The untold story of elimination of human schistosomiasis from Gimavi village, Ratnagiri district, Maharashtra State, India: A qualitative study

Background & objectives Infection with Schistosoma haematobium (S. haematobium) is associated with substantial morbidity and mortality in humans, primarily affecting the African countries. In 1952, a pathology professor discovered an endemic focus of S. haematobium in a small village named Gimavi in Ratnagiri district, Maharashtra. Its emergence about 5,000 km away from its homeland in Africa, the absence of the known vector, Bullinus, in India, and its confinement to only one village were enigmatic. The Government of Maharashtra executed several activities and eliminated the focus after about 40 years. Many practicing and teaching public health experts today are unaware of the focus and the efforts undertaken for its elimination. This study's objectives were to identify clinical features, enlist the containment activities undertaken by the government, and identify reasons for confinement. Methods We conducted a qualitative study using in-depth interviews. All available past patients, two health personnel (male and female health workers), a medical officer, a district health officer, the concerned senior officer from the Directorate of Health Services, a scientist from Haffkine Institute, Gramsevak/Talathi (village level healthcare workers), Sarpanch/Up-sarpanch (administrative heads of a large village or a cluster of small villages), at least one from each category, were interviewed. The study included persons who worked during that period. Results The investigator interviewed ten personnel and two past patients. Many children had painless and mild haematuria, which persisted for some years. All respondents knew about the tiny snails living in the rivulet transmitted the disease. Construction of bridges, tanks, toilets, water supply schemes, barbed fencing along banks, manual collection/destruction of snails, health education, and mass drug administration eliminated the focus. Besides Gimavi, the rivulet flows through two villages and joins an estuary of a river where, due to high salinity, tiny freshwater snails cannot survive. Interpretation & conclusions A new species of snail was discovered to transmit S. haematobium. The disease was mild and self-limiting. A multipronged attack eliminated the focus. The unique environmental conditions restricted the spread of the disease.