Tanzania | Beyond the Pill: Reframing Schistosomiasis Elimination through Ecohydrology, One Health, and Climate Adaptation in Tanzania

3rd Five Universities Consortium Conference at Nelson Mandela African Institution of Science and Technology (NM-AIST)

Arusha, Tanzania | 23–25 September 2026

Grite Nelson Mwaijengo^a, Teckla Angelo^b, Tedson Nkoana^c, Charles Lugomela^b

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a School of Materials, Energy, Water and Environmental Sciences, the Nelson Mandela African Institution of Science and Technology (NM-AIST), P. O. Box 447, Arusha, Tanzania; b School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, P.O. Box 447, Arusha, Tanzania; c Future Africa Campus, University of Pretoria, South Street, Koedoespoort 456‐Jr, Pretoria, 0186, Gauteng, South Africa.

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Abstract

Schistosomiasis remains one of Tanzania’s most persistent neglected tropical diseases, with an estimated 53.2 million people at risk, and the country carries the second‐highest burden in sub‐Saharan Africa despite more than two decades of preventive chemotherapy. Although mass drug administration (MDA) has substantially reduced morbidity, transmission persists because current control strategies primarily target infected humans while leaving the environmental and socio-ecological processes that continually regenerate transmission largely unaddressed. We argue that schistosomiasis should be reframed as an ecohydrological and One Health challenge, in which transmission emerges from dynamic interactions among hydrology, freshwater ecosystem functioning, intermediate-host snail ecology, climate variability, water-resources development, and human behaviour. Drawing on recent evidence from Tanzania and across East Africa, we demonstrate how climate change, water-resources development, and land-use change are reshaping transmission landscapes. At the same time, advances in Earth observation, spatial analysis, and machine‐learning models now enable environmentally explicit prediction of transmission risk at operational scales. We propose an integrated framework in which ecohydrology provides the scientific foundation for understanding transmission processes, climate science enables anticipation of future risk, precision ecohydrological surveillance through a Schistosomiasis Ecohydrological Surveillance System (SEHSS) translates environmental intelligence into decision-making, and One Health provides the governance architecture for coordinating multisectoral interventions. By integrating these complementary components within a single climate-adaptive strategy, we present a roadmap for

transforming schistosomiasis control from reactive morbidity management to proactive environmental risk management. This framework provides a practical pathway towards sustainable schistosomiasis elimination in Tanzania while offering a transferable model for other schistosomiasis endemic countries confronting similar interconnected public‐health, environmental, and climate‐related challenges.

Keywords: Schistosomiasis; Ecohydrology; One Health; Climate Change; Precision Surveillance; Tanzania