Life cycle of human schistosomiasis (A) adult worms, (B) eggs (left to right, S. haematobium , S. mansoni , S. japonicum ), (C) miracidium, (D) intermediate snail host (left to right, Oncomelania , Biomphalaria , Bulinus ), (E) cercaria. Used with permission from the Institute of Tropical Medicine Antwerp 

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... schistosomiasis is one of the most common NTDs; it is an intravascular parasite caused by the trematode blood fluke ( Schistosoma ). Most human infections are caused by S. haematobium , S. mansoni , and S. japonicum ; less prevalent species include S. mekeongi and S. intercalatum . Schistosomiasis is endemic in 77 countries in tropical and subtropical regions; estimates of infected individuals worldwide are 237 million; another 600–779 are at risk of being infected (Chitsulo et al. 2000; Steinmann et al. 2006; WHO Weekly Epidemiological Report 2012). The life cycle of the parasite is characterized by alteration of generation; asexual reproduction occurs in the snail intermediate host and sexual reproduction occurs in humans ( Fig. 1). The pathology of schistosomiasis is due to egg-mediated immune response in the form of granuloma formation followed by fibrosis which results in obstruc- tive manifestations in the gastrointestinal tract (GIT) in case of intestinal schistosomiasis and in the urinary tract in the case of S. haematobium (Nash et al. 1982; Wynn et al. 2004; Wilson et al. 2007). However, eggs can be disseminated to other organs, e.g., the brain, the spinal cord, genital organs, and the lungs leading to severe morbidity (Gryseels et al. 2006). Squamous cell carcinoma is one of the serious complications of urinary schistosomiasis in Egypt and North Africa (Fedewa et al. 2009). In infected children, studies of physical and intellectual functions indicate significant reductions in physical fitness and spontaneous activity among children (Latham et al. 1990). Linear growth and nutrition are impaired, resulting in stunting and underweight status among infected children (Assis et al. 1998; Coutinho et al. 2006). Poor performance in standardized intelligence and achievement tests has also been associated with schistosomiasis (Nazel et al. 1999; Jukes et al. 2002; Ezeamama et al. 2005, 2012). The MENA Region includes 21 countries inhabited by 336.5 million people (Fig. 2). Population density in MENA accounts for 5 % of the world’s total population. The highest density is found in Egypt (82 million), followed by Iran (75 million), Algeria (36 million), Morocco and Iraq (31–32 million each), Kingdom of Saudi Arabia (KSA) (26 million), and Yemen (25 million) (Population Reference Bureau 2013). Both S. mansoni and S. haematobium are endemic in the Region; approximately 12.7 million individuals are infected. However, distribution of infected cases is not uniform; the largest number of cases occur in Egypt (7.2 million), followed by Yemen (2.9 million), Algeria (2.3 million), and Libya (0.3 million) (Hotez et al. 2012). The Eastern Mediterranean Region ranked second after the Sub-Sahara African Region according to the number of individuals requiring preventive chemotherapy for schistosomiasis (14,493,641); however, only 2,137,787 cases were given treatment in 2010 (WHO Weekly Epidemiological Report 2012). Clustering of infected cases in a few countries of the Region is due to a low level of socioeconomic standards including poverty, bad environmental sanitation, and high population density. Estimates since 2011 indicate that 2.4 % of the population lives below the World Bank poverty figure of US$1.25 per day and 12 % lives below US$2 per day. It is noteworthy that most of the countries in the Region are classified by the World Bank as low-middle income countries (World Bank (n.d.) Data:Middle East and North Africa). However, during the past 20 years significant changes have occurred in the Region. Schistosomiasis was eliminated from the Islamic Republic of Iran, Oman, Lebanon, and Tunisia. Transmission has been greatly reduced in Egypt, Iraq, Jordan, Morocco, Saudi Arabia, and Syria, while in Yemen schistosomiasis is considered a major health problem (Table 1 and Fig. 3) (Fenwick et al. 2006; Rollinson et al. 2012; International Association for Medical Assistance to Travelers 2012). In this chapter the focus will be on countries with a large population size which achieved notable progress in the control of schistosomiasis, e.g., Egypt, Morocco, and Saudi Arabia, and countries where schistosomiasis has remained as a major health problem such as the Yemen. The history of urinary schistosomiasis in Egypt is long-standing, i.e., since the time of ancient Egypt. The first description of the disease was found in Kahun papyrus (1900 B.C.) referring to hematuria as a manifestation of a disease known as a-a-a disease (Shokeir and Hussein 1999) (Fig. 4). The parasite etiology of the disease is proposed in the Ebers papyrus in (1550 B.C.), while the eggs of S. haematobium have been found in the tissues taken from mummies of the twentieth dynasty, 1250–1000 B.C. (Ruffer 1910; Ebbel 1937). The morbidity of urinary schistosomiasis was mentioned in the Chester Beatty papyrus describing bladder cancer as a disease complication (Badr 1981). The causative organism was termed Bilharzia after Theodor Bilharz, who described the parasite from human autopsy in Kasr El Ainy hospital in Cairo in 1851 (Bilharz 1853). The discovery of the life cycle and presence of both S. haematobium and S. mansoni in Egypt was first reported by Leiper (1915). Recently, in the early 1990s, Schistosome antigens were detected in tissues from mummies using the ELISA technique (Deelder et al. 1990; Miller et al. 1992). The comprehensive epidemiology of schistosomiasis was first described by Scott (1937). He mapped the distribution of both S. haematobium and S. mansoni in the Nile Delta representing Northern Egypt and the Nile Valley representing Southern Egypt. The Nile Valley comprises Middle Egypt which extends from Giza to Menya Governorate and Upper Egypt extending from ...