Script 42.7


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With a better understanding of bilharzia everyone in your village can learn how to control it.Bilharzia is a disease which comes from flat worms called flukes.These flat worms spent part of their life in snails and the other part in people.They burrow through your skin when you are in water. Passing blood in your urine or feces is the most common sign of bilharzia. A low fever, weakness, an itchy rash and stomach pains when urinating, are other signs of bilharzia. If you don’t get treatment, these flat worms can live inside you for years.If they are inside you, you will slowly become weak and sick and you may even die.

The flat worms living inside you make thousands of eggs. These eggs come out when you urinate or defecate. If you urinate or defecate in the water, or near the water, then the worm eggs will keep living and flat worms will hatch from the eggs.These flat worms swim in the water looking for snails to burrow into. If there are no snails in the water, the flat worms will die.

The flat worms that do get inside snails start to grow. When they are old enough, these adult worms leave the snails and swim around until they find a person to burrow into. If an adult worm can not find a person to live in, it will die.

If these adult worms are in the water around your village then you could become infected with bilharzia. This can happen when you are fetching water, washing your clothes, taking a bath, playing a water game, walking through irrigation channels or swamps, or swimming.

While you are in the water, the adult worms burrow through your skin and get into your blood.They lay their eggs in blood vessels close to your gut or bladder. There are several types of flat worms that cause bilharzia. Some worms lay their eggs close to your bladder and this makes you pass blood and worm eggs in your urine. Other worms lay their eggs close to your gut. This causes you to pass blood and worm eggs in your feces. When this happens, you can see the blood but you cannot see the worm eggs.

If you are passing blood then you may have bilharzia. You need to go to a medical clinic.A health worker will use a microscope to look for the worm eggs in your urine or feces.If you do have worm eggs then your health worker can give you pills to take.Be sure to finish all of your pills and follow your health worker’s instructions.

These pills are given to kill the flat worms that are inside you but they do not prevent you from getting the disease again.There are other things you need to do to control bilharzia in your village.Everyone in your village will need to kill the snails that are in the water, build latrines, and improve all water sources.

One way of reducing the number of snails that carry this disease is to pull weeds from the sides of swamps and ponds.This will help because snails like weedy areas. Also, if the sides of a pond or river are steep then the snails will not gather there. They like shallow water that flows slowly.

You can kill the snails which carry the disease. Chemicals can be used, but they are expensive and harmful to the environment.Soapberry, often called Endod (Phytolacca dodecandra), is a plant which can kill fresh water snails.Many people use this plant to make soap. If your community has endod plants then put sun dried endod berries in ponds, swamps or rivers close to your village.Endod berries release a toxin which kills the snails that are in the water.

Some people say if you stay out of the water then you won’t get bilharzia. This is true but difficult to do.Preventing bilharzia from entering the water would be easier.The people in your village can do this by encouraging everyone to use latrines.If everyone used latrines then the people who have bilharzia would not infect the water and fewer people would get bilharzia.

Clean water is important.If you wash your clothes, bathe, work or play in water that is infected with the adult worms then you will probably get bilharzia.

Wells are a good water source because they are underground.Snails do not live in wells and it is easier to keep this water clean because it is protected.You can collect your water from them and set up washing slabs close to the wells.Everyone can use the washing slabs to wash clothes and bathe.

If the only water source in your village is from a pond or river then it is important to wash, bathe or play in the morning.The flat worms don’t come out until the afternoon.

If you have stomach pains, a fever, an itchy rash, some weakness, or blood in your feces or urine you need to see your health worker.You may have bilharzia. You need treatment.

If you got this disease from your village’s water source, tell the people in your village. If bilharzia is in your water then many more people will need to see their health worker.

To control bilharzia in your village everyone needs to work together.You need to clean up water sources or find new ones, build latrines, and lower the number of snails that are in your water.


This script was prepared by Catherine Fergusson, a certified international health nurse living in Toronto, Canada.


It was reviewed by Babita Kara PhD and John Dixie,BSc., Toronto, Canada

Information Sources

Where there is no doctor, David Werner, 1992, page 146.  The Hesperian Foundation, P.O. Box 1692, Palo Alto, California 94302, U.S.A.

Lecture Notes on Tropical Medicine, Dion R. Bell, 1990, pages 171‑184.  Blackwell Scientific Publications, 25 John Street, London, WC1N 2BL.

IDRC Reports, July 1993,  Volume 21, Number 2,  Cleaning up on schistosomiasis.   The International Development Research Centre of Canada, PO Box 8500, Ottawa, Ontario, Canada, K1G 3H9.