water. Outside the water, nothing happens. This is. To summarize, or to finish, what happens in the transmission cycle of this parasite system. Thank you so much.
