WickedSchisto: Developing an robust interdisciplinary-informed WASH framework for the wicked public-health problem of schistosomiasis

超过2.4亿人患有血吸虫病，这是一种使人虚弱的疾病，本质上与水、卫生设施和个人卫生(洗澡)不足有关。恶问题是指难以或不可能解决的社会或文化问题。尽管大规模的药物管理(MDA)，血吸虫病仍然是一个邪恶的公共卫生问题。要实现世界卫生组织(世卫组织)2030年消除公共卫生问题的目标，就需要采取卫生行动干预措施。然而，我们不了解血吸虫病的全部影响，因此不能确定什么可行且成本效益高的清洁卫生干预措施最能减少这种影响，也不能确定对长期控制方案成功的威胁，以及如何减轻这些威胁。我将回答五个雄心勃勃的问题：1.血吸虫病对健康、经济和社会的真正影响是什么？2.洗涤和丙二醛干预措施的最具成本效益的组合是什么？3.我们如何才能最好地扩大这些公共卫生洗涤干预措施的规模，以实现世卫组织2030年的目标？4.人口流动对实现和维持世卫组织2030年目标有什么风险？5.如何利用跨部门政策的支持来帮助实现这些目标？我将使用创新的跨学科方法来解决这个邪恶的公共卫生问题，包括：一种前所未有的、自下而上的方法，以确定可接受的、公平的、具有成本效益的、可行的、多方面的干预措施，具有最高的“金钱价值”和对血吸虫病健康相关生活质量的影响；开发实地发病率标记物以监测成功情况；将最先进的寄生虫基因组学与数学模型相结合，为控制方案终点提供信息；并确定社区乃至国际一级的促进者，以促进干预成功。我的开创性研究将告诉乌干达和其他国家的政策制定者如何最好地消除血吸虫病。我将填补一个关键的全球卫生知识空白，并为其他与洗涤相关的疾病提供一个框架。

Over 240 million people have schistosomiasis, a debilitating disease intrinsically linked to inadequate water, sanitation and hygiene (WASH). A wicked problem is a social or cultural problem that is difficult or impossible to solve. Despite extensive mass drug administration (MDA), schistosomiasis remains a wicked public-health problem. WASH-interventions are needed to reach the World Health Organization (WHO) 2030 goal of elimination as a public-health problem. Yet we don't understand the full impact of schistosomiasis, and therefore cannot identify what feasible and cost-effective WASH interventions best reduce this impact, nor the threats to long-term control programme success, and how to mitigate these. I will address five ambitious questions:1. What are the true health, economic and societal impacts of schistosomiasis?2. What are the most cost-effective combinations of WASH and MDA interventions?3. How best can we scale-up these public-health WASH interventions to reach WHO 2030 goals?4. What are the risks from human mobility to achieving and sustaining WHO 2030 goals?5. How can cross-sectorial policy buy-in be leveraged to help reach these goals?I will use innovative interdisciplinary methods to tackle this wicked public-health problem including: an unprecedented, bottom-up approach to identify acceptable, equitable, cost-effective, feasible, multifaceted interventions with highest 'value for money' and impact on schistosomiasis health-related quality of life; develop a field-based morbidity marker to monitor success; combine state-of-the-art parasite genomics with mathematical models to inform on control programme endpoints; and identify community, through to international level, facilitators to leverage for intervention success. My pioneering research will inform policymakers in Uganda and beyond on how best to eliminate schistosomiasis. I will fill a critical global-health knowledge gap and provide a framework for other WASH-associated diseases.